支架辅助弹簧圈栓塞基底动脉夹层动脉瘤近期疗效分析

Stent-assisted coil embolization for basilar artery dissecting aneurysm: analysis of short-term efficacy

目的评价支架辅助弹簧圈栓塞治疗基底动脉夹层动脉瘤(BADA)近期影像学随访、并发症及预后。方法回顾性分析2012年6月至2017年1月采用支架辅助弹簧圈栓塞术治疗的17例BADA患者临床资料,均通过头部MRI、CTA和DSA造影明确诊断。结果平均随访7.3(3～9)个月,14例完成复查造影,结果 5例(35.7%)改善,8例(57.2%)稳定,1例(7.1%)复发;1例拒绝复查造影,2例死亡。术后5例(29.4%)出现并发症,其中3例脑桥梗死(1例术后4个月死亡;1例脑积水,术后1个月接受脑室-腹腔分流术,术后5个月症状明显缓解,CT平扫显示脑积水好转;1例脑桥及基底节脑梗死,术后7个月因心律失常死亡)。随访期间改良Rankin量表(mRS)评分0～2分10例(58.8%),3～6分7例(41.2%)。结论支架辅助弹簧圈栓塞假腔及重建真腔是治疗BADA有效方法。

Objective To evaluate the safety and curative effect of stent-assisted coil embolization for basilar artery dissecting aneurysm（BADA）, and to discuss the complications and prognosis. Methods The clinical data of a total of 17 BADA patients, who were treated with stent-assisted coil embolization during the period from June 2012 to January 2017 at the First Affiliated Hospital of Xinjinag Medical University, China,were retrospectively analyzed. The diagnosis was confirmed by MRI, CT angiography and DSA in all patients.Results The patients were followed up for a mean of 7.3 months（3-9 months）. Reexamination with DSA was performed in 14 patients, the results showed that improvement was obtained in 5 patients（35.7%） and stable disease was seen in 8 patients（57.2%）, and recurrence occurred in one patient（7.1%）. One patient refused to have angiography reexamination, and 2 patients died. After treatment, 5 patients（29.4%） developed complications, among them 3 patients had pontine infarction（one patient died in 4 months after treatment;one patient suffered from hydrocephalus and had to receive ventricle-peritoneal cavity shunt treatment one month after stent-assisted coil embolization, the symptoms were remarkably improved in 5 months, and plain CT scan showed that the hydrocephalus was obviously improved; one patient had pontine and basal ganglia infarction and died of arrhythmia seven months after operation）. During the follow-up period, modified Rankin Scale（mRS） score of 0-2 points were obtained in 10 patients（58.8%） and 3-6 points were obtained in 7 patients（41.2%）. Conclusion Stent-assisted coil embolization can obstruct the false lumen and reconstruct the real lumen of basilar artery dissecting aneurysm. This technique is an effective therapy for BADA.