未破裂大脑后动脉夹层动脉瘤的血管内治疗  

Endovascular Treatment of Unruptured Posterior Cerebral Artery Dissecting Aneurysms

作　　者：纪文军[1] 康慧斌[1] 孙立倩[1] 刘爱华[1] 李佑祥[1] 杨新健[1] 姜除寒[1] 吴中学[1] 

机构地区：[1]首都医科大学北京市神经外科研究所,首都医科大学附属北京天坛医院神经介入科,北京100050

出　　处：《中国卒中杂志》2015年第11期918-922,共5页Chinese Journal of Stroke

基　　金：首都卫生发展科研专项(2014-3-2044;2011-1015-04);国家自然科学基金(81441038;81371314);北京自然科学基金(7142032)

摘　　要：目的探讨未破裂大脑后动脉夹层动脉瘤的临床特点及其血管内治疗效果。方法回顾性分析2012年1月至2014年12月首都医科大学附属北京天坛医院连续血管内诊治的20例未破裂大脑后动脉夹层动脉瘤的临床资料,并进行影像学和临床随访。结果 20例大脑后动脉夹层动脉瘤中,男11例(55.0%),女9例(45.0%),年龄(46.2±15.5)岁。位于P1段4例(20.0%),P2段12例(60.0%),P1-P2段2例(10.0%),P3段2例(10.0%)。单纯弹簧圈栓塞3例(15.0%),载瘤动脉闭塞11例(55.0%),支架辅助弹簧圈栓塞6例(30.0%)。术后即刻影像学结果,Raymond分级:1级15例(75.0%),2级5例(25.0%)。术后并发症:缺血事件2例(10.0%),术后出现肌力1级1例,3级1例,均经对症治疗3个月后好转。16例(80.0%)影像学随访10.5(6.5)个月,Raymond分级:1级13例(81.3%),2级2例(12.5%),术后复发(3级)1例(6.2%)行2次支架辅助栓塞,6个月影像学随访无再复发。20例(100.0%)临床随访12(9.3)个月,改良的rankin量表(modified Rankin scale,m RS)0分9例(45.0%),m RS 1分5例(25.0%),m RS 2分5例(25.0%),m RS 3分1例(5.0%),预后良好率为95.0%。结论大脑后动脉夹层动脉瘤多位于P2段,根据部位选择合适的血管内栓塞方法,临床效果满意。Objective To explore the clinical characteristics and clinical effect of endovascular treatment of unruptured posterior cerebral artery dissecting aneurysms.Methods We consecutively enrolled 20 cases with unruptured posterior cerebral artery dissecting aneurysm in department of interventional neuroradiology of Beijing Tiantan Hospital from January 2012 to December 2014. Clinical data were collected and we followed up the cases by imaging and telephone.Results For 20 cases of posterior cerebral artery dissecting aneurysms, male in 11 cases（55.0%）, female in 9 cases（45.0%）, age（46.2±15.5） years. 4 cases were in P1 segment（20.0%）, 12 cases were in P2 segment（60.0%）, 2 cases were in P1-2 segment（10.0%）, 2 cases were in P3 segment（10.0%）. Embolization only by coils was for 3 cases（15.0%）, and parent artery occlusion was for 11 cases（55.0%）, stent-asissted coiling was for 6 cases（30.0%）. Instant imaging results by Raymond scale（class1 to class 3）： class 1 in 15 cases（75%）, class 2 in 5 cases（25.0%）. Ischemic events occurred in 2 cases（10.0%） after procedures and recovered after 3 months of antisypotomatic treatment. Imaging was followed up in 16 cases for 10.5（6.5） months. Imaging results of follow-up by Raymond scale： class 1 in 13 cases（81.3%） and class 2 in 2 cases（12.5%）. 1 case（class 3, 6.2%） was recurrent and received the second endovascular treatment with stent-assisted coiling, the case was not recurrent in 6 months follow-up. Clincal follow-up was carried out in 20 cases for 12（9.3）months, m RS 0 was in 9 cases（45.0%）, m RS 1 was in 5 cases（25.0%）, m RS 2 was in 5 cases（25.0%）, m RS 3 was in 1 case（5.0%）, rate of good prognosis was 95.0%.Conclusion Unruptured posterior cerebral artery dissecting aneurysms ware mainly located in P2 segment, embolization based on location, the clinical results were satisfactary.

关 键 词：大脑后动脉 夹层动脉瘤 血管内 随访 

分 类 号：R743[医药卫生—神经病学与精神病学]