血管内治疗大脑后动脉动脉瘤的疗效

Clinical observation of endovascular treatment of posterior cerebral artery aneurysms

目的 探讨血管内治疗大脑后动脉（PCA）动脉瘤的安全性和疗效.方法 收集第二军医大学附属长海医院神经外科采用血管内治疗的27例PCA动脉瘤患者的临床资料,回顾性分析血管内治疗的方法和疗效.结果 全部病例均成功手术,4例单纯动脉瘤栓塞者均为致密栓塞（P2段动脉瘤）,载瘤动脉通畅;3例行单纯载瘤动脉闭塞者（P2段动脉瘤）,瘤体及载瘤动脉远端均不显影;1例行单纯支架置入术（P1段）,1例行支架辅助弹簧圈栓塞术（P1-P2交界处）者,动脉瘤均不显影,载瘤动脉通畅;18例行动脉瘤栓塞＋载瘤动脉闭塞术（P1段1例,P2段11例,P2-P3交界处2例,P3段4例）,其中17例瘤体致密栓塞,1例动脉瘤疏松栓塞.闭塞载瘤动脉的21例（77.8％）患者中,5例（23.8％）发生闭塞血管供血区缺血事件,4例（19.0％）为脑梗死.临床随访23例,随访时间1个月至5年,2例死亡.6例行MR血管造影检查,12例行DSA检查,3例动脉瘤复发,再次治疗后随访治愈,其余病例恢复良好.结论 对于P1段动脉瘤,栓塞动脉瘤并保持载瘤动脉通畅是主要目标,P2段及以远动脉瘤,应致密栓塞动脉瘤,同时确切闭塞载瘤动脉.血管内治疗PCA动脉瘤是安全、有效的.

Objective To investigate the safety and efficacy of endovascular treatment of posterior cerebral artery （PCA） aneurysms.Methods The clinical data of 27 patients with PCA aneurysm treated with endovascular treatment at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University from September 1998 to December 2009 were collected.The methods and efficacy of endovascular treatment were analyzed retrospectively.Results All patients underwent endovascular treatment.The aneurysms of 4 patients embolized alone were packed densely （aneurysm at P2 segment）,and the parent arteries were patent;3 patients underwent parent artery occlusion alone （aneurysm at P2 segment）,the aneurysms and the distal end of parent arteries did not develop.One patient performed stenting alone （at P1 segment）,1 performed stent-assisted coil embolization （at the junction of P1-P2）,his aneurysms did not develop,and his parent artery was patent;18 patients performed aneurysm embolization ＋ parent artery occlusion （1 case at PI segment,11 at P2 segment,2 at the junction of P2-P3 segments,4 at P3 segment）,including 17 performed aneurysm dense packing ＋ parent artery occlusion,and one performed loose aneurysm embolization ＋ parent artery occlusion.Of the 21 patients （77.8%） occluded parent arteries,5 （23.8%） occurred ischemic events in the occluded blood supply area,and 4 （19.0%） were cerebral infarction.Twenty-three patients were followed up clinically,the follow-up time ranged from 1 month to 5 years,and 2 died.Six patients performed MR angiography （MRA） examination,12 performed DSA examination,3 had aneurysm recurrence,and after being treated again,they were cured during the follow-up period.Other patients recovered well.Conclusions As for the aneurysm at P1 segment,the embolization of aneurysm and maintaining parent artery patency are the main objectives.The t2 segment and the distal aneurysms should be packed densely.At the same time,the parent artery should be occluded exactly.Endovascular treatment of PCA aneurysms is safe and effective.