支架重建技术治疗未破裂颅内自发性椎动脉夹层动脉瘤的预后及其影响因素

Prognosis and its predictors after treatment of unruptured intracranial spontaneous vertebral artery dissecting aneurysms with stent-related reconstructive techniques

目的 探讨采用支架重建技术治疗未破裂的颅内自发性椎动脉夹层动脉瘤（uisVADAs）的预后及其影响因素.方法 回顾性分析海军军医大学附属长海医院神经外科（92例）和首都医科大学附属北京天坛医院神经介入科（90例）2009年1月至2015年12月采用支架重建技术治疗的uis-VADAs患者的临床资料,共182例.评估患者的预后[改良Rankin量表评分（mRS）0 ～2分为预后良好,3～6分为预后不良],分析影响预后不良的相关危险因素.结果 182例患者中,术后即刻造影显示,135例（74.2％）为致密或次全栓塞,47例（25.8％）为部分栓塞.围手术期4例（2.2％）发生手术相关的并发症,其中2例为支架内血栓形成,1例为小脑后下动脉远端不显影,3例预后均良好;1例为小脑半球、脑干多发梗死,预后不良.182例患者中,术后12例（6.6％）预后不良,其中死亡4例（2.2％）;170例（93.4％）预后良好.存活的178例患者,随访中位时间为45（12 ～72）个月,131例（73.6％）行血管造影随访,23例（17.6％,23/131）病变复发.多因素logistic回归分析显示,术前脑梗死（OR=9.212,95％CI：2.154～39.395,P=0.003）、病变最大径（OR=1.112,95％CI：1.036 ～1.194,P=0.003）是影响预后的独立因素.结论 支架重建技术治疗uis-VADAs,术后患者疗效较好,并发症发生率低;夹层动脉瘤的最大径和患者术前合并脑梗死是治疗后预后不良的独立危险因素.

Objective To evaluate the prognosis and its predictors after treatment of the unruptured intracranial spontaneous vertebral artery dissecting aneurysms （uis-VADAs） with stent-related reconstructive techniques.Methods Clinical data of 182 consecutive patients harboring 182 uis-VADAs,which were treated with the stent-related reconstructive techniques at Department of Neurosurgery,Changhai Hospital,Naval Military Medical University （92 cases） and Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University （90 cases） from January 2009 to December 2015,were retrospectively reviewed and analyzed.The prognosis [favorable prognosis,modified Rankin Scale （mRS）：0-2;unfavorable prognosis,mRS：3-6] and its predictors were evaluated and analyzed.Results The postoperative control angiography confirmed complete obliteration or near-complete obliteration in 135 （74.2％） cases and partial obliteration in 47 （25.8％） cases.Four （2.2％） patients suffered from periprocedural complications,which included stent thrombosis in 2 cases and occlusion of the distal posterior inferior cerebellar artery in 1 case with favorable prognosis,and the cerebellar hemisphere and brainstem multiple infarctions in 1 with unfavorable prognosis.Of 182 patients with uis-VADAs,12 （6.6％） had unfavorable prognosis and included 4 （2.2％） deaths.In contrast,of 178 survivals with the median follow-up of 45 months （range：12-72 months）,170 （93.4％） patients had favorable prognosis.Follow-up angiography was available for 131 （73.6％） cases and reported recurrence in 23 （17.6％）.The multivariate logistic regression analysis indicated that preoperative cerebral infarction（OR =9.212,95％ CI：2.154-39.395,P =0.003） and the largest diameter of VADAs （OR =1.112,95％ CI：1.036-1.194,P =0.003） were predictors of unfavorable prognosis in the reconstructed uis-VADAs.Conclusions Patients with stent-related reconstructive treatment for uis-VADAs seem to have favorable prognosis with a low complication rate.The largest diameter of VADAs and preoperative cerebral infarction may be 2 independent predictors of unfavorable prognosis in the reconstructed uis-VADAs.