血管内技术治疗椎基底动脉夹层动脉瘤术后复发因素分析  

Incidence and risk factors of recurrence after endovascular treatment of vertebrobasilar dissecting aneurysms Zang Yizheng

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》2017年第21期1655-1658,共4页National Medical Journal of China

摘　　要：目的 评估椎基底动脉夹层动脉瘤（VBDA）血管内治疗术后的复发率，探讨复发的原因。方法 山东大学第二医院神经外科自2007年1月至2015年12月采用血管内技术治疗VBDA 45例，长期随访40例，其中男25例，女15例，年龄25-73岁，平均50.9岁，根据动脉瘤是否复发分为复发组（10例）和未复发组（30例），对相关因素进行统计分析。结果 长期造影随访显示10例动脉瘤术后复发，复发率为25.0%（10/40），复发病例全部发生在重建性手术组。支架辅助微弹簧圈栓塞术后6例瘤体复发，3例瘤颈复发，其中完全栓塞的7例复发，未完全栓塞的2例复发，7例单纯支架置入术1例（单层支架）复发，破坏性手术组无复发。重建性手术较破坏性手术复发率高（33.3%比0.0），差异有统计学意义（P〈0.05）。结论 血管内技术治疗VBDA术后复发率较高，重建性手术方式是动脉瘤复发的独立危险因素，需长期随访。Objective To evaluate the incidence and risk factors of recurrence after endovascular treatment of vertebrobasilar dissecting aneurysms （VBDAs）. Methods Retrospective analysis was used for the clinical information of 40 cases of vertebrobasilar dissecting aneurysms treated with endovascular methods in our department between January 2007 and December 2015. According to whether recurrence occurred, the patients were divided into recurrence group （10 patients） and non-recurrence group （30 patients）. The data of the patients＇ age, sex, hypertension history, smoking history, aneurismal size, presenting symptoms, degree of embolization, GCS scores, aneurismal localization and treatment methods were analyzed to evaluate the risk factors for recurrence after endovascular treatment. Results There were 40 patients performed long- term angiographic follow-up. The recurrence rate after endovascular treatment was 25.0% （ 10/40 ） in the present study, and they all occurred in reconstructive group. Among the patients who underwent stent-assisted coil embolization, recurrence in aneurismal body occurred in 6 patients, and recurrence in aneurismal neck 3 cases. In these cases, 7 recurrences occurred with complete embolization, and 2 recurrences occurred with partial embolization. Recurrence occurred in 1 case that underwent single stent placement. The incidence of recurrence in reconstructive group was higher than that in destructive group （33.3% vs 0.0） with significant difference. Conclusions The recurrence rate was high in VBDAs treated with endovascular methods. The only independent risk factor for recurrence was reconstructive methods and that suggests the necessity of long- term angiographic follow-up.

关 键 词：夹层动脉瘤 椎基底动脉 血管内治疗 复发 

分 类 号：R651.12[医药卫生—外科学]