编织支架在颅内未破裂椎-基底动脉夹层动脉瘤中的应用

Application of braided stent in unruptured vertebrobasilar dissecting aneurysms

目的探讨编织支架在未破裂椎-基底动脉夹层动脉瘤中的应用。方法回顾性分析15例行介入手术的椎-基底动脉夹层动脉瘤病人的临床资料,病变位于基底动脉1例,左侧椎动脉8例,右侧椎动脉6例。根据病人术前检查及术中造影评估,行单纯双支架重叠2例,单支架辅助弹簧圈栓塞9例,双支架辅助弹簧圈栓塞4例。结果本组完全栓塞11例,次全栓塞2例,部分栓塞2例。术后即刻造影未见出血及载瘤动脉闭塞;术后1 d头颅CT无明显出血、脑梗死等异常情况。术后3~6个月,12例复查DSA示夹层动脉瘤处血管重塑良好、血流通畅,均未见复发。电话随访15例,症状完全好转12例,头痛轻度缓解2例,仍有头晕1例。术后3月mRS评分:0分13例,1分1例,3分1例。结论颅内编织支架(LEO及LVIS支架)在未破裂椎-基底动脉夹层动脉瘤治疗中效果可靠。

Objective To explore the application of braided stent in unruptured vertebrobasilar dissecting aneurysms(UVDA).Methods Clinical data of 15 UVDA patients were analyzed retrospectively,and the lesions were located in the basilar artery in 1 patient,in the left vertebral artery in 8 patients and right vertebral artery in 6.According to the preopreative examination and intraoperative angiography assessment,simple double-stent overlap were performed in 2 patients,single-stent assisted with coil embolization in 9 and double-stents assisted with coil embolization in 4.Results Complete embolization was achieved in 11 patients,subtotal embolization in 2 and partial embolization in 2.No hemorrhage or parent artery occlusion was observed by immediately postoperative angiography.No hemorrhage,cerebral infarction or other abnormalities was observed 1 d after the operation by CT.DSA reexamination 3 to 6 months after the operation showed good vascular remodeling and unobstructed blood flow were achieved in the dissecting aneurysm,and no recurrence occurred in 12 patients.Fifteen patients were followed up by telephone,and the symptoms completely improved in 12 patients,headache slightly relieved in 2 and still had a dizziness in 1 patient.Modified Rankin score(mRS)3 months after the operation was 0 point in 13 patients,1 point in 1 and 3 points in 1.Conclusion Intracranial braided stents(including LVIS and LEO stents)have a reliable therapeutic effect on UVDA.