椎基底动脉夹层瘤的影像学特征和介入治疗策略  

Radiological features and strategies of interventional treatment for intracranial vertibrobasil dissection.

作　　者：赵文元[1] 刘建民[1] 许奕[1] 洪波[1] 黄清海[1] 张珑[1] 赵瑞[1] 

机构地区：[1]上海第二军医大学长海医院神经外科,200433

出　　处：《介入放射学杂志》2004年第S1期89-89,共1页Journal of Interventional Radiology

摘　　要：目的　总结椎基底动脉夹层瘤的影像诊断和介入治疗经验。方法　收治临床表现为蛛网膜下腔出血 ,小脑梗死或基底动脉供血不足的椎基底动脉夹层患者 4 8例 ,全部病人进行DSA ,部分作CTA或MRA。 4例患者行单纯口服抗凝治疗 ,6例行血管内孤立治疗 ,4例行单纯血管内支架植入治疗(其中 2例行双支架植入 ) ,34例行支架植入加弹簧圈栓塞治疗。结果　无患者出现严重并发症或再次出血 ,椎基底动脉供血不足者临床症状明显改善 ,无手术死亡病例。结论　椎基底动脉夹层瘤好发于椎动脉PICA上段 ,内膜剥脱造成的血管内充盈缺损、血管狭窄和膨大相混杂呈串珠状或血管线样狭窄、偏心性动脉瘤为椎基底动脉的主要影像学特征。治疗策略应根据临床症状、夹层瘤的部位、形态及其与周围分支的关系而确定。对影像表现为血管轻度狭窄的缺血性颅内外夹层瘤可行药物抗凝治疗 ;对狭窄较重 ,尤其是累及基底动脉者可行支架植入。对出血的颅内夹层瘤均应手术治疗 :非供血主干侧PICA上段或PICA下段夹层瘤可行血管内隔绝 ;与PICA或前脊髓动脉毗邻者行支架植入加弹簧圈栓塞 ;累及PICA或前脊髓动脉者行近端闭塞 ,支架植入或外科手术治疗。优势供血侧或侧支循环不足的椎基底动脉夹层瘤应作支架植入加弹簧圈栓塞治疗。随着支架性能的不断改进?Objective To summarize primary experiences in radiological diagnosis and interventional management for intracranial vertebral dissection.Methods Forty-eight cases present with SAH, cerebellar infarctions, or vertibrobasil insufficiency were referred to our unite. All patients underwent DSA examination, partial with workup of CTA or MRA. Four cases receipt simply oral anticoagulation, 6 were trapped endovascular, 4 implanted with stents, 34 underwent stent-assisted coiling.Results There is no severe complication and recurrent SAH in this series. Patients with vertibrobasil insufficiency were signicantly ameliorated after operation. No death related to endovascular intervention.Conclusions Vertibrobasil dissection has a preference in supra PICA segment of vertebral artery. Radiological features include a lineal filling defection representing intima, pearl and string sign due to irregular enlargement and stenosis of vessel, thread like stenosis, and eccentric aneurysm. Therapeutic strategies depend on clinical symptoms, the location, configuration of the dissection, and the relationship of vital branches arrounded. For patients with a mild stenotic dissection, simple oral anticoagulation may be suddicent, meanwhile stent inplantation is necessary for severe, especially for cases incorporated the basilar artery. All hemorrhagic cases should be treated radically. For dissection in supra or infra-PICA segment of nondominent vertibroartery, endovascular trapping is ideal candidate, while patients with a close relationship with PICA or anterior spinal artery, stent-assisted coiling is a option. When the PICA or anterior spinal artery is involved, proximal occlusion, stenting, and surgical bypass is a alternative choice. If the locus in a dominant vessel or collateral circulation is insufficient, stent-assisted coiling is reasonable. As the advance of stent product and improvation of stenting technique, perhapse stenting will gradually take place of endovascular trapping.

关 键 词：动脉 夹层瘤 支架 弹簧圈 

分 类 号：R743.3[医药卫生—神经病学与精神病学]