血管内治疗小脑后下动脉瘤24例临床经验

Clinical experience of 24 cases of posterior inferior cerebellar aneurysm treated by the endovascular treatment

目的 探讨血管内治疗小脑后下动脉(PICA)瘤的治疗策略、安全性及临床疗效。方法 回顾性分析安徽医科大学第一附属医院2017年7月至2022年1月行血管内治疗的24例PICA动脉瘤病人的临床资料(其中,PICA近端13例、过渡段1例、远端10例;以蛛网膜下腔出血首诊的21例、未破裂动脉瘤3例),单纯栓塞12例、动脉瘤及载瘤动脉闭塞7例(闭塞材料使用弹簧圈3例、Onyx胶4例)、支架辅助弹簧圈栓塞5例。术后随访3~24个月。结果 24例PICA动脉瘤病人术中动脉瘤均栓塞顺利。23例病人无近期并发症,1例出血病人合并严重脑血管痉挛自动出院(临床预估死亡)。随访结果:19病人远期随访无复发;4例复发,其中2例二期行支架辅助栓塞,后期随访良好、未再复发;1例首次支架辅助栓塞病人再次行穿支架网孔弹簧圈单纯栓塞,后期随访良好、未再复发;1例首次单纯栓塞病人再次行弹簧圈栓塞,后期随访良好、未再复发。结论 血管内治疗PICA动脉瘤安全、可行,疗效可靠。根据动脉瘤血管解剖位置,对于破裂出血的PICA动脉瘤首次治疗倾向单纯栓塞或载瘤动脉闭塞术。首次单栓病例术后复发,可二期行支架辅助栓塞能取得满意效果。对于复发动脉瘤经再次血管内治疗可获得满意效果。

Objective To investigate the treatment strategy,safety and clinical efficacy of endovascular treatment of posterior inferior cerebellar aneurysm(PICA).Methods The clinical data of 24 patients with PICA aneurysms who underwent endovascular therapy in the First Affiliated Hospital of Anhui Medical University from July 2017 to January 2022 were retrospectively analyzed(among them,13 patients with proximal PICA,1 patient with transitional segment,and 10 patients with distal PICA;Subarachnoid hemorrhage was diagnosed for the first time in 21 cases,unruptured aneurysm in 3 cases),simple embolization in 12 cases,occlusion of aneurysm and bearing artery in 7 cases(using spring coil as occlusive material in 3 cases,Onyx glue in 4 cases),and stent assisted spring coil embolization in 5 cases.Postoperative follow-up was 3-24 months.Results All 24 patients with PICA aneurysms were successfully embolized during operation.Twenty-three patients had no recent complications,and one bleeding patient was automatically discharged with severe cerebral vasospasm(clinically estimated death).Follow-up results:19 patients without recurrence after long-term follow-up,4 patients relapsed,two second stage stent-assisted embolization,good late follow-up,no recurrence,one first stent-assisted embolization,good late follow-up,no coil embolization,good late follow-up.Conclusions The endovascular treatment of PICA aneurysm is safe,feasible and reliable.According to the anatomical location of the aneurysm vessel,the first treatment of a PICA aneurysm with ruptured bleeding favors simple embolization or occlusion of the parent artery.In the first postoperative recurrence,there can be secondary stentassisted embolization to achieve satisfactory results.The recurrent aneurysm can be satisfactory by reendovascular treatment.