血管内栓塞治疗椎基底动脉瘤(附245例报告)

Endovascular treatment of vertibrobasilar aneurysms:report of 245 cases

目的 本文总结 2 4 5例椎基底动脉瘤血管内治疗经验。方法 本组 1986年 7月至 2 0 0 2年 6月共收治 2 4 5例椎基底动脉瘤 ,其中 2 2 4例进行了血管内栓塞治疗。治疗方法包括 :单侧椎动脉球囊闭塞术 (5 1例 ) ,单纯弹簧圈栓塞术 (10 7例 ) ,球囊再塑形技术加弹簧圈栓塞术 (34例 ) ,支架加弹簧圈术 (2 4例 ) ,单纯支架术 (4例 ) ,可脱性球囊栓塞术 (4例 ) ,2 1例中 2例因导管不能到位放弃治疗。另外 1例血管造影时出现脑梗塞 ,放弃治疗。其余 18例因各种原因未治。结果 本组病例无一例死亡。有 1例支架加弹簧圈栓塞术病例术后 3小时出现脑干缺血症状经 4 5天药物治疗症状消失。 2 2 4例病人中有 14 5例进行 4个月至 8年的复查或随访 ,宽颈动脉瘤有 11例第一次栓塞术后复发 ,动脉瘤又有增大 ,其中有 1例出现蛛网膜下出血 ,这 11例中有 5例又再次弹簧圈栓塞 ,另外 6例因经济困难尚未继续栓塞治疗。结论 由于血管内治疗技术和材料的不断进步 ,绝大多数椎基底动脉瘤可以得到有效治疗 ,过去被视为“不治之症”的某些基底动脉梭形动脉瘤也取得了良好疗效。

Objective To analyze the experience of endovascular treatment of vertibrobasilar aneurysms.Methods A total of 245 cases were enrolled from July, 1986 to June, 2002, in which 224 cases were treated with endovascular therapy.Methods of treatment included: occlusion of unilateral vertibral arteries with balloons(51 cases); simply embolization with coils(107 cases); treatment with balloon assisted remodeling technique and coils(34 cases); embolization with stents and coils(24 cases); simply implantation of stent(4 cases); treatment with detachable balloons(4 cases). Among the 21 failure cases, two cases failed because of difficulty of getting ideal position of the microcatheter.One case was given up because of the cerebral infarction in the procedure of angiogram.The other 18 cases failed because of various reasons.Results There was no mortality in our series. One case suffered from ischemia of brain stem 3 hours after operation and recovered after 45 days of medical treatment.145 of the 224 cases were followed up from 4 months to 8 years after treatment. Recurrence and enlargement of the aneurysms were found in eleven cases of wide necked aneurysms after the first embolization, in which subarachnoid hemorrhage was found in one case.Five in these 11 cases were embolized again with coils.The other 6 patients refused the second treatment because of the economic problem.Conclusions Most of the vertibrobasilar aneurysms could be treated effectively because of the improvement of endovascular technique.The fusiform vertibrobasilar aneurysms which were regarded as incurable disease could also been treated with good outcome.