支架辅助栓塞治疗颈内动脉背侧血泡样动脉瘤（附九例报告）  

Endovascular treatment with stent assisted coiling of BBAs arising from the dorsal wall of internal carotid artery

作　　者：杨洪宽 赵亚军 陈如东 厉华 于加省 雷霆[1] Yang Hongkuan, Zhao Yajun, Chen Rudong, Li Hua, Yu Jiasheng, Lei Ting(Department of Neurosurgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Chin)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2018年第3期273-276,共4页Chinese Journal of Neurosurgery

基　　金：湖北省自然科学基金项目（2014CFB151）;武汉市科技局科技攻关计划重点基金资助项目（200960323130）

摘　　要：目的探讨支架辅助弹簧圈栓塞颈内动脉背侧血泡样动脉瘤的疗效。方法回顾性纳入华中科技大学同济医学院附属同济医院神经外科2011年1月至2014年12月收治的9例颈内动脉背侧血泡样动脉瘤患者，对所有患者采用支架辅助弹簧圈栓塞治疗，填塞满意后即刻行CT血管成像（CTA）观察动脉瘤的栓塞情况，出院时行改良Rankin量表评分（mRS）评估预后。出院后3个月、6个月、1年和2年对所有患者行门诊随访，随访内容为数字减影血管造影（DSA）检查，观察动脉瘤有无复发。结果9例患者中，1例行双支架套叠结合弹簧圈栓塞，8例行单支架辅助弹簧圈栓塞动脉瘤。术后即刻CTA显示，7例患者动脉瘤完全栓塞，2例瘤颈少量残余。1例患者术后5h再出血，治疗后呈植物生存状态，未接受随访。出院时mRS为，5例0分，2例1分，1例2分，1例5分。8例患者的随访时间为3～38个月，平均13．6个月。2例瘤颈少量残余的患者均复发，1例行单纯支架辅助栓塞，另1例再次置入编织支架1枚，术后均恢复良好。其余6例患者均无复发。结论支架辅助弹簧圈栓塞治疗颈内动脉背侧血泡样动脉瘤是一种可行且有效的治疗方法。Objective To analyze and evaluate the effect of interventional treatment with stent assisted coiling of BBAs （blood blister-like aneurysms） arising from the dorsal wall of internal carotid artery （ICA）. Methods We retrospectively analyzed the clinical data of 9 patients with BBAs protruding from the dorsal wall of ICA who underwent stent assisted coiling at Neurosurgery Department of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2011 to December 2014. CTA was performed immediately after completion of endovascnlar procedure and modified Rankin scale （mRS） was used for outcome assessment at discharge. DSA was performed for recuiTence detection at 3- month, 6-month, 1-year and 2-year follow-up. Results Among all 9 cases, 1 case underwent double overlapping stent-assisted coiling and single stent-assisted coiling was performed in 8 cases. CTA immediately after operation demonstrated complete occlusion in 7 cases and little residual aneurysm in the other 2 cases. Follow-up was conducted for all except 1 patient who developed rebleeding at 5 hours post operation and was subsequently in persistent vegetative state. The mRS score at discharge was 0 in 5 cases, 1 in 2 cases, 2 in 1 case and 5 in 1 case. Eight patients were followed up for a period of 3 to 38 months with an average of 13.6 months. Recurrence was found in 2 cases with little residual flow in the aneurysm neck including 1 undergoing second stent-assisted coiling and 1 receiving placement of weaved stent, and both recovered well. No recurrence was reported in the other 6 cases. Conclusion Endovascular treatment with stent assisted coiling is feasible and effective for BBAs arising from the dorsal wall of ICA.

关 键 词：动脉瘤 颈内动脉 支架 血管内治疗 治疗结果 

分 类 号：R743[医药卫生—神经病学与精神病学]