椎-基底动脉大型夹层动脉瘤的血管内治疗  

Endovascular treatment of vertebrobasilar large dissecting aneurysms

作　　者：王杰军 张义森[1] 吕明[1] 杨新健[1] 田忠彬 陈希恒 刘凯 Wang Jiejun;Zhang Yisen;Lyu Ming;Yang Xinjian;Tian Zhongbin;Chen Xiheng;Liu Kai(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100050,China)

机构地区：[1]北京市神经外科研究所首都医科大学,100050

出　　处：《中华神经外科杂志》2018年第8期767-772,共6页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划（2016YFC1300802）

摘　　要：目的 总结血管内治疗椎-基底动脉大型夹层动脉瘤（VBLDAs）的临床效果,评估血管内治疗对VBLDAs的有效性.方法 回顾性分析2010年1月至2016年5月首都医科大学附属北京天坛医院神经介入科收治的41例VBLDAs患者（共44个动脉瘤）的临床资料.41例VBLDAs患者中,行单纯支架置入术18例（43.9％）,支架辅助弹簧圈栓塞18例（43.9％）,载瘤动脉闭塞5例（12.2％）.以改良Rankin量表评分（mRS）评估患者的预后.结果 术后即刻造影结果显示,完全栓塞9例（22.0％）,次全栓塞24例（58.5％）,部分栓塞8例（19.5％）.术中无一例出现并发症,术后4例出现并发症.41例患者术后临床随访3～60个月,平均（12.4±11.3）个月.mRS评分0～1分30例（73.2％）,2～4分6例（14.6％）,5～6分5例（12.2％）,较术前未见改善.随访期间,复发4例（9.8％）,未复发32例（78.0％）,死亡5例（12.2％）.结论 血管内治疗对于VBLDAs的治疗效果并不理想,且VBLDAs的复发率和病死率较高.Objectives To summarize the clinical outcomes of endovascular treatment of vertebrobasilar large dissecting aneurysms （VBLDAs） and to evaluate the effectiveness of endovascular treatment for VBLDAs.Methods The clinical data,therapeutic effects and follow-up results of 44 VBLDAs in 41 patients admitted to Department of Neurological Intervention,Beijing Tiantan Hospital,Capital Medical University from January 2010 to May 2016 were analyzed retrospectively to investigate the efficacy of endovascular treatment for VBLDAs.Among 41 VBLDAs patients undergoing endovascular treatment,18 （43.9％） were treated with stent alone,18 （43.9％） with stent-assisted coil embolization and 5 （12.2％） with parent artery occlusion.Patients outcome was evaluated by modified Rank Scale （mRS）.Results Immediate post-operative angiography showed complete occlusion in 9 （22.0％） cases,nearly complete occlusion in 24 （58.5％） and partial occlusion in 8 （19.5％） cases.None of the 41 patients had any complications during the procedures.Four patients had complications post surgery.The follow-up period is 3-60 months （mean：12.4 ± 11.3 months）.The mRS was 0-1 in 30 case,2-4 in 6 cases,5-6 in 5 cases.Postoperative follow-up revealed deaths in 5 （12.2％） patients,recurrence in 4 （9.8％） and no recurrence in 32 （78.0％）.Conclusion The therapeutic effect of endovascular treatment of VBLDAs does not seem to be satisfactory and the recurrence and mortality rates of VBLDAs patients are relatively high.

关 键 词：颅内动脉瘤 动脉瘤 夹层 椎-基底动脉 血管内治疗 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]