单支架及重叠支架植入术治疗椎-基底动脉夹层动脉瘤的疗效分析  

Efficacy analysis of single-stent and overlapping-stent implantation for vertebrobasilar dissecting aneurysm

作　　者：吴琪[1] 张庆荣[1] 陈姝娟[1] 王汉东[1] 史继新[1] 张鑫[1] 

机构地区：[1]南京军区南京总医院神经外科,210002

出　　处：《中国微侵袭神经外科杂志》2012年第11期485-487,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：南京军区南京总医院青年基金(编号:2009Q030)

摘　　要：目的观察与评价单支架植入术与重叠支架植入术治疗椎一基底动脉夹层动脉瘤（VBDA）的疗效。方法回顾性分析24例VBDA病人临床资料，共28个夹层动脉瘤。其中破裂动脉瘤3个，未破裂动脉瘤25个；椎动脉夹层动脉瘤25个。基底动脉夹层动脉瘤3个。采用单支架技术治疗夹层动脉瘤（单支架组）13个，重叠支架技术治疗（重叠支架组）15个。结果术后6个月随访DSA显示：单支架组夹层动脉瘤完全闭塞2个，部分闭塞5个，无变化6个；重叠支架组夹层动脉瘤完全闭塞7个，部分闭塞8个。两组动脉瘤闭塞率经统计学分析，有显著性差异（P=0．000）。单支架组发生支架内狭窄1例；重叠支架组发生支架移位2例，短暂性脑缺血2例，蛛网膜下腔出血1例。所有病人临床随访8-75个月，均在随访结束时行改良Rankin量表（mRS）评分，其中mRS评分0分20例，1分4例。结论单纯支架植入术治疗椎一基底动脉夹层动脉瘤安全、有效，且重叠支架技术有助于更好地闭塞夹层动脉瘤。得到更满意的影像学结果。Objective To observe and evaluate the therapeutic efficacy of single-stent and overlapping-stent implantation for vertebrobasilar dissecting aneurysm （VBDA）. Methods Clinical data of 24 patients with 28 VBDAs were analyzed retrospectively, including 3 ruptured aneurysms and 25 unruptured aneurysms, while 25 vertebral dissecting aneurysms and 3 basilar dissecting aneurysms. The single-stent implantation was performed in 13 patients （single-stent group） and overlapping-stent implantation in 15 （overlapping-stent group）. Results DSA reexamination 6 months after the treatment showed the aneurysms completely occluded in 2 cases, partially occluded in 5 and unchanged in 6 in single-stent group, while completely occluded in 7 and partially occluded in 8 in overlapping-stent group. Overlapping-stent group was obviously superior to single-stent group in stenting outcome （P = 0.000）. The in-stent restenosis occurred in 1 case in single-stent group, while 2 stent migrations, 2 transient ischemie attacks and 1 subarachnoid hemorrhage in overlapping-stent group. All the patients were followed up clinically from 8 to 75 months. The latest modified Rankin Scale score was 0 in 20 patients and 1 in 4. Conclusions Single stent implantation is safe and effective for VBDA. Overlapping stent technique is more helpful to occlude the dissecting aneurysms, and can obtain more favorable imaging outcome.

关 键 词：动脉瘤 夹层 椎动脉 基底动脉 血管内治疗 支架 

分 类 号：R743[医药卫生—神经病学与精神病学]