介入治疗基底动脉夹层动脉瘤效果分析  

Analysis of curative effect of endovascular interventional treatment for basilar artery dissecting aneurysms

作　　者：李钊硕[1] 李天晓[1] 薛绛宇[1] 冯光[1] 王子亮[1] 白卫星[1] 朱良付[1] 赵同源[1] 许岗勤[1] 杨博文[1] 

机构地区：[1]郑州大学人民医院脑血管介入治疗中心、河南省介入治疗中心、河南省脑血管病防治中心,450003

出　　处：《介入放射学杂志》2016年第6期478-482,共5页Journal of Interventional Radiology

摘　　要：目的评价血管内介入治疗基底动脉夹层动脉瘤的安全性、有效性。方法回顾性分析2009年1月至2015年4月在我院接受血管内介入治疗的26例基底动脉夹层动脉瘤患者。按瘤体大小分为大型-巨大型组和中小型组,比较两组患者治疗效果。记录并发症和随访情况。结果 26例基底动脉夹层动脉瘤患者均获得成功治疗,其中接受单纯支架植入9例,支架植入结合弹簧圈栓塞17例。围手术期共发生5例并发症,其中3例为后循环梗死(单纯支架组1例,支架结合弹簧圈组2例),2例为小脑出血(均发生于支架结合弹簧圈组),随后4例恢复良好出院,1例支架内急性血栓形成死亡。22例患者获得DSA随访,结果显示12例改善,7例稳定,3例复发(2例有新发症状)。亚组分析显示单纯支架组并发症发生率低于支架结合弹簧圈组,两组远期疗效相当;大型-巨大型组并发症发生率和严重残死率均高于中小型组,差异均有统计学意义(P=0.020,Z=3.247)。结论血管内介入治疗基底动脉夹层动脉瘤有较好的安全性和有效性。多重支架技术仍然是目前优先推荐的术式,需依据不同病变特点确定是否使用弹簧圈辅助。大型和巨大型夹层动脉瘤治疗仍然棘手,需要进一步研究。Objective To evaluate the safety and effect of endovascular interventional therapyin treating dissecting aneurysmsof basilar artery. Methods A total of 26 patients with dissecting aneurysm of basilar artery, who were treated with endovascular interventional therapy at authors＇ hospital during the period from January 2009 to April 2015, were enrolled in this study. According to the size of the aneurysm, the patients were divided into big-huge group and medium-small group. The therapeutic results were compared between the two groups. The complications and follow-up findings were recorded. Results Successful revascularization was achieved in all the 26 patients with dissecting aneurysm of basilar artery. Of the 26 patients, simple stent implantation was used in 9 and stent implantation together with spring coil embolization was adopted in 17. During the perioperative period, complications occurred in 5 patients, among them posterior circulation infarction was seen in 3 patients （one patient in the simple stent implantation group and two patients in the stent implantation plus spring coil embolization group ） and cerebellar hemorrhage was observed in 2 patients （both patients in the stent implantation plus spring coil embolization group）. Among the 5 patients, four patients were well recovered at the time of discharge, and one patient died due to acute thrombosis in the stent. Follow-up DSA examination was performed in 22 patients, which showed that the clinical condition was improved in 12 patients, stable disease was obtained in 7 patients, and recurrence of dissecting aneurysm was observed in 3 patients （2 patients developed new symptoms）. Subgroup analysis indicated that the incidence of complication in the simple stent implantation group was lower than that in the stent implantation plus spring coil embolization group, but the long-term effect were approximately the same in the two groups. The incidence of complication and the severe disability rate in the big-huge group were higher than those in t

关 键 词：基底动脉夹层 动脉瘤 支架 血管内介入治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]