载瘤动脉闭塞术与支架辅助栓塞术治疗未破裂VDA疗效分析

Efficacy of parent artery occlusion and stent-assisted embolization in the treatment of unruptured VDA

目的载瘤动脉闭塞术及支架辅助栓塞术治疗未破裂椎动脉夹层动脉瘤(VDA)的疗效及安全性分析。方法选择未破裂VDA患者80例,按手术方式不同分为闭塞组及栓塞组。栓塞组采用支架辅助栓塞术治疗,闭塞组采用载瘤动脉闭塞术治疗,术后均随访1年。统计两组术后椎动脉栓塞情况,采用改良Rankin评分评估两组预后,采用健康状况调查问卷(SF-36)评估患者手术前后生活质量,统计围手术期并发症发生率及随访期间复发率、病死率。结果栓塞组术后即刻椎动脉完全栓塞率高于闭塞组(P<0.05);栓塞组术后不同时间改良Rankin评分均低于闭塞组,术后生活质量评分均高于闭塞组(P<0.05);栓塞组围手术期并发症发生率低于闭塞组(P<0.05);两组随访期间复发率及病死率比较无显著差异(P>0.05)。结论与载瘤动脉闭塞术相比,支架辅助栓塞术治疗未破裂VDA的完全栓塞率更高,围手术期并发症发生率更低,可更有效改善患者预后,提高生活质量。

Objective To explore the efficacy and safety of parent artery occlusion and stent-assisted embolization in the treatment of unruptured vertebral artery dissection aneurysm(VDA).Methods A total of 80 patients with unruptured VDA were selected and divided into an occlusion group and an embolization group based on the different operation techniques.The embolization group was treated with the stent-assisted embolization method and the occlusion group was with the parent artery occlusion method.Both groups were followed up for one year.The embolization of vertebral artery after operation in both groups was recorded,the prognosis was scored via modified Rankin scale,the life quality of patients before and after operation was evaluated based on the Short Form-36 Health survey Questionnaire(SF-36);the incidence of perioperative complications,and the recurrence rate and mortality during follow-up period were recorded.Results The complete embolization rate right after the operation in the embolization group was higher than that in the occlusion group(P<0.05);the scores by modified Rankin scale in the embolization group at multiple time points were lower than in the occlusion group,the postoperative life quality scores were higher than in the occlusion group(P<0.05);and the incidence of perioperative complications in the embolization group was lower than in the occlusion group(P<0.05).There was no difference in the recurrence rate and mortality in both groups during follow-up period(P>0.05).Conclusion Compared with the parent artery occlusion,the stent-assisted embolization is associated with better efficacy in reaching complete embolization in unruptured VDA,lower incidence of perioperative complications,and improved prognosis and lifted life quality.