破裂椎动脉夹层动脉瘤介入治疗

Treatment for ruptured vertebral artery dissecting aneurysm

目的回顾总结颅内破裂椎动脉夹层动脉瘤治疗方法及结果。方法回顾性分析2013年1月—2017年10月于本中心接受治疗的颅内破裂椎动脉夹层动脉瘤患者的治疗方法和结果,结合其随访结果作回顾总结。结果 33例患者中,载瘤动脉闭塞治疗15例,采用一侧闭塞方法治疗10例、两端闭塞方法治疗5例,术后即刻造影提示完全闭塞;支架辅助栓塞治疗15例,术后即刻造影提示9例动脉瘤不显影、6例瘤体部分显影,无支架内血栓病例;2例单纯弹簧圈栓塞,动脉瘤不显影;1例未能接受介入治疗。随访载瘤动脉闭塞病例中仅单侧载瘤动脉闭塞法后1例再通,其余稳定;支架辅助治疗者动脉瘤稳定或显影好转,4例残留部分瘤颈显影;单纯栓塞者1例动脉瘤稳定。平均随访时间(22.6±10.6)m。有2例失访。入院时Glasgow Coma Scale(GCS)≤8分9例,4例因病情重死亡;3例存活,预后不良者modified Rankin Scale(mRS)≥3分。结论闭塞载瘤动脉及支架辅助栓塞均为治疗破裂椎动脉夹层动脉瘤的有效方法,但入院GCS评分低者预后仍差。

Objective To review and summarize the treatment method and results of intracranial ruptured vertebral artery dissecting aneurysms. Methods The treatment methods and results of ruptured vertebral artery dissecting aneurysms were retrospectively analyzed for patients received treatment in our neurosurgical center during January 2013 and October 2017.Results Totally 33 cases were included,15 cases were treated by artery occlusion carrying aneurysm,10 cases were treated with hemi-occlusion and 5 cases treated double occlusion. The immediate postoperative angiography images show entirely shut. Stent-assisted embolization was performed in 15 cases. Angiography immediately after operation,9 cases had no aneurysm and 6 cases had partial development,none thrombus occurred in the bracket. Thrombus was embolized in spring coil in 2 cases,and 1 case was not treated by interventional therapy. Follow-up results show only one recurrence need to retreat. The aneurysms were stable or improved in patients received stent adjuvant therapy,the aneurysms neck imaging in 4 cases with and 1 case with stable simple embolization. The average follow-up time was 22. 6 ± 10. 6 months,and two cases lost following-up. Among the 9 cases who ＇s Glasgow Coma Scale（ GCS） score less than 8,4 cases died from worse disease condition and 3 cases survived. The cases with worse prognosis with the modified Rankin Scale（ mRS）score more than 3. Conclusions Intra-trapping and stent assisted coiling are effective methods for ruptured vertebral artery dissecting aneurysms. Patients with low GCS score still have poor prognosis.