支架辅助技术在出血性椎动脉夹层动脉瘤治疗中的应用  

Stent-assisted technique for the management of subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm

作　　者：张庆荣[1] 张鑫[1] 吴琪[1] 文立利[1] 张翔圣[1] 薛锦[1] 陈姝娟[1] 邓金龙[1] 王汉东[1] 

机构地区：[1]南京军区南京总医院神经外科,南京医学博士210002

出　　处：《医学研究生学报》2018年第3期249-253,共5页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81471183);江苏省"科教强卫工程"重点人才培养项目(ZDRCA2016094)

摘　　要：目的支架辅助弹簧圈栓塞治疗出血性椎动脉夹层动脉瘤的应用普遍,但远期效果尚未明确。文中总结该技术围手术期并发症及远期临床疗效。方法回顾性分析19例经CT及CT血管造影检查明确蛛网膜下腔出血和椎动脉夹层动脉瘤患者。所有患者入院24 h内完成全脑血管造影检查和动脉瘤介入治疗。19例患者中2例诊断为双侧椎动脉夹层动脉瘤,其中1例闭塞出血侧动脉瘤及载瘤动脉,2枚支架辅助栓塞对侧夹层动脉瘤;另1例两侧均采取双支架辅助栓塞动脉瘤。4例患者采用单支架辅助栓塞治疗动脉瘤。其余13例患者中,2例患者采取双Lvis支架辅助栓塞,11例患者采取双Enterprise支架辅助栓塞治疗。结果 19例患者均成功完成手术治疗。3例在术后半个月内死亡,其中2例明确为再出血、1例死因不明。1例术前Hunt-Hess分级Ⅴ级,术后有较严重认知功能障碍。其余15例患者恢复顺利,未出现明显神经功能障碍。所有存活病例均临床随访6~36个月,未见明显新发神经系统并发症。患者在术后6个月~3年内行脑血管造影随访,复发2例,其中1例接受再次治疗后复查良好,1例继续随访,复发部位稳定。1例支架内狭窄、2例椎动脉闭塞。结论支架辅助栓塞是出血性椎动脉夹层动脉瘤一种安全有效的治疗方法,双支架辅助在预防动脉瘤复发中有更好的疗效。Objective The stent-assisted technique is widely applied in the treatment of subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm（VADA）.This study investigated the perioperative complications and long-term clinical effect of stent-assisted coiling in the management of VADA-induced subarachnoid hemorrhage.Methods The clinical data on 19 cases of VADA-induced subarachnoid hemorrhage were analyzed retrospectively.All the patients underwent digital subtraction angiography（DSA） and stent-assisted coiling within 24 hours after admission.Two of the patients were diagnosed with bilateral VADA and treated with double stents,4 with a single stent,2 with the low-profile visualized intraluminal support device（LVIS）,and 11 with double Enterprise stents.Results Operations were successfully performed in all the cases.Three of the patients died within 2 weeks after surgery,2 from post-operative rebleeding and the other 1 from some unknown cause; 1 patient developed severe postoperative cognitive dysfunction,while the other 15 were well recovered.The survived patients were followed up for 6 to 36 months,during which no obvious new neurological deficits were observed.Follow-up DSA revealed 2 cases of recurrence,1 case of stenosis in the stent,and 2 cases of vertebral artery occlusion.Conclusion Stent-assisted coiling is a safe and effective method for the management of VADA-induced subarachnoid hemorrhage,and double-stent implantation may achieve an even better effect.

关 键 词：颅内动脉瘤 椎动脉夹层动脉瘤 蛛网膜下腔出血 介入治疗 支架 

分 类 号：R739.41[医药卫生—肿瘤]