基底动脉干囊性动脉瘤血管内治疗的临床效果分析

Clinical effect of endovascular treatment of basilar artery trunk saccular aneurysm

目的评价血管内治疗基底动脉干囊性动脉瘤的安全性和有效性。方法回顾性连续纳入了2009年8月至2019年8月于海军军医大学第一附属医院神经外科接受血管内治疗的30例基底动脉干囊性动脉瘤患者。依据动脉瘤大小、瘤颈宽度、载瘤动脉远近端直径制定治疗策略(单纯弹簧圈栓塞或支架辅助弹簧圈栓塞)。根据Raymond分级评价术后即刻栓塞程度。观察围手术期并发症(术中动脉瘤破裂出血、载瘤动脉血栓形成及穿支动脉闭塞,术后神经功能障碍加重或出现新神经功能障碍,影像学检查发现新的病灶)。术后6个月DSA随访,随访结果分为治愈、改善、稳定、复发。出院时和随访期间采用改良Rankin量表(mRS)评分评估患者临床预后。结果30例患者中,5例接受单纯弹簧圈治疗,25例行支架辅助弹簧圈治疗。所有患者成功实施血管内治疗,术后即刻造影显示,动脉瘤RaymondⅠ级栓塞12个(40.0%),Ⅱ级13个(43.3%),Ⅲ级5个(16.7%),所有载瘤动脉及动脉瘤累及的分支均通畅。围手术期并发症2例(6.7%),1例于术后24 h内左侧肢体肌力Ⅳ级、左侧舌面瘫,MRI示脑桥新发小梗死灶,出院时恢复正常;1例于术后10 d猝死。29例临床随访10~100个月,中位随访时间14(12,27)个月,临床预后良好率(mRS评分≤2分)为100.0%。19例患者接受DSA随访[6~72个月,中位随访时间9(7,14)个月],其中16例支架辅助弹簧圈栓塞治疗患者中,11例动脉瘤治愈,2例改善,3例复发;3例单纯弹簧圈栓塞患者均复发。结论基底动脉干囊性动脉瘤支架辅助弹簧圈栓塞治疗有较好的安全性和有效性,单纯弹簧圈栓塞治疗的患者动脉瘤复发率较高。

Objective To evaluate the safety and efficacy of endovascular treatment for basilar artery trunk saccular aneurysms.Methods From August 2009 to August 2019,a total of 30 patients with basilar artery trunk saccular aneurysm who received endovascular treatment in the Department of Neurosurgery of the First Hospital Affiliated to the Naval Military Medical University were included retrospectively.The treatment strategy was made according to the size of the aneurysm,the width of the neck,distal and proximal diameter of parent artery(simple coil embolization or stent-assisted coil embolization).The degree of embolization was evaluated immediately after operation according to Raymond grade.The perioperative complications(rupture of aneurysm,thrombosis of parent artery and occlusion of perforating artery,aggravation of neurological dysfunction or new neurological dysfunction after operation,and new lesions were found by imaging examination)were observed.DSA was followed up six months after operation,and the results were divided into cure,improvement,stability and recurrence.The score of modified Rankin scale(mRS)was used to evaluate the clinical prognosis at discharge and during follow-up.Results Among 30 patients,5 received simple coil embolization and 25 received stent-assisted coil embolization.Intravascular therapy was successfully performed in all 30 patients.Immediate angiography after operation showed that 12 aneur ysms(40.0%)were embolized in Raymond gradeⅠ,13 aneurysms(43.3%)in gradeⅡ,and 5 aneur ysms(16.7%)in gradeⅢ.All parent arteries and branches involved in aneurysms were unobstructed.Perioperative complications occurred in 2 cases(6.7%).One case had gradeⅣmuscle strength of the left limb and left lingual facial paralysis within 24 hours after operation.MRI showed a new focus of small infarction in the pontine which returned to normal at discharge.One case died suddenly 10 days after operation,and the cause of death was unknown.Twenty-nine cases were followed up for 10 to 100 months,with a median follow-up period of 14(12,27)months.The rate of good clinical prognosis(mRS score≤2)was 100%.Nineteen patients were followed up by DSA for 4 to 72 months,with a median follow-up period of 9(7,14)months.Among 16 patients treated with stent-assisted coil embolization,11 were cured,2 improved,and 3 relapsed.All 3 patients with simple coil embolization relapsed.Conclusion Stent-assisted coil embolization of basilar artery trunk saccular aneurysms is safe and effective,and the recurrence rate of aneurysms treated with simple coil embolization is higher.