血管内栓塞治疗后循环动脉瘤65例

Endovascular emboUzation for the treatment of posterior circulating aneurysms in 65 patients

目的 总结血管内栓塞治疗后循环动脉瘤的经验.方法 回顾性分析在江门市中心医院接受血管内栓塞治疗的后循环动脉瘤患者的临床和随访资料.结果 共65例后循环动脉瘤患者在江门市中心医院接受血管内栓塞治疗.男性35例（53.8％）,女性30例（46.2％）,年龄37～76岁,平均（57.3±10.25）岁;破裂动脉瘤57例（87.7％）,未破裂动脉瘤8例（12.3％）;载瘤动脉：椎动脉22例（33.8％）,基底动脉23例（35.4％）,大脑后动脉3例（9.2％）,小脑上动脉2例（3.1％）,小脑前下动脉2例（3.1％）,小脑后下动脉10例（15.4％）;Hunt-Hess分级：Ⅰ级15例,Ⅱ级29例,Ⅲ级11例,Ⅳ级6例,Ⅴ级4例.单纯弹簧圈栓塞21例（32.3％）、支架辅助弹簧圈栓塞29例（44.6％）、单纯支架置入6例（9.2％）、载瘤动脉栓塞9例（13.8％）.术后即刻造影显示,54例（83.1％）完全栓塞,11例（16.9％）栓塞不完全.并发脑梗死3例（4.6％）,术中破裂2例（3.1％）,呼吸障碍2例（3.1％）,声嘶1例（1.5％）,玻璃体出血1例（1.5％）.出院时改良格拉斯哥转归量表评估显示转归极好53例（81.5％）;转归良好5例（7.7％）;转归不良7例（10.8％）,其中死亡2例（3.1％）.34例（52.3％）接受血管造影随访,其中6例（17.6％）复发,1例因并发脑梗死死亡.结论 尽管后循环动脉瘤的血管内治疗比较困难,但灵活选用血管内治疗术式多能达到良好的治疗效果.

Objective To summarize the experience of endovascular embolization for the treatment of posterior circulation aneurysms. Methods The clinical and follow-up data of 65 patients with posterior circulation aneurysm treated with endovascular embolization in Jiangmen Central Hospital, Guangdong Province were analyzed retrospectively. Results A total of 65 patients with posterior circulation aneurysm received endovascular embolization in Jiangmen Central Hospital, including 30 females （46.2%） and 35 males （53.8%）. Their age ranged from 37 to 76 years old（mean 57.3 ± 10.25）.Ruptured aneurysms were found in 57 cases （87.7%） and unruptured aneurysms were found in 8 cases （12.3%）. Parent arteries：22 （33.8%） in vertebral artery,23 （35.4%） in basilar artery,3 （9.2%） in posterior cerebral artery,2 （3.1%） in superior cerebellar artery, 2 （3.1%） in anterior inferior cerebellar artery, and 10 （15.4%） in posterior inferior cerebellar artery. Hunt-Hess grade：gradeⅠin 15 cases,gradeⅡin 29 cases,gradeⅢin 11 cases, grade Ⅳ in 6 cases, and grade Ⅴ in 4 cases. Twenty-one patients （32.3%） were treated with coil embolization alone,29 （44.6%） were treated with stent-assisted coil embolization, 6 （9.2%） were treated with stenting alone, and 9 （13.8%） were treated with parent artery embolization. Immediate angiography after surgery revealed that 54 patients （83.1%） were completely embolized, and 11 （16.9%） were not embolized completely. Three patients （4.6%） complicated with cerebral infarction, 2 （3.1%） had intraoperative rupture,2 had respiratory disturbance（3.1%）,1 （1.5%） had hoarseness, and 1 had vitreous hemorrhage （1.5%）.At discharge,the modified Glasgow outcome scale assessment showed that 53 patients （81.5%） had excellent outcome,5 （7.7%） had good outcome, and 7 （10.8%） had poor outcome. Of the patients with poor outcome, 2 （3.1%） died. Thirty-four patients （52.3%） were followed up by angiography, of whom 6 （17.6%） recurred, and 1 died of complicated cerebral infarction. Conclusion Although endovascular treatment of posterior circulation aneurysms is difficult, flexible selection of endovascular treatment may achieve good therapeutic effect.