累及小脑后下动脉的椎动脉夹层动脉瘤(Ⅱ型)治疗方法选择和疗效分析(单中心70例分析)  

Treatment Options and Efficacy Analysis of Vertebral Artery Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery(Type Ⅱ):A Single Center's Experience of 70 Cases

作　　者：亚生江.麦麦提 陈功[1] 刘盈君[1] 郑永涛[1] 李京润 雷宇[1] 江汉强[1] 倪伟[1] 廖煜君[1] 安庆祝[1] 高超[1] 徐锋[1] 田彦龙[1] 徐斌[1] 顾宇翔[1] 冷冰[1] 

机构地区：[1]复旦大学附属华山医院神经外科,200040

出　　处：《中国临床神经科学》2017年第2期157-164,182,共9页Chinese Journal of Clinical Neurosciences

基　　金：国家重点研发计划资助课题(编号:2016YFC0901003)

摘　　要：目的探讨累及小脑后下动脉椎动脉夹层动脉瘤(VADA)Ⅱ型的治疗方法和各种介入治疗的疗效。方法收集70例VADAⅡ型病例,根据临床症状分为对照组(药物随访,12例)和介入治疗组(58例)。介入治疗组依据治疗方法分为闭塞组(14例)和血管重建组(44例)。血管重建组再根据支架方向的不同分为血管重建(单纯支架)A亚组、血管重建(支架方向VA-VA)B亚组和血管重建(支架方向VA-PICA)C亚组。回顾性分析和比较各组VADAⅡ型患者的临床资料、术后疗效和随访(平均2年)结果,结合复习文献资料进行探讨。结果 2年随访结果:对照组、闭塞组、血管重建A亚组和血管重建B亚组+C亚组的治愈率+改善率分别为18.2%、69.2%(9/13例)、47.1%(8/17例)和80.0%(16/20例);并发症发生率分别为18.2%(2/11例)、15.4%(2/13例)、11.8%(2/17例)和5.0%(1/20例)。血管重建组的单支架、双/多支架和密网支架治愈率+改善率分别为57.1%(12/21例)、69.2%(9/13例)和100%(3/3例);并发症发生率分别为9.5%(2/21例)、7.7%(1/13例)和0。结论 VADAⅡ型介入治疗的疗效较药物随访好;支架辅助动脉瘤栓塞的疗效较闭塞和单纯支架治疗好,但并发症发生率差异无显著性;不同数量和类型的支架,其疗效及并发症是否有差异需进一步研究。Aim To study the treatment methods for PICA-involving （type II） vertebral artery dissecting aneurysm （VADA） and compare the efficacy of different endovascular procedures. Methods Between 2013 and 2015, 70 patients with type II VADA were treated at the authors＇ institution. According to clinical symptoms, 12 patients were received conservative drug treatment [drug follow-up （control） group] and 58 patients were treated with endovascular methods （intervention group）, which were further divided into a vocclusion sub-group （14 patients） and a vascular reconstructive sub-group （44 patients）. Results The cure and improvement rate of different treatment methods were 18.2% （conservative treatment）, 69.2% （occlusion）, 47.2% （stent） and 80% （stent-assisted embolization） after a a-year follow-up. Recurrence rate was 18.2%, 15.4%, 11.8% and 5.0% in the four groups, respectively. Among the different numbers and types of stent methods, the cure and improvement rate were 57.1% （single-stent）, 69.2% （dual/ multi-stent） and 100% （flow-diverting stent）. Recurrence rate was 9.5%, 7.7% and zero in the three groups, respectively. Conclusion Endovascular treatment group had better outcome compared with conservative drug treatment group. And stent-assisted aneurysm embolization had a more favorable result compared with stent implantation. Further study with larger case series is necessary to validate whether different stent approaches have difference on efficacy and complications.

关 键 词：椎动脉 夹层动脉瘤 小脑后下动脉 介入治疗 疗效 

分 类 号：R815[医药卫生—放射医学] R543.5[医药卫生—临床医学]