支架治疗破裂椎-基底动脉夹层动脉瘤的围手术期再出血风险及预后

The application of stent in rupture vertebral-basilar artery dissecting aneurysm treatment: risk of perioperative rehaemorrhagia and prognosis

目的探讨支架治疗破裂椎-基底动脉夹层动脉瘤的围手术期再出血风险及预后。方法收集23例患者共23枚椎-基底动脉夹层动脉瘤的临床资料,对比研究支架植入后破裂和未破裂动脉瘤的围手术期及预后情况。结果破裂的椎-基底动脉夹层动脉瘤共12例,均以自发性蛛网膜下腔出血(SAH)为主要临床表现,未破裂夹层动脉瘤共11例。单纯支架植入10例,支架辅助弹簧圈栓塞13例,支架植入均成功。破裂组和未破裂组介入治疗相关并发症的发生率分别为8.3%(1/12)和0%(0/11),破裂组出现1例术后24 h内非动脉瘤部位出血。随访的椎-基底动脉夹层动脉瘤,未破裂组:动脉瘤完全闭塞率为90.9%(10/11),部分闭塞率为9.1%(1/11);破裂组:动脉瘤完全闭塞率为50%(6/12),部分闭塞率为41.7%(5/12),无复发病例。随访过程中均无新发神经功能障碍出现。结论破裂椎-基底动脉夹层动脉瘤急性期术中应用支架不会显著增加围手术期再出血的风险,并可以改善患者的预后。推荐将支架作为破裂椎-基底动脉夹层动脉瘤治疗的重要手段。

Objective To investigate the risk of perioperative rehaemorrhagia and prognosis of using stent in the treatment of rupture vertebral-basilar artery dissecting aneurysms. Methods Clinical data of 23 patients with 23 vertebral-basilar artery aneurysms were analyzed;the difference was compared between ruptured and unruptured vertebral-basilar artery aneurysm after stenting on perioperative and prognosis. Results There were 12 cases of rupture vertebral-basilar artery dissecting aneurysms;all of them were manifested of spontaneous subarachnoid hemorrhage（SAH）. There were 11 cases of unruptured vertebral-basilar artery aneurysms. There were 10 cases of stenting alone and 13 cases of stent-assisted coil embolization. Stent was successfully implanted. The rate of procedure-related complications in rupture aneurysms group was8.3%（1/12）and was 0%（0/11）in unrupture aneurysms group. 1 case of non-aneurysmal hemorrhage within 24 hours after surgery was reported in the rupture group. The follow-up of vertebral-basilar artery dissecting aneurysms,in the group of unruptured：the rate of total obliteration was 90.9%（10/11）,partial obliteration was 9.1%（1/11）,in the group of ruptured：the rate of total obliteration was 50%（6/12）,partial obliteration was 41.7%（5/12）, no recurrence. There were no new nerve dysfunction happened during the follow-up. Conclusion Rupture vertebral-basilar artery dissecting aneurysms treatment with stent in acute stage would not significantly raise the risk of perioperative rehaemorrhagia. The application of the stent could improve its prognosis. Stent should be recommended as an important treatment method for rupture vertebralbasilar artery dissecting aneurysm.