缺血性脑血管病伴未破裂动脉瘤的影像学特点及治疗方法

Imaging features and treatments of ischemic cerebrovascular disease with unruptured intracranial aneurysms

目的探讨缺血性脑血管病伴未破裂动脉瘤的影像学特点和治疗方法。方法回顾性分析23例缺血性脑血管病伴未破裂动脉瘤患者(未破裂组)及147例动脉瘤破裂脑出血患者(破裂组)的临床资料。结果两组患者年龄、性别、高血压、糖尿病、高脂血症、心脏病、吸烟、饮酒差异均无统计学意义(均P>0.05)。未破裂组中颅内动脉瘤单发病灶者16例(69.6%),多发病灶者7例(30.4%);总计动脉瘤病灶34个。破裂组中颅内动脉瘤单发病灶者125例(85%),多发病灶者22例(15%);总计动脉瘤病灶170个。两组间颅内动脉瘤单发与多发的差异无统计学意义(P>0.05)。未破裂组动脉瘤最大直径及大型动脉瘤、夹层动脉瘤的比例明显大于破裂组,中小型动脉瘤及囊状动脉瘤的比例明显小于破裂组(均P<0.05)。未破裂组中5例行动脉瘤介入治疗,1例行手术夹闭治疗,术后均恢复良好;6例行波立维抗血小板治疗,5例行阿司匹林抗血小板治疗,随访6个月未见脑血管病事件发生;6例未服用抗血小板治疗,随访中有1例出现脑梗死。破裂组中46例行介入治疗,死亡2例;101例行手术夹闭治疗,死亡6例。结论缺血性脑血管病伴未破裂动脉瘤患者中以中小型动脉瘤常见,但动脉瘤最大直径较动脉瘤破裂脑出血患者明显增大。与缺血性脑血管病有责任关系的未破裂动脉瘤多为夹层动脉瘤和囊状动脉瘤。动脉瘤介入治疗相对安全有效。

Objective To investigate the imaging features and the treatments of ischemic cerebrovascular disease with unruptured intracranial aneurysms. Methods The clinical data of 23 patients of ischemic cerebrovascular disease with unruptured intracranial aneurysms（ unruptured group） and 147 patients of hemorrhagic cerebrovascular with ruptured intracranial aneurysms（ ruptured group） were retrospectively analyzed. Results There were no statistical significances between the two groups baselines such as age,gender,hypertension,diabetes,hyperlipidemia,heart disease,smoking,drinking alcohol（ all P 0. 05）. There were 16 patients（ 69. 6%） with single intracranial aneurysm and 7 patients（ 30. 4%） with multi-intracranial aneurysms in the unruptured group,and the number of intracranial aneurysms were 34. There were 125 patients（ 85%） with single intracranial aneurysm and22 patients（ 15%） with multi-intracranial aneurysms in the ruptured group, and the number of intracranial aneurysms were 170. There was no statistical significance of single aneurysm and multi-aneurysms percentage between the two groups（ P 0. 05）. The maximum aneurysm diameter and the percentage of large aneurysms,dissecting aneurysms of the unruptured group were significantly greater than the ruptured group; and the percentage of smallmiddle aneurysms and saccular aneurysms were significantly smaller than the ruptured group（ all P 0. 05）. In the unruptured group,5 cases were treated with intervention treatment and 1 case was treated with aneurysm clip surgery,all of which recovered well after surgery; 6 cases were treated with Plavix antiplatelet therapy,5 cases were treated with Aspirin antiplatelet therapy,cerebrovascular disease events were not found of which followed-up for 6 months; 6cases were not taken antiplatelet therapy,and 1 case of which followed-up and occurred cerebral infarction. In the ruptured group,46 cases were treated with intervention treatment,2 cases of which were died; 101 cases were treated with aneurysm clip surgery,6 cases of which were died. Conclusions Small-middle aneurysms are more commonly occurred in patients of ischemic cerebrovascular disease with unruptured intracranial aneurysm, however, the maximum aneurysm diameter of which is significantly bigger than patiehts of hemorrhagic cerebrovascular with ruptured intracranial aneurysms. Most of unruptured aneurysms which had duty relationship with cerebral ischemic events are dissecting aneurysms and saccular aneurysms. Intervention treatment of unruptured intracranial aneurysms is relatively safe and effective.