闭塞载瘤动脉与保留载瘤动脉栓塞治疗未破裂大脑后动脉动脉瘤疗效的比较

Curative effects of endovascular embolization on un-ruptured posterior cerebral artery aneurysms: occluding parent artery versus preserving parent artery

目的探讨闭塞载瘤动脉与保留载瘤动脉栓塞治疗未破裂大脑后动脉动脉瘤(PCA)的效果。方法回顾性分析2009年1月至2014年1月栓塞治疗的36例PCA的临床资料,其中闭塞载瘤动脉22例(闭塞组),保留载瘤动脉14例(保留组)。结果闭塞组大或巨大动脉瘤比例(77.3%,17/22)明显高于保留组(35.7%,5/14;P<0.05)。术后即刻造影显示,闭塞组Raymond分级1级栓塞率(95.5%,21/22)明显高于保留组(64.3%,9/14;P<0.05)。两组术后缺血性事件发生率、颅内出血发生率均无统计学差异(P>0.05)。术后随访6个月至2年,闭塞组改良Rankin量表(m RS)评分≤2分18例,>2分4例;保留组m RS评分≤2分13例,>2分1例;两组m RS评分无统计学差异(P>0.05)。闭塞组12例、保留组11例接受DSA或CTA随访,其中闭塞组血管再通或复发1例(8.3%);保留组复发或动脉瘤腔仍显影2例(18.2%);两组血管再通率或复发率无统计学差异(P>0.05)。结论血管内栓塞治疗未破裂PCA时,根据动脉瘤具体特点选择闭塞载瘤动脉或保留载瘤动脉均是行之有效的方法。

Objective To compare the curative effect of endovascular treatment with occlusion of the parent artery on the un-ruptured posterior cerebral artery aneurysm with that of endovascular treatment without occlusion of patent artery. Methods The clinical data of 36 patients with un-ruptured posterior cerebral artery aneurysms, of whom, 22 （control group） treated by endovascular occlusion of the aneurysms and parent arteries and 14 （observed group） by the occlusion of the aneurysms and preservation of the parent # arteries between January, 2009 to January, 2014 were analyzed retrospectively. All the patients were followed up 6, 12 and 24 months after the treatment. The rate of the postoperative complications occurrence and curative effects were compared between both the groups. Results The rate of complete occlusion of the aneurysms （95.5%, 21/22） was significantly higher in the control group than that （64.3%, 9/ 14） in the observed group （P〈0.05）. There were insignificant differences in the rates of isehemia complication occurrence and aneurysmal recurrence and the prognoses 2 years after the treatment between both the groups （P〉0.05）. Conclusion The curative effects of endovascular embolization of the aneurysms and parent arteries or only embolization of the aneurysms and preservation of the parent arteries on the un-ruptured posterior cerebral artery aneurysms are good.