破裂小脑后下动脉瘤的血管内治疗效果分析  

Efficacy analysis of endovascular treatment for ruptured posterior inferior cerebellar artery aneurysm

作　　者：赵心同[1] 张子焕 刘佳强[1] 秦飞云 方兴根[1] 李真保[1] Zhao Xintong;Zhang Zihuan;Liu Jiaqiang;Qin Feiyun;Fang Xinggen;Li Zhenbao(Department of Neurosurgery,Yijishan Hospital of Wannan Medical College,Wuhu,Anhui 241001,China)

机构地区：[1]皖南医学院弋矶山医院神经外科,安徽省芜湖市241001

出　　处：《中国脑血管病杂志》2021年第4期234-239,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的评价血管内介入治疗破裂小脑后下动脉瘤的安全性和有效性。方法回顾性连续纳入2012年6月至2019年10月在皖南医学院弋矶山医院神经外科血管内治疗的39例破裂小脑后下动脉瘤患者,分析其临床及影像学资料。应用Raymond-Roy分级(R-R分级)评价即刻栓塞程度(Ⅰ级为动脉瘤完全栓塞,Ⅱ级为瘤颈残留,Ⅲ级为动脉瘤瘤体显影),记录患者围手术期并发症,术后采用DSA进行影像学随访,出院时及随访期间采用格拉斯哥预后量表(GOS)评分评估患者临床预后(GOS评分4~5分为预后良好,1~3分为预后较差)。结果16例小脑后下动脉远端动脉瘤和1例近端动脉瘤行载瘤动脉闭塞术,3例远端动脉瘤和11例近端动脉瘤行单纯弹簧圈栓塞术,6例近端动脉瘤行支架辅助弹簧圈栓塞术,2例近端动脉瘤行单纯支架置入术。17例行载瘤动脉闭塞的患者术后即刻造影显示动脉瘤及血管闭塞成功,其余22例患者术后即刻造影显示R-RⅠ级栓塞12例(54.5%),R-RⅡ级栓塞6例(27.3%),R-RⅢ级栓塞4例(18.2%)。围手术期病死率为10.3%(4/39),均发生于入院Hunt-Hess分级Ⅳ~Ⅴ级的患者(8例)中。出院时预后良好率为76.9%(30/39)。除4例患者出院前死亡,3例患者失访外,32例患者经过2~49个月(中位数6个月)的临床随访,随访期间无再出血发生,30例(93.8%)随访时预后良好。载瘤动脉闭塞术及单纯弹簧圈栓塞术后复发占比分别为2/11、3/9,支架辅助弹簧圈栓塞治疗的患者均无复发。结论血管介入治疗是治疗小脑后下动脉瘤安全、有效的方法,治疗策略的制定应根据动脉瘤的位置、载瘤动脉的走向而定,术后应定期行血管造影随访。Objective To evaluate the safety and effectiveness of endovascular approach for ruptured posterior inferior cerebellar artery(PICA)aneurysm.Methods From June 2012 to October 2019,39 consecutive patients with ruptured PICA aneurysms and treated by endovascular approach in the Department of Neurosurgery,Yijishan Hospital of Wanan Medical College were recruited.Clinical and radiological records were collected retrospectively.Clinical and radiological outcomes were followed up and analyzed.Raymond-Roy(R-R)occlusion classification was used to evaluate the immediate angiographic outcome.R-R grading evaluation immediately after embolization degree(ClassⅠ:complete obliteration;ClassⅡ:residual neck;ClassⅢ:residual aneurysm).Perioperative complications of the patients were recorded.Postoperative imaging follow-up was performed by DSA,and clinical prognosis was evaluated by Glasgow outcome scale(GOS)score at discharge and during follow-up(GOS score 4-5 for good prognosis and 1-3 for poor prognosis).Results Parent artery occlusion was performed in 16 distal PICA aneurysms and 1 proximal PICA aneurysm.Coiling alone was performed in 3 distal aneurysms and 11 proximal aneurysms.Stent-assisted coiling was performed in 6 proximal aneurysms.Simple stent implantation was performed in 2 proximal aneurysms The immediate angiographic outcomes in patients treated with parent artery occlusion showed those aneurysms and parent artery were occluded completely.Among the remaining 22 patients,R-RⅠwas achieved in 12 procedures(54.5%),R-RⅡin 6 procedures(27.3%)and R-RⅢin 4 procedures(18.2%).The rate of perioperative mortality was 10.3%(4/39),and all occurred in patients with Hunt-HessⅣ-Ⅴ(8 cases).The rate of good outcome at discharge was 76.9%(30/39).Except 4 deaths before discharge and 3 cases lost to follow-up,32 patients were followed up for 2 to 49 months(median 6 months).No recurrent bleeding occurred during follow-up,and 30 cases(93.8%)had good prognosis.The recurrence rate by parent artery occlusion and coil embolizatio

关 键 词：小脑后下动脉瘤 血管内治疗 支架辅助弹簧圈栓塞 载瘤动脉闭塞 

分 类 号：R743.4[医药卫生—神经病学与精神病学]