血管内介入治疗合并烟雾病的基底动脉尖动脉瘤  

Endovascular treatment for basilar tip aneurysms associated with moyamoya disease

作　　者：陈岩[1] 戴冬伟[1] 方奕斌 黄清海[1] 赵文元[1] 刘建民[1] 

机构地区：[1]第二军医大学长海医院神经外科,上海200433

出　　处：《第二军医大学学报》2015年第3期330-334,共5页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81271271)~~

摘　　要：目的探讨血管内介入治疗合并烟雾病的基底动脉尖动脉瘤的安全性和有效性。方法 2006年10月至2013年7月我科经血管内介入治疗7例合并烟雾病的基底动脉尖动脉瘤患者,其中单纯弹簧圈栓塞2例,支架辅助弹簧圈栓塞5例。即刻栓塞结果采用Raymond分级评价,所有患者均获得影像学和临床随访,患者的临床随访结果依据改良Rankin评分（mRS）评价。结果所有患者均成功行介入治疗,无手术相关并发症。术后即刻造影提示：致密栓塞3例,瘤颈残留2例,部分栓塞2例。所有患者均获得影像学随访,平均随访时间（10.4±3.5）个月,6例治愈,1例稳定,支架组患者无支架内再狭窄和血栓形成。临床随访平均（21.1±15.8）个月,所有患者均预后良好（mRS 0~2）。结论血管内介入治疗合并烟雾病的基底动脉尖动脉瘤安全有效,对大型或宽颈动脉瘤,支架植入可能是安全有效的,但仍需长期随访进一步证实。Objective To assess the safety and efficacy of endovascular treatment for basilar tip aneurysms associated with moyamoya disease. Methods Seven patients with basilar tip aneurysms associated with moyamoya disease were treated by endovascular embolization in our department between Oct. 2006 and Jul. 2013. Two patients were treated by pure coiling and the others were treated by stent-assisted coiling. The immediate angiographic result was evaluated by Raymond scale. Postoperative angiographic and clinical follow-ups were obtained in all the 7 cases, and the clinical outcomes were evaluated by the modified Rankin score （mRS）. Results All the 7 patients successfully received endovascular embolization without procedure-related complications. Immediate angiographie results showed complete occlusion in 3 cases, neck residual in 2, and partial occlusion in 2. Postoperative angiographic follow-ups were obtained for a mean of （10. 4± 3.5） months, with complete occlusion found in 6 patients and stable in 1 patient. No progressive thrombosis or in-stent occlusion were detected by follow-up angiograms in the stent group. Clinical follow-ups were obtained for a mean of （21. 1±15. 8） months and all the patients reported good outcomes （mRS 0-2）. Conclusion Our data suggest that endovascular embolization is a safe and efficient treatment for basilar tip aneurysms associated with moyamoya disease. Stent-assistance might be a safe and effective option for the large or wide-necked aneurysms, though the long-term safety still remains to be confirmed.

关 键 词：烟雾病 基底动脉尖动脉瘤 血管内治疗 

分 类 号：R651.12[医药卫生—外科学]