椎动脉V4段夹层动脉瘤引起低级别蛛网膜下腔出血行支架辅助栓塞的效果分析

Analysis of the effect of stent-assisted embolization for low-grade subarachnoid hemorrhage caused by V4 segment dissecting aneurysm of vertebral artery

目的探讨支架辅助栓塞治疗椎动脉V4段夹层动脉瘤引起蛛网膜下腔出血的有效性与安全性。方法回顾性分析北部战区总医院神经外科2016年1月至2019年6月收治的39例自发性蛛网膜下腔出血V4段夹层动脉瘤患者的临床资料。男性21例,女性18例,年龄(48±17)岁(范围:35~68岁),HUNT-HESS分级Ⅰ级24例,Ⅱ级15例。其中20例行单支架辅助栓塞,9例行多支架辅助栓塞,9例行半密网辅助栓塞,1例行密网支架辅助栓塞。收集患者术中和术后并发症情况及复发情况。结果39例患者均完成支架辅助栓塞治疗,术后即刻造影均显示动脉瘤致密栓塞;发生术中并发症4例(10.3%,4/39),其中动脉瘤破裂2例,急性血栓形成2例;发生术后并发症3例(7.7%,3/39),均为远期责任血管缺血(改良Rankin评分<2分)。患者平均随访时间15.1个月(范围:12~29个月)。截至末次随访,动脉瘤复发10例,复发率为25.6%(10/39)。20例单支架辅助栓塞患者中,复发6例,发生并发症2例;9例多支架辅助栓塞患者中,复发3例,发生并发症4例;9例半密网支架辅助栓塞动脉瘤患者中,复发1例,发生并发症1例。结论椎动脉夹层动脉瘤患者可行支架辅助栓塞治疗,应根据患者血管结构、动脉瘤位置选择适合手术方式。

Objective To investigate the efficacy and safety of different stents assisted embolization in the treatment of subarachnoid hemorrhage(SAH)caused by V4 dissecting aneurysm of vertebral artery.Methods The clinical data of 39 patients with spontaneous SAH V4 dissecting aneurysm treated at the Department of Neurosurgery,the Northern Theater General Hospital from January 2016 to June 2019 were analyzed retrospectively.There were 21 males and 18 females,aged(48±17)years(range:35 to 68 years).There were 24 cases of HUNT-HESS gradeⅠand 15 cases of gradeⅡ.Among them,20 cases were treated with single stent-assisted embolization,9 cases with multi-stent-assisted embolization,9 cases with semi-dense mesh-assisted embolization,and 1 case with dense-mesh stent-assisted embolization.The perioperative and postoperative complications,postoperative recurrence were collected.Results Intraoperative complications included 2 cases of aneurysm rupture and 2 cases of acute thrombosis.All aneurysms were densely packed according to the angiography performed immediately after operation.Postoperative complications included 3 cases of long-term responsible vascular ischemia(modified Rankin score<2).The patients were followed up for 15.1 months(range:12 to 29 months).At the last follow-up,aneurysms recurrence occured in 10 cases,the recurrence rate was 25.6%(10/39).There were 6 cases of recurrence and 2 cases of complications in 20 cases with single stent-assisted embolization,3 cases of recurrence and 4 cases of complications in 9 cases with multi-stent-assisted embolization,1 case of recurrence and 1 case of complications in 9 cases with semi-dense mesh stent.Conclusion Endovascular treatment is feasible for patients with vertebral artery dissecting aneurysm,and the appropriate surgical method should be selected according to the vascular structure and the location of the aneurysm.