出血性椎动脉夹层动脉瘤的血管内治疗

Endovascular tgeatntent of ruptured vertebral artery dissecting aneurysms

目的探讨血管内治疗出血性椎动脉夹层动脉瘤的有效性和安全性。方法回顾性纳入出血性椎动脉夹层动脉瘤患者，收集患者的一般临床资料、数字减影血管造影或头颈部CT血管造影图像、治疗方式以及门诊随访资料，分析血管内介入治疗的手术方式、围手术期常见并发症和临床疗效。结果共纳入出血性椎动脉夹层动脉瘤24例，男性17例（70．8％），女性7例（29．2％），平均年龄（52．0±9．4）岁。22例（91．7％）行血管内介入治疗，包括闭塞载瘤动脉19例（79．2％）、支架辅助弹簧圈栓塞3例（12．5％），均获得技术成功，术后合并脑梗死l例。另2例（8．3％）采用保守治疗，均在住院期间发生再出血并死亡。介入治疗患者术后随访时间中位数15个月（范围5～50个月），转归良好18例（75．0％），无出血复发病例。结论血管内闭塞载瘤动脉或支架辅助弹簧圈栓塞是出血性椎动脉夹层动脉瘤的一种安全和有效的治疗方法。

Objective To investigate the effectiveness and safety of endovascular treatment of raptured vertebral artery dissecting aneurysms. Methods The patients with ruptured vertebral artery dissecting anenrysm were enrolled retrospectively, and their gcneral clinical data, digital subtraction angiography or head and neck CT angiography images, treatment modalities, and outpatient follow-up data were collected. The surgical approaches, common complications in perioperative period, and clinical efficacy of endovascular interventional therapy were analyzed. Results A total of 24 patients with ruptured vertebral artery dissecting anenrysm were enrolled, including 17 male （70. 8%） and 7 female （29.2%） （mean age, 52.0 ＋9. 4 years）. Endovascular interventional treatment was performed in 22 patients （91.7%）, including occlusion of parent artery in 19 cases （79.2%）, and stent-assisted coil embolization in 3 cases （12. 5% ）. Technical success was achieved in all patients. After procedure, 1 patient complicated with cerebral infarction. The other 2 （8. 3 % ） were treated with conservative treatment, and both of them died of recurrent hemorrhage during the period of hospitalization. The median follow-up time of the patients after interventional treatment was 15 months （range, 5-50 months）, 18 patients （75.0%） had good outcome. No recurrence of blecding was observed. Conclusions Intravascular occlusion of the parent artery or stentassisted coil embolization is a safe and effectivetreatment for ruptured vertebral artery dissecting aneurysm.