老年椎动脉V4段及基底动脉夹层动脉瘤行血管内治疗的疗效分析

Efficacy of endovascular therapy for elderly vertebral artery V4 segment and basilar artery dissecting aneurysms

目的探讨老年椎动脉V4段及基底动脉夹层动脉瘤引起蛛网膜下腔出血患者使用不同支架辅助弹簧圈栓塞治疗的有效性与安全性。方法选择2016年1月~2020年12月北部战区总医院神经外科收治的自发性蛛网膜下腔出血椎动脉V4段及基底动脉动脉瘤并顺利完成手术患者54例,将35~60岁的20例作为中青年组,年龄>60岁的34例作为老年组。回顾性分析患者术中和术后并发症情况及动脉瘤复发情况。结果术中和术后出现并发症10例(18.5%),其中术中6例;术后远期责任血管缺血4例。随访期间,动脉瘤复发12例(22.2%),其中单支架辅助弹簧圈栓塞复发7例,多支架辅助弹簧圈栓塞复发3例,半密网支架辅助弹簧圈栓塞动脉瘤复发2例,密网支架患者复发0例。复发时间在6~10个月5例、11~14个月5例、15~18个月2例。老年组与中青年组并发症发生率和动脉瘤复发率比较,均无统计学差异(20.6%vs 15.0%,17.6%vs 30.0%,P>0.05)。结论椎动脉及基底动脉夹层动脉瘤患者可行血管内治疗,应根据患者血管硬化程度、血管结构、动脉瘤位置选择适合手术方式。

Objective To investigate the effectiveness and safety of different stent assisted embolization in middle-aged and elderly patients with subarachnoid hemorrhage due to dissecting aneurysm of V4-segment of vertebral artery and basilar artery.Methods A total of 54 patients with spontaneous subarachnoid hemorrhage due to dissecting aneurysm of V4 segment of vertebral artery and basilar artery and undergoing successful surgical treatment in our separtment from January 2016 to December 2020 were enrolled in this study.The patients aged 35 to 60 years were assigned into the young and middle-aged group(n=20)and those over 60 years old into the elderly group(n=34).Intraoperative and postoperative complications and aneurysm recurrence were were retrospectively analyzed.Results In the 10 cases(18.5%)experiencing complications,intraoperative complications were observed in 6 cases,and long-term insufficient blood flow in responsible vessels were seen in 4 cases.During the follow-up period,12 cases(22.2%)of aneurysm recurred,including 7 cases of single-stent-assisted embolization,3 cases of multi-stent-assisted embolization,2 cases of semi-dense mesh stent-assisted embolization,and 0 case of flow diverter-assisted embolization.5 cases recurred within 6 to 10 months,5 cases recurred within 11 to 14 months,and 2 cases recurred within 15 to 18 months.There were no statistical differences in the incidence of complications and aneurysm recurrence rate between the elderly and young and mid-dle-aged groups(20.6%vs 15.0%,17.6%vs 30.0%,P>0.05).Conclusion Endovascular treatment is feasible for patients with vertebral artery and basilar artery aneurysms.Appropriate surgical approach should be selected according to vascular sclerosis,vascular structure,and aneu-rysm location of the patients.