血流导向装置治疗椎动脉夹层动脉瘤的单中心临床经验

Treatment of vertebral artery dissecting aneurysms with flow diverter:A single-center experience

目的评价血流导向装置(FD)治疗椎动脉夹层动脉瘤(VADA)的安全性和疗效性。方法回顾性纳入2010年8月至2019年3月海军军医大学附属长海医院神经外科采用FD治疗的22例(22个)VADA患者。其中复发性动脉瘤4例,破裂动脉瘤1例,未破裂动脉瘤17例。临床预后评估采用改良Rankin量表评分(mRS),影像学评估采用0'kelly-Marotta(OKM)分级标准。结果22例患者共置入24枚FD(19枚Tubridge FD,5枚Pipeline FD),手术成功率为100%,无手术相关并发症。临床随访中位数为13.0(8.3-67.9)个月,mRS均为0分。术后短期[中位数为6.0(4.7?7.1)个月])影像学随访20例,13例动脉瘤完全闭塞(OKM分级为D级),7例瘤颈残余(OKM分级为C级);末次影像学随访的20例[中位数为7.7(6.0-24.4)个月]患者中,17例完全闭塞,3例瘤颈残余;长期[中位数为26.5(23.3-31.4)个月]影像学随访8例,动脉瘤均为完全闭塞。随访期无动脉瘤复发。被FD覆盖的8支小脑后下动脉(PICA)和3支瘤体累及的PICA,均未见狭窄和闭塞。1例置入Tubridge FD后3.5个月发生支架内重度狭窄,予以球囊扩张支架成形术,术后22个月复查,狭窄段管腔正常,动脉瘤完全不显影。结论FD治疗VADA,手术安全性高,疗效满意;长期疗效有待于大宗病例进一步评估。

Objective To evaluate the safety and efficacy of flow diverter(FD)in the treatment of vertebral artery dissecting aneurysms(VADA).Methods The clinical and imaging data of perioperative period and follow-up were retrospectively collected and analyzed from 22 patients with VADA treated with FD at Department of Neurosurgery,Changhai Hospital,Navy Medical University from August 2010 to March 2019.Of the 22 aneurysms,4 were recurrent aneurysms,1 was acute ruptured aneuiysm and 17 were unruptured aneuiysms.Modified Rankin scale(mRS)was used to comprehensively evaluate the patients after surgery,and Okelly-Marotta(OKM)grading scale was to evaluate aneurysm embolization.Results All 24 FDs were implanted successfully in 22 VADA(with 19 Tubridge FDs and 5 Pipeline FDs).The technical success rate was 100%.Ten aneurysms were treated with FD combined with coil embolization.The immediate results of embolization were classified according to Raymond's classification,with 2 cases of grade[]and 8 cases of grade HI.Twelve aneurysms were treated with only FD and significant intra-aneurysmal contrast hemostasis was retained immediately after operation in all 12 cases.No procedure-related hemorrhagic or ischemic complications occurred during the perioperative period.As for clinical follow-up 13.0(8.3-67.9)months,22 patients had the mRS score of 0.No novel neurological deficits were reported.The short-term imaging follow-up at 6.0(4.7-7.1)months involved 20 cases and the complete occlusion rate was 13/20.The complete occlusion rates were 17/20 for last follow-up at 7.7(6.0-24.4)months and 8/8 for long-term follow-up at 26.5(23.3-31.4)months,respectively.No recuiTence was demonstrated.Eight PICAs covered by FD and 3 PICAs haiboring aneurysms were all patent during follow-up.One case developed severe in-stent stenosis at 3.5-month follow?up post FI)placement in which balloon dilatation and angioplasty with stenting was performed.Twenty-two months later,the stenosis of the lumen retumed to normal arid the aneurysm was completely occluded.Conclusion FD treatment of VADA seems to have high surgical safety and satisfactory results.Long-teim efficacy needs to be further evaluated in large case series.