弹簧圈闭塞基底动脉治疗巨大夹层动脉瘤一例并文献复习  

Endovascular coil embolization of parent artery for giant intracranial basilar dissection： a case report and literature review

作　　者：于金录[1] 王宏磊[1] 许侃[1] 王柏[2] 罗祺[1] 

机构地区：[1]吉林大学第一医院神经外科,长春130021 [2]吉林大学第一医院放射科,长春130021

出　　处：《中华神经外科杂志》2011年第1期69-72,共4页Chinese Journal of Neurosurgery

摘　　要：目的 探讨弹簧圈闭塞基底动脉治疗巨大夹层动脉瘤的方法及可行性.方法 1例巨大的基底动脉夹层动脉瘤,行动脉瘤内的支架植入.术后DSA复查见夹层动脉瘤继续发展,并波及左侧椎动脉,且在椎基底动脉结合处呈球形扩张.采用弹簧圈将动脉瘤及基底动脉下端一并闭塞,闭塞后左侧椎动脉造影见基底动脉及动脉瘤不显影,右侧椎动脉造影仅见少量的血流缓慢通过.结果 术后患者恢复良好,无后遗症.随访至6个月时复查DSA,见基底动脉完全闭塞,动脉瘤不显影,侧枝循环代偿良好.结论 对于发生于基底动脉的夹层动脉瘤,可尝试采用弹簧圈闭塞基底动脉下端进行治疗,这为此类动脉瘤的治疗提供了新思路.Objective The purpose of the current study was to evaluate the method and result of endovascular treatment for a giant unruptured dissection of the basilar artery （ BA ） .Method A 14-year- old boy underwent computed tomography （CT） scan following a minor head trauma was incidentally found a lesion located anterior to brain stem. Further imaging with magnetic resonance imaging （ MRI ） , computed tomography angiography （ CTA ） and digital subtraction angiography （ DSA ）were consistent with a diagnosis of giant unruptured dissection of the BA.The patient was initially treated with BA stenting of the dissected lumen.The follow - up DSA obtained 15 days later showed thrombosis in dissected lumen and a reduction in diameter of the vessel wall.DSA obtained 3 months later revealed extension of the dissection inferiorly to involve the left vertebral artery （ VA ）.The dissection expanded at the conjunction of VAs in the shape of ball.Therefore, coil embolization to partly occlude BA at the bottom of aneurysm was performed as a further treatment.Results The prognosis was good.Follow -up DSA 6 months later demonstrated complete obliteration of the dissection and good compensative perfusion from extensively established collateral circulation.Conclusions For young patients with isolated dissection of the BA, coil embolization to partly occlude BA at the bottom of aneurysm might be a tolerable and effective approach, which takes effect probably through resulting in the procedure of slow occlusion of BA.

关 键 词：基底动脉 动脉瘤 夹层 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]