椎动脉颅内段破裂与未破裂梭形动脉瘤的血管内重建治疗

Endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms

目的探讨椎动脉颅内段破裂与未破裂梭形动脉瘤(VAFAs)血管内重建治疗的安全性与有效性。方法回顾性分析北京医院神经外科2009年10月至2017年9月连续收治行血管内重建治疗VAFAs 26例患者的临床、影像与随访资料。结果 (1)26例患者共26个VAFAs,年龄为38～69岁,破裂9例,未破裂17例;瘤径5～12 mm。重建技术成功率100%。(2)破裂组9例中,采用支架辅助弹簧圈栓塞技术8例,单纯支架置入1例;多枚支架重建5例,单枚支架重建4例。未破裂组17例中,支架辅助栓塞技术13例,单纯支架置入4例;多枚支架重建7例、单枚支架重建10例。无围手术期相关并发症发生。(3)临床随访8.0～97.5个月,中位时间39.5个月,无一例新发脑梗死或脑出血,预后均良好(改良Rankin量表评分0～2分)。22例接受造影随访3.5～34.0个月,中位时间10.3个月,14例(63.6%)治愈,4例(18.2%)稳定或好转,4例(18.2%)复发;其中破裂组8例治愈5例,未破裂组14例治愈9例,两组各有2例复发。结论血管内重建治疗对破裂与未破裂VAFAs临床可行,安全性较高,中长期随访疗效较好;破裂VAFAs的复发率有增高的趋势,术后需密切随访。

Objective To investigate the safety and efficacy of endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms （VAFAs）. Methods The clinical,imaging and follow-up data of 26 consecutive patients with VAFA treated with endovascular reconstruction at the Department of Neurosurgery, Beijing Hospital between October 2009 and September 2017 were analyzed retrospectively. Results （ 1 ） Twenty-six patients had 26 VAFAs. Their age ranged from 38 to 69 years old. Nine patients had ruptured aneurysms and 17 had unruptured aneurysms. The diameter of the aneurysms ranged from 5 to 12 mm. The success rate of reconstruction technology was 100%. （2） In 9 patients of the rupture group,8 were embolized by stent-assisted coils, 1 was treated with stent-assisted coil embolization alone. Five patients were treated with muhiple-stent reconstruction and 4 were treated with stent reconstruction alone. Of the 17 patients in the unrupture group,13 were treated with stent-assisted embolization and 4 were treated with stent implantation alone;7 were treated with muhiple-stent reconstruction,and 10 were treated with stent reconstruction alone. No perioperative complications occurred. （3） The patients were followed up for 8.0 -97.5 months with a median time of 39. 5 months. No new cerebral infarction or cerebral hemorrhage occurred. The patients with good prognosis （the modified Rankin scale scale 0-2） was 100%. Twenty-twopatients were followed up for 3.5 to 34. 0 months with a median time of 10. 3 months. Fourteen patients （63.6%） were cured,4 （18.2% ） were stable or improved, and 4 （18.2% ） had recurrence;Five of 8 patients were cured in the rupture group ;9 of 14 were cured in the unrupture group. There were 2 cases of relapse in each of the two groups. Conclusions Endovascular reconstruction for ruptured and unruptured VAFAs is clinically feasible and the safety is higher. The efficacy of mid-term and long-term follow-up is better. The recurrence rate of ruptured VAFAs has an increasing trend,and close follow-up is required after procedure.