颅内椎动脉夹层动脉瘤介入治疗个体因素分析

The individual factors of interventional treatment for intracranial vertebral artery dissecting aneurysms

目的总结介入栓塞治疗颅内椎动脉夹层动脉瘤（IVADA）影像和临床效果，探讨个体化治疗策略。方法回顾性分析2011年至2015年郑州大学第一附属医院分别采用单纯弹簧圈栓塞、夹层动脉瘤及载瘤动脉闭塞、支架辅助弹簧圈栓塞和覆膜支架植入术治疗的24例IVADA患者资料、治疗经过及临床疗效，探讨不同动脉瘤介入治疗时须考虑的个体化因素。结果24例IVADA患者介入治疗均获成功：动脉瘤和载瘤动脉闭塞5例，弹簧圈栓塞动脉瘤1例，支架辅助弹栓塞动脉瘤16例，覆膜支架植入2例。术后临床随访平均11个月（5～29个月）．所有患者症状明显减轻或消失，无新发出血。12例获脑血管造影随访，11例夹层动脉瘤不显影，1例复发，再次介入治疗。结论介入栓塞术治疗IVADA安全有效，须结合夹层动脉瘤是否破裂及相关临床症状、是否位于优势侧椎动脉及对侧椎动脉情况、动脉瘤形态及是否累及小脑后下动脉制定个体化治疗方案。

Objective To summarize the imaging manifestations and clinical results of intracranial vertebral artery dissecting aneurysms （IVADA） treated with interventional embolization, and to discuss the individualized management strategy for IVADA. Methods The clinical data of 24 IVADA patients, who were treated with simple spring coil embolization, embolization of dissecting aneurysm and its parent artery, stent- assisted coil embolization or covered stent implantation, etc. at the First Affiliated Hospital of Zhengzhou University during the period from 2011 to 2015, were retrospectively analyzed. The individual factors of different IVADA, which ought to be considered when interventiona] therapies were employed, were discussed. Results Successful interventional treatment was accomplished in all 24 IVADA patients, including embolization of dissecting aneurysm and its parent artery （n=5）, simple spring coil embolization （n=l）, stentassisted spring coil embolization （n=16） and covered stent implantation （n=2）. All patients were followed up for a mean period of 11 months （ranging from 5 to 29 months）; the clinical symptoms were significantly improved and no new bleeding occurred. Follow-up cerebral angiography was performed in 12 patients, which revealed that the IVADA was not visualized in 11 patients and recurrence was seen in one patient, for this patient interventional embolization had to be carried out once more. Conclusion For the treatment of IVADA, interventional embolization is safe and effective. However, in clinical practice individualized treatment program should be formulated based on the following information： whether the aneurysm is ruptured or not and its related clinical symptoms, whether the aneurysm is located at the dominant vertebral artery or thecontralateral vertebral artery, the shape of the aneurysm and whether the posterior inferior cerebellar artery is involved, etc.