介入栓塞基底动脉顶端动脉瘤临床治疗策略

Interventional embolization of aneurysms located at basilar artery apex:clinical therapeutic strategies

目的分析和总结后循环基底动脉顶端动脉瘤介入栓塞治疗的安全性和有效性。方法回顾性分析2008年11月至2015年3月介入栓塞治疗21例基底动脉顶端动脉瘤患者临床资料。术前均经DSA检查证实为基底动脉顶端动脉瘤,Hunt-Hess动脉瘤临床分级0~Ⅱ级12例,Ⅲ~Ⅳ级9例。单纯弹簧圈栓塞16例,支架辅助弹簧圈栓塞5例。结果 17例完全致密栓塞（100%栓塞）,4例接近完全栓塞（95%栓塞）,术中无动脉瘤破裂。根据Glasgow预后量表（GOS）评分,术前15分、13~14分、9~12分、3~8分者分别为9例、3例、2例、7例,术后15分、13~14分、3~8分者分别为13例、5例、3例。18例患者术后随访6~48个月,15例无复发,2例于术后6个月,1例于术后12个月复发。全部患者均无再出血。结论介入栓塞术是治疗基底动脉顶端动脉瘤的安全有效方法。

Objective To analyze and to summarize the therapeutic safety and efficacy of interventional embolization for aneurysms located at basilar artery apex of posterior circulation. Methods The clinical data of 21 patients with basilar artery apex aneurysm, who were admitted to authors＇ hospital during the period from November 2008 to March 2015 to receive interventional embolization therapy, were retrospectively analyzed. Before treatment, the aneurysm was confirmed to be situated at the apex of basilar artery by DSA examination in all patients. Of the 21 patients, Hunt-Hess grade 0-Ⅱ of clinical aneurysm classification was seen in 12 and Hunt-Hess grade Ⅲ-Ⅳ was observed in 9. Interventional embolization with detachable coils only was performed in 16 patients and embolization with stent-assisted detachable coils in 5 patients. Results Complete dense embolization（100% embolization） was achieved in 17 patients, while almost complete embolization（95% embolization） was obtained in 4 patients. No aneurysm rupture occurred during embolization procedure. Glasgow Outcome Scale（GOS） was used to evaluated the lesions： the preoperative GOS scores of 15, 13-14, 9-12 and 3-8 points were seen in 9, 3, 2 and 7 patients respectively; and the postoperative GOS scores of 15, 13-14 and 3-8 points were seen in 13, 5 and 37 patients respectively. After the operation 18 patients were followed up for 6-48 months, and no recurrence was observed in 15 patients, and a relapse of aneurysm at 6 and 12 months after operation was seen in 2patients and one patient respectively. No re-bleeding was seen in all patients. Conclusion Interventional embolization is a safe and effective treatment for aneurysms located at basilar artery apex.