血管内治疗基底动脉夹层动脉瘤的随访研究

Follow-up study of endovascular treatment of basilar artery dissecting aneurysms

目的 探讨血管内治疗基底动脉夹层动脉瘤（BDA）的安全性和有效性.方法 回顾性分析2009年1月至2014年6月在河南省人民医院脑血管复合手术外科接受血管内治疗的21例BDA患者的临床资料,探讨患者术后短期（≤1年）和长期（＞3年）疗效.结果 21例患者中,7例采用单纯支架置入术,术后即刻造影瘤体均部分显影;14例采用支架联合弹簧圈栓塞术,术后即刻造影瘤体不显影5例,瘤体部分显影4例,瘤颈残余5例.8例（38.1％）患者发生并发症,5例发生于围手术期（2例死亡）,3例发生于随访期（1例死亡）;支架辅助弹簧圈栓塞组7例（2例死亡）,单纯弹簧圈组1例（死亡）;出血性并发症3例,缺血性并发症5例.术后19例影像学随访时间为12～62个月（中位时间为16个月）.7例单纯支架置入者中,瘤体不显影4例,瘤颈残余2例,复发1例;12例支架联合弹簧圈栓塞者中,8例瘤体不显影,3例瘤颈残余,1例复发.19例临床随访22～110（64.6±19.9）个月,末次随访时预后良好[改良Rankin量表评分（mRS）≤2分]17例（81.0％）.结论 血管内治疗BDA短期和长期疗效均较好,但并发症发生率较高.

Objective To explore the safety and efficacy of intravascular treatment of basilar artery dissecting aneurysms （BDA）.Methods The clinical data and follow-up results of 21 patients with BDA treated at Department of Cerebrovascular Hybrid Surgery,Henan Provincial People＇s Hospital from January 2009 to June 2014 were retrospectively analyzed to explore the short-term （≤ 1 year） and long-term （＞ 3 years） outcome.Results Among 21 patients,7 were treated with stent-only technique and all of them showed partially developed immediately after operation.Fourteen cases were treated with stent-assisted coiling and included 5 with non-development,4 with partial developed and 5 with neck residual.Complications occurred in 8 （38.1％） cases till the last follow-up.Among them,5 had complications during perioperative period （2 deaths） and 3 reported complications during follow-up period （1 death）.Seven cases were in the stent-assisted coiling group （2 deaths） and 1 was in the stent-only group （death）.Hemorrhagic complications occurred in 3 cases and ischemic complications in 5 cases.Postoperative imaging follow-up lasted for 12-62 months with the median of 16 months in 19 cases.Among the 7 patients with stent-only,4 cases had complete occlusion,2 reported neck residual and 1 case developed recurrence.Among the 12 patients with stent-assisted coiling,8 cases showed complete occlusion,3 cases had neck residual and 1 had recurrence.The clinical follow-up was performed in 19 cases for 22-110 （64.6 ± 19.9） months,and the good outcome [modified Rankin Scale （mRS） ≤2] was achieved till the last follow-up in 17 （81.0％） cases.Conclusion Endovascular treatment of BDA seems to have good short-term and long-term efficacy.However,the incidence of complications could be high.