枕动脉⁃小脑后下动脉搭桥术治疗累及小脑后下动脉的椎动脉瘤

Occipital artery-posterior inferior cerebellar artery bypass for the treatment of vertebral aneurysms involving posterior inferior cerebellar artery

目的探讨枕动脉⁃小脑后下动脉(OA⁃PICA)搭桥术治疗累及小脑后下动脉的椎动脉瘤的效果。方法纳入2016年1月至2020年12月在华中科技大学同济医学院附属同济医院诊断与治疗的6例累及小脑后下动脉的椎动脉瘤患者,均行OA⁃PICA搭桥术,联合同期动脉瘤孤立术、择期血管内介入治疗孤立动脉瘤或择期支架植入术。术中吲哚菁绿荧光血管造影术(ICGA)显示桥血管吻合口通畅,记录住院期间手术相关并发症,术后1~3年复查CTA或DSA评估桥血管吻合口通畅情况,术后1年改良Rankin量表(mRS)评价预后。结果6例患者均顺利完成OA⁃PICA搭桥术,术中ICGA均显示桥血管吻合口通畅。1例(例4)同期行动脉瘤孤立术;3例(例1、例3、例5)择期行血管内介入治疗孤立动脉瘤;1例(例2)择期行支架植入术;1例(例6)术前动脉瘤已破裂患者术后10 h发生动脉瘤再出血而死亡。5例生存患者住院期间均未发生手术相关并发症,术后平均随访37个月,复查CTA或DSA均显示桥血管吻合口通畅,术后1年预后良好(mRS评分均为1)。结论OA⁃PICA搭桥术是治疗累及小脑后下动脉的椎动脉瘤的有效方法。

Objective To assess the efficacy of occipital artery(OA)⁃posterior inferior cerebellar artery(PICA)bypass for the treatment of vertebral aneurysms involving PICA.Methods and Results A total of 6 patients with vertebral aneurysms involving PICA treated by OA⁃PICA bypass in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2016 to December 2020 were retrospectively reviewed.Complications were recorded and outcomes were assessed by modified Rankin Scale(mRS).OA⁃PICA bypass was successfully performed in 6 patients and bypass patency was confirmed by intraoperative indocyanine green angiography(ICGA).OA⁃PICA bypass and surgical trapping were performed in the same session in one patient(Case 4).Elective endovascular trapping was applied after bypass in 3 cases(Case 1,Case 3,Case 5).Elective stent implantation was conducted in one patient(Case 2)after the bypass surgery.One patient(Case 6)died of aneurysm rehemorrhage 10 h after OA⁃PICA bypass.No complications were observed during the hospitalization in the remaining 5 patients.Bypass patency was achieved in a mean follow⁃up time of 37 months and outcome was favorable(mRS was 1,for all)one year after the final surgery.Conclusions OA⁃PICA bypass is an effective method for the treatment of PICA⁃involved vertebral aneurysms.