经颈静脉入路栓塞治疗后循环动静脉畸形的初步观察

Transjugular embolization of brain arteriovenous malformations involving the posterior circulation:a preliminary observation

目的初步观察经颈静脉入路栓塞治疗后循环(椎-基底动脉系统主要供血)动静脉畸形(AVM)的疗效。方法回顾性分析2016年11月至2021年4月河南省人民医院介入治疗中心脑血管病科采用经颈静脉入路栓塞治疗的14例后循环AVM患者的临床资料。术后30~90 d门诊随访患者有无神经系统并发症,采用改良Rankin量表评分(mRS)评估预后,mRS≤2分为预后良好。术后90~180 d复查头颅MRI及数字减影血管造影(DSA),将DSA显示无静脉早显定义为完全栓塞。结果14例患者中,经颈静脉入路栓塞技术成功13例,术后即刻造影显示完全栓塞11例,残留病变2例;另1例栓塞失败。术后1周内发生脑出血6例,脑梗死1例;其中1例脑出血患者死亡。出院时mRS0分1例,1分5例,2分4例,5分3例。术后90d随访时,失访1例;余12例患者中,预后良好11例,预后不良1例。10例患者完成影像学随访,随访时间为(8.8±3.3)个月(3~30个月);结果显示8例完全栓塞,1例再发弥散型血管畸形,1例畸形血管团仍有少量残留。结论初步观察发现,经颈静脉入路栓塞治疗后循环AVM的技术具有可行性,疗效较好,可作为传统手术的补充治疗方法。

Objective To preliminarily explore the outcomes of transjugular embolization of brain arteriovenous malformations(AVM)involving the posterior circulation(vertebrobasilar system).Methods A retrospective analysis was conducted on the clinical data of 14 patients with posterior circulation AVM who were treated by transjugular embolization in the Department of Cerebrovascular Diseases.,Interventional Treatment Center,Henan Provincial People's Hospital from November 2016 to April 2021.The patients were followed up for 30 to 90 days after operation in the outpatient department for neurological complications.The modified Rankin scale(mRS)was used to evaluate the outcomes,and mRS≤2 was regarded as a good outcome.Cranial MRI and digital subtraction angiography(DSA)were re-examined 90-180 days after operation,and complete embolization was defined as no early venous drainage vein on DSA.Results Among the 14 patients,13 underwent successful transjugular embolization.Immediate postoperative angiography indicated complete embolization in 11 patients and incomplete embolization in 2.Embolization failed in 1 patient.There were 6 cases of cerebral hemorrhage and 1 case of cerebral infarction within 1 week after operation.One patient of cerebral hemorrhage died.At discharge,the mRS score was0 in1 case,1 in5,2 in4,and 5 in3.At the 90-day follow-up after operation,1 case was lost to follow-up,and among the remaining 12 patients,11 had a good outcome and 1 had a poor outcome.Imaging follow-up was performed in 10 patients,and the follow-up time was 8.8±3.3 months(3-30 months).The results showed that 8 patients achieved complete embolization,1 patient had recurrent diffuse vascular malformation,and 1 patient still had a small amount of residual vascular mass.Conclusion Preliminary observation has suggested that the technique of transjugular embolization of posterior circulation AVM is feasible and can be used as a supplementary treatment method for traditional surgery with good therapeutic effect.