血管内技术治疗椎基底动脉夹层动脉瘤的疗效分析  

Clinical analysis of endovascular strategies in the treatment of vertebrobasilar dissecting aneurysms

作　　者：臧贻征[1] 王志刚[2] 王成伟[1] 张媛[1] 丁璇[1] 王小飞[1] 

机构地区：[1]山东大学第二医院神经外科,济南250033 [2]山东大学齐鲁医院青岛院区神经外科

出　　处：《中华医学杂志》2016年第41期3329-3332,共4页National Medical Journal of China

基　　金：山东大学第二医院青年基金（Y2013010052）

摘　　要：目的评价血管内技术治疗椎基底动脉夹层动脉瘤（VBDA）的有效性和安全性，分析不同血管内技术治疗VBDA的疗效差异。方法回顾性分析山东大学第二医院神经外科2007年1月至2015年12月采用血管内技术治疗45例VBDA患者的临床资料。根据是否保持载瘤动脉通畅，治疗方法分为重建性手术和破坏性手术。重建性手术包括支架辅助微弹簧圈栓塞术（24例）和单纯支架置入术（8例），破坏性手术采取动脉瘤＋载瘤动脉近端栓塞术（13例）。结果围手术期并发症发生率和死亡率分别为11．1％（5／45）和4．4％（2／45），其中重建性手术1例发生术中动脉瘤破裂出血、死亡，1例术中载瘤动脉内血栓形成，溶栓后无神经功能障碍，上述并发症均发生在支架辅助微弹簧圈栓塞术，单纯支架置入术无并发症发生；破坏性手术3例术后发生脑缺血，1例死亡，2例重度残疾。长期随访改良Rankin量表（mRS）评分：0～2分41例，3—6分4例。重建性手术组较破坏性手术组预后好（96．9％比76．9％），差异有统计学意义（P〈0．05）；并发症发生率低（6．2％比23．1％），但差异无统计学意义（P〉0．05）。结论血管内技术治疗VBDA安全、有效，重建性手术较破坏性手术并发症发生率低，预后较好。Objective To evaluate the efficacy and safety of endovascular strategies for vertebrobasilar dissecting aneurysm （VBDA） and analyze advantages and disadvantages of different endovascular methods for the treatment of VBDA through long-term follow-up. Methods Retrospectively analyzing was used for the clinical information of 45 cases of vertebrobasilar dissecting aneurysms treated with endovascular methods in our department from January 2007 to December 2015. The treatment modalities were classified into reconstructive surgery and destructive surgery that were based on parent artery preservation. Reconstructive surgery included stent-assisted coil embolization （24 patients ） and the placement of single or muhiple overlapping stents （ 8 patients）. Destructive surgery was coil embolization combined with proximal coil trapping of the dissected segment of the parent artery （CE ＋ PT, 13 patients）. Results The incidence of perioperative complications was 11.4%, and the mortality associated with these complications was 4.4%. In the patients undergoing reconstructive surgery, one patient suffered from aneurysm rerupture and died, one patient had intraoperative thrombi in the parent artery and resulted in a complete pateney after thrombolysis was performed with Tirofiban. Both perioperative complications occurred in patients treated with stent-assisted coil embolization. No complications occurred in patients treated with single or multiple overlapping stents placements. Perioperative brainstem ischemia occurred in three patients who were treated with destructive surgery, and caused one death and two severe disabilities. Clinical outcome evaluations were performed using the Modified Rankin Scale and resuhed in the following scores： 0 - 2 for 41 patients, 3 - 6 for 4 patients. The prognosis of reconstructive group was better than that of destructive group, with statistical differences （ P 〈 0.05 ）. The incidence of perioperative complications in reconstructive group was lower than that in destructive

关 键 词：夹层动脉瘤 椎基底动脉 血管内治疗 栓塞 

分 类 号：R651.12[医药卫生—外科学]