保持载瘤动脉通畅的椎动脉夹层动脉瘤治疗:附28例报告

Treatment of vertebral artery dissection aneurysm keeping parent artery patent: a report of 28 cases

目的:探讨保持载瘤动脉的椎动脉夹层动脉瘤治疗方法及效果。方法:回顾性分析2013年1月—2018年10月28例接受保持载瘤动脉通畅治疗的颅内椎动脉夹层动脉瘤患者的临床资料。结果:28例患者中,未破裂12例,破裂16例,平均年龄(51.8±7.5)岁。28例患者手术技术成功率为100%。5例未破裂患者采用单纯2枚及2枚以上支架植入,术后即刻造影显示动脉瘤内造影剂滞留,随访造影发现动脉瘤消失或动脉瘤明显变小,Raymond分级Ⅰ级3例(3/5),Ⅱ级例2(3/5)。另外23例患者采用2枚重叠支架辅助弹簧圈栓塞,术后即刻造影显示,动脉瘤Raymond分级Ⅰ级11(11/23)例,Raymond分级Ⅱ级5(5/23)例,Raymond分级Ⅲ级7(7/23)例,其中19例(19/23)获随访(14.5±7.9)个月。随访造影发现动脉瘤Raymond分级Ⅰ级16例(16/19),Raymond分级Ⅱ级3例(3/19),无Raymond分级Ⅲ级病例。16例破裂患者中,2例发生支架内血栓形成或术后穿支事件,给予溶栓治疗后消退。预后mRS评分≤2分27例(27/28),≥3分1例(1/28)。结论:保持载瘤动脉通畅,多支架或多支架辅助弹簧圈栓塞椎动脉夹层动脉瘤可以获得较好的临床结果。

Objective: To investigate the treatment method for vertebral artery dissecting aneurysms keeping the parent artery patent and the efficacy. Methods: The clinical data of 28 patients with vertebral artery dissecting aneurysms treated with the parent artery patent from January 2013 to October 2018 were retrospectively analyzed. Results: Of the 28 patients, 12 cases had unruptured lesions and 16 cases had ruptured lesions, with an average age of (51.8±7.5) years. The surgical technical success rate of the 28 patients was 100%. Five patients with unruptured aneurysms were implanted with two or more stents. Immediate postoperative angiography showed that the contrast agent was retained in the aneurysm. The follow-up angiography showed that the aneurysms disappeared or diminished, with the Raymond grade Ⅰ in 3 cases (3/5) and grade Ⅱ in 2 cases (3/5). The other 23 patients were treated with double overlapping stent-assisted coil embolization. Immediate postoperative angiography showed Raymond grade Ⅰ in 11 cases (11/23), grade Ⅱ in 5 cases (5/23) and grade Ⅲ in 7 cases (7/23), of whom, 19 cases (19/23) were followed up for (14.5±7.9) months, and the follow-up imaging results showed Raymond grade Ⅰ in 16 cases (16/19), grade Ⅱ 3 cases (3/19) and no grade Ⅲ lesion. In the 16 patients with ruptured lesions, 2 cases developed in-stent thrombosis or perforating branch events, which were resolved after thrombolytic therapy. The prognostic mRS score ≤2 in 27 patients and ≥3 in one patient. Conclusion: Leaving the parent artery patent, multiple stent placement or multiple stent assisted coil embolization can achieve good clinical results in treatment of vertebral artery dissection aneurysms.