胚胎型大脑后动脉伴发型颈内动脉后交通动脉瘤血管内治疗——单中心经验

Endovascular treatment for the posterior communicating artery aneurysms of the internal carotid artery associated with the fetal posterior cerebral artery:a single center experience

目的探讨胚胎型大脑后动脉(fPCA)伴发型颈内动脉后交通动脉瘤血管内治疗的安全性和有效性。方法回顾性分析2010年12月至2018年12月采用血管内弹簧圈栓塞治疗的25例fPCA伴发型颈内动脉后交通动脉瘤患者临床资料。采用改良Raymond-Roy分类(MRRC)评估动脉瘤即刻治疗和随访结果,改良Rankin量表(mRS)评分评估患者预后。结果25例共25枚fPCA伴发型颈内动脉后交通动脉瘤患者中女22例,破裂出血23例。术后即刻造影显示充分栓塞15例(MRRCⅠ级7例,Ⅱ级8例),不全栓塞10例(Ⅲa级6例,Ⅲb级4例)。DSA随访平均(20.7±20.6)(3~73)个月,除二期支架辅助弹簧圈栓塞治疗3例外,复发4例,其中2例接受支架辅助弹簧圈栓塞再治疗;随访终点显示MRRCⅠ级10例,Ⅱ级10例,Ⅲb级4例。临床随访平均(40.1±30.5)(3~117)个月,患者预后均良好(mRS评分0分23例,1分1例)。结论血管内弹簧圈栓塞治疗fPCA伴发型颈内动脉后交通动脉瘤安全有效,很多情况下需要支架辅助,且需要长期密切随访。

Objective To explore the safety and effectiveness of endovascular treatment for the posterior communicating artery aneurysms of the internal carotid artery associated with fetal posterior cerebral artery(fPCA).Methods The clinical data of 25 patients with posterior communicating artery aneurysms of the internal carotid artery associated with fPCA,who were treated with endovascular coil embolization therapy during the period from December 2010 to December 2018,were retrospectively analyzed.Modified Raymond-Roy classification(MRRC)was used to evaluate the immediate therapeutic response and follow-up results of the aneurysms,and modified Rankin scale(mRS)score was used to assess the prognosis of patients.Results In the 25 patients,a total of 25 posterior communicating artery aneurysms of the internal carotid artery associated with fPCA were detected.Of the 25 patients,22 were females and ruptured aneurysm with bleeding was observed in 23.Immediate postoperative angiography showed that MRRC gradeⅠwas achieved in 7 patients,gradeⅡin 8 patients,gradeⅢa in 6 patients and gradeⅢb in 4 patients.The mean follow-up time with DSA was(20.7±20.6)months(range of 3-73 months).Except 3 patients who received second-stage stent-assisted coiling(SAC)embolization,4 patients developed recurrence,among them 2 patients had to further receive SAC.At the time of follow-up end-point,MRRC gradeⅠwas obtained in 10 patients,gradeⅡin 10 patients and gradeⅢb in 4 patients.The mean clinical follow-up time was(40.1±30.5)months(range of 3-117 months),and all patients had a good prognosis with an mRS score of 0 point(n=23)or one point(n=1).Conclusion For the treatment of posterior communicating artery aneurysms of the internal carotid artery associated with fPCA,endovascular coil embolization therapy is safe and effective,although stent-assisted technique is needed in many cases and long-term close follow-up to observe the therapeutic efficacy is also necessary.