支架结合弹簧圈治疗破裂椎动脉夹层动脉瘤  被引量:13

Endovascular treatment of ruptured vertebral artery dissecting aneurysms with stents and coils

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作  者:方亦斌[1] 赵开军[1] 李强[1] 许奕[1] 洪波[1] 黄清海[1] 赵文元[1] 刘建民[1] 

机构地区:[1]第二军医大学附属长海医院神经外科,上海200433

出  处:《中国微侵袭神经外科杂志》2013年第4期145-148,共4页Chinese Journal of Minimally Invasive Neurosurgery

基  金:国家自然科学基金面上项目(编号:81171093);上海市卫生局局级课题(编号:20114232)

摘  要:目的评估支架结合弹簧圈技术治疗破裂椎动脉夹层动脉瘤(VADA)的可行性、有效性和安全性。方法回顾性分析57例破裂VADA的临床资料,均使用支架结合弹簧圈技术治疗,按使用支架数量分为单支架组(n=32)和多支架组(n=25),比较两组间即刻和随访的影像学结果及临床结果。结果治疗即刻VADA完全栓塞、近全栓塞和部分栓塞,单支架组分别为4例(12.5%)、7例(21.9%)、21例(65.6%),多支架组分别为13例(52%)、7例(28%)、5例(20%)。影像学随访12~78个月,单支架组30例,其中VADA完全栓塞19例(63.3%),显影11例;多支架组24例,其中VADA完全栓塞23例(95.8%)、显影1例。术后即刻与随访期VADA完全栓塞率,多支架组显著高于单支架组(P〈0.05)。死亡3例。改良mRS评分在两组间差异无统计学意义(P〉0.05)。结论长期随访结果显示,支架辅助栓塞治疗破裂椎动脉夹层动脉瘤在技术上是安全有效的,多支架结合弹簧圈栓塞可有效提高即刻及远期的完全栓塞率,降低术后复发及再出血风险。Objective To evaluate the feasibility,efficacy and safety of stent assisted coiling for ruptured intracranial vertebral artery dissection aneurysms(VADA).Methods Clinical features of 57 ruptured VADA were retrospectively analyzed.Stent-assisted coiling was performed in all the patients.According to number of stents,the patients were grouped into single-stent group(n = 32) and multiple-stent group(n = 25).The difference was compared between the two groups on angiographic and clinical results.Results The instant results of radiography revealed total occlusion of the VADA was achieved in 4(12.5%) and 13(52%) patients,near total occlusion in 7(21.9%) and 7(28%),and partial occlusion in 21(65.6%) and 5(20%) in single-stent group and multiple-stent group respectively.Thirty patients in single-stent group and 24 in multiple-stent group were angiographically followed up for 12-78 months.A total occlusion and subtotal occlusion were seen in 19(63.3%) and 11 patients in single-stent group,and in 23(95.8%) and 1 patient in multiple-stent group.The complete occlusion rates immediately postoperation and during follow-up period were significantly higher in multiple-stent group than in single-stent group(P < 0.05).Three patients died.There was no difference in modified Rankin score between the single-stent group and multiple-stent group(P > 0.05).Conclusions Stent-assisted coiling is safe and effective for ruptured intracranial VADA,which is confirmed by long-term follow-up.Application of multiple overlapping stents is effective to elevate the rate of total occlusion,and to reduce the risk of recurrence and rebleeding.

关 键 词:动脉瘤 夹层 椎动脉 血管内治疗 支架 

分 类 号:R651.1[医药卫生—外科学]

 

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