血管内治疗椎动脉V4段梭型动脉瘤的疗效分析  

Efficacy of endovascular treatment in fusiform aneurysms at V4 segment of vertebral artery

作　　者：鲍娟[1] 曹毅[1] 杨勇涛[1] 景睿[1] 李云飞[1] 胡佳怡 赵青[1] 陈飞雄[1] Bao Juan;Cao Yi;Yang Yongtao;Jing Rui;Li Yunfei;Hu Jiayi;Zhao Qing;Chen Feixiong(Department of Cerebrovascular Diseases,Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院脑血管病科,昆明650101

出　　处：《中华神经医学杂志》2023年第1期37-42,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨血管内治疗椎动脉V4段梭型动脉瘤的有效性及安全性。方法回顾性分析昆明医科大学第二附属医院脑血管病科自2016年5月至2022年1月经血管内治疗的25例椎动脉V4段梭型动脉瘤患者资料。评估患者术后短期(1个月内)及远期(>8个月)并发症发生情况,包括动脉瘤再出血、缺血性脑卒中等。所有患者随访3~21个月,复查DSA评估动脉瘤复发情况及载瘤动脉情况,以末次随访时改良Rankin量表(mRS)评分评价患者预后,mRS评分0~2分为预后良好。结果25例患者共26个动脉瘤,其中破裂动脉瘤13个,未破裂动脉瘤13个。7个动脉瘤位于优势椎动脉,7个动脉瘤累及小脑后下动脉(PICA)。13个破裂动脉瘤中6个采用弹簧圈闭塞动脉瘤及病变段血管,7个采取支架辅助弹簧圈栓塞。13个未破裂动脉瘤中9个采用支架辅助栓塞,4个采用Tubridge血流导向装置植入术。16个支架辅助栓塞动脉瘤中7个采用了双支架叠加辅助技术。所有患者术后短期及远期均未出现出血、缺血性脑卒中等并发症。20例患者完成DSA随访,中位随访时间8个月,3例动脉瘤复发,1例出现无症状性支架内血管闭塞。25例患者均于2022年5月完成末次随访(电话或门诊随访),其中24例患者预后良好。结论根据椎动脉优势、动脉瘤与PICA关系等特点,采取个体化的血管内治疗方式治疗椎动脉V4段梭型动脉瘤安全有效。Objective To analyze the safety and efficacy of endovascular treatment in fusiform aneurysms at V4 segment of vertebral artery.Methods Twenty-five patients with fusiform aneurysms at V4 segment of vertebral artery,accepted endovascular treatment in Department of Cerebrovascular Diseases,Second Affiliated Hospital of Kunming Medical University from May 2016 to January 2022 were chosen;their clinical data were retrospectively analyzed.The short-term(within one month of surgery)and long-term(>8 months of surgery)complications were evaluated,including aneurysm re-bleeding and ischemic stroke.All patients were followed up for 3-21 months;aneurysm recurrence and parent arteries were evaluated by DSA.The prognosis of patients was evaluated by modified Rankin scale(mRS)at the last follow-up(mRS scores of 0-2 as good prognosis).Results Twenty-six aneurysms involved in 25 patients,including 13 ruptured aneurysms and 13 un-ruptured aneurysms;7 aneurysms were located at the dominant vertebral artery and 7 aneurysms involved in the origin of posterior inferior cerebellar artery(PICA).In these 13 ruptured aneurysms,6(46.15%)were treated with parent artery sacrifice and 7(53.85%)were with stent-assisted coil embolization;in 13 un-ruptured aneurysms,9(69.23%)were treated with stent-assisted coil embolization and 4(30.77%)were with flow diversion devices(Tubridge).Seven aneurysms(43.75%)used multi-stent in these 16 aneurysms accepted stent-assisted coil embolization.No short-term and long-term re-bleeding or ischemic stroke were noted in all patients.Twenty patients completed DSA follow-up,with a median follow-up time of 8 months;3 patients had recurrent aneurysms and one had asymptomatic stent occlusion.All 25 patients completed the last follow-up(telephone or outpatient follow-up)in May 2022,and 24 had good prognosis.Conclusion According to characteristics of dominant vertebral artery and relations between aneurysms and PICA,individualized endovascular treatment can be safe and effective in fusiform aneurysms at V4 segment of v

关 键 词：椎动脉V4段 梭型动脉瘤 血管内治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]