单纯支架置入术治疗未破裂椎动脉夹层动脉瘤的随访结果

Stent-only treatment for unruptured vertebral artery dissecting aneurysms--An analysis of clinical follow-up

目的探讨单纯支架置入术治疗未破裂椎动脉夹层动脉瘤(VADA)的可行性、有效性以及安全性。方法回顾性分析2010年8月至2014年6月复旦大学附属华山医院神经外科采用单纯支架置入术治疗的36例未破裂VADA患者的临床资料。术中置入单枚支架10例,2枚支架15例,3枚支架9例,4枚支架2例。根据未破裂VADA与小脑后下动脉的位置关系进行分型,Ⅰ型10例,Ⅱ型21例,Ⅲ型5例。术后进行6个月以上的随访。临床预后采用改良Rankin量表评分(mRS)评估,影像学预后采用数字减影血管造影(DSA)、CT血管成像或磁共振血管成像评估。结果36例患者的支架置入成功率为100%。围手术期仅1例患者出现对侧肢体麻木,行MRI检查提示脑干小面积梗死,其后症状自行缓解。31例患者获临床随访,中位随访时间为23.0(12~58)个月,其中30例预后良好(mRS为0~1分);1例患者因蛛网膜下腔出血死亡。30例患者行影像学随访,中位随访时间为10.5(6~38)个月,动脉瘤完全消失16例,体积较术前缩小9例,稳定5例。2例复查DSA发现支架远端或近端新发狭窄。结论采用单纯支架置入术治疗未破裂VADA的治疗效果好,并发症少。

Objective To investigate the feasibility, efficacy and safety of stent-only treatment for unruptured vertebral artery dissecting aneurysm (uVADA). Methods Clinical data of 36 uVADA patients who received stent-only treatment at Department of Neurosurgery, Huashan Hospital, Fudan University from August 2010 to June 2014 were retrospectively studied. Ten cases were implanted with a single stent and 26 cases with overlapping stents. All cases underwent imaging (DSA, CTA or MRA) and assessment of clinical outcome based on the modified Rankin scale (mRS). Results The surgical success rate was 100%. Twenty-nine patients had varying hemodynamic changes immediately after stent(s) implantation. Minor brain stem infarction occurred only in 1 case during the perioperative period, which presented with numbness of contralateral limbs and was confirmed by MRI scan.Thirty-one cases underwent clinical follow-up. Median follow-up of 23 months (range: 12-58 months) in 31 cases showed that aneurysm completely disappeared in 16 patients, improved in 9 patients, and stable in 5 cases. Thirty patients had good outcome with mRS scores between 0-1. Only 1 patient died from subarachnoid hemorrhage (SAH) 2 months later. Lastly, among the patients treated with overlapping stents, 2 had varying degrees of new stenosis discovered in distal or proximal end of the stent and no obvious sign of posterior circulation ischemia was detected. Conclusions Stent-only treatment for uVADA might lead to good clinical outcome and few complication.