单支架辅助栓塞治疗老年患者症状性后循环梭形动脉瘤效果分析  

Efficacy of single stent-assisted embolization in treatment of symptomatic posterior circulation fusiform aneurysms in the elderly

作　　者：崔鹏[1] 许友松[1] 张武豪 尚玮 Cui Peng;Xu Yousong;Zhang Wuhao;Shang Wei(Department of Neurosurgery,the First Affiliated Hospital of Dalian Medical University,Dalian 116000,Liaoning Province,China)

机构地区：[1]大连医科大学附属第一医院神经外科,116000

出　　处：《中华老年心脑血管病杂志》2022年第9期965-969,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 探讨单支架辅助栓塞治疗老年症状性后循环梭形动脉瘤(PCFA)的效果,并探讨手术安全性和预后影响因素。方法 选择2015年1月~2020年1月大连医科大学附属第一医院神经外科收治的行血管内介入治疗的老年症状性PCFA患者37例,术后随访12个月,回顾性分析临床和影像资料,根据围术期并发症发生情况分为并发症6例,无并发症31例。术后12个月根据改良的Rankin量表评分分为预后良好30例,预后不良7例。对围术期并发症发生风险和预后不良风险进行单因素分析。结果 37例PCFA患者中,临床表现为蛛网膜下腔出血16例(43.2%),后循环缺血及脑梗死12例(32.4%),因头痛入院5例(13.5%),占位效应引起神经功能缺损4例(10.8%)。造影显示动脉瘤位于椎动脉14例(37.8%),基底动脉9例(24.3%),小脑后下动脉7例(18.9%),大脑后动脉5例(13.5%),椎基底动脉交界处2例(5.4%)。术后即刻造影显示,动脉瘤获得完全栓塞15例(40.5%),出院时患者自觉症状明显缓解并改善26例(70.3%),围术期并发症6例。并发症患者动脉瘤长径较无并发症患者更长,横径/长径比值较无并发症患者更低(P<0.05)。术后12个月随访时,预后不良患者动脉瘤位于基底动脉-椎基底动脉交界处比例较预后良好患者更高(71.4%vs 20.0%,P<0.05)。结论 采用单支架辅助栓塞技术治疗老年症状性PCFA效果可靠,动脉瘤位于基底动脉-椎基底动脉交界处与预后不良相关。Objective To explore the efficacy of single stent-assisted embolization in the treatment of symptomatic posterior circulating fusiform aneurysms(PCFA) in the elderly patients, and to investigate the safety and prognostic factors of the surgery.Methods A total of 37 elderly symptomatic PCFA patients who underwent endovascular interventional therapy in our department from January 2015 to January 2020 were enrolled in this study.They were all followed up for 12 months, and their clinical and imaging data were collected and retrospectively analyzed.According to the occurrence of perioperative complications, they were divided into complication group(n=6) and non-complication group(n=31).At the last follow-up, modified Rankin Scale was used to assess their prognosis, and 30 cases obtained good prognosis and 7 poor prognosis.Univariate analysis was performed to analyze the risk for perioperative complications and the risk of poor prognosis.Results Among the 37 PCFA patients, 16 cases(43.2%) had subarachnoid hemorrhage, 12 cases(32.4%) experienced posterior circulation ischemia and cerebral infarction, 5 cases(13.5%) were admitted to hospital because of headache, and 4 cases(10.8%) developed functional impairment induced by space-occupying lesions.Angiography displayed that the aneurysms were located in the vertebral artery in 14 cases(37.8%),basilar artery in 9 cases(24.3%),posterior inferior cerebellar artery in 7 cases(18.9%),posterior cerebral artery in 5 cases(13.5%),and vertebrobasilar junction in 2 cases(5.4%).Immediate postoperative angiography showed that the aneurysms were completely embolized in 15 cases(40.5%).At discharge, the subjective symptoms of the patients were significantly relieved and improved in 26 cases(70.3%).There were 6 cases experiencing perioperative complications.The patients with complications had significantly longer length of aneurysm, and lower ratio of transverse to length diameter(P<0.05) than those without.At 12-months of follow-up, the proportion of aneurysms located in the vertebrob

关 键 词：支架 颅内动脉瘤 蛛网膜下腔出血 栓塞 治疗性 

分 类 号：R651.12[医药卫生—外科学]