血管内介入治疗颅内动脉瘤合并缺血性脑血管疾病的临床研究  

Clinical Study of Intravascular Intervention for Intracranial Aneurysm Complicated with Ischemic Cerebrovascular Disease

作　　者：杨帆[1] 徐睿[1] 李佳兵 彭世鑫 仇玉龙 黄志坚[1] 朱继[1] 张晓冬[1] YANG Fan;XU Rui;LI Jia-bing;PENG Shi-xin;QIU Yu-long;HUANG Zhi-jian;ZHU Ji;ZHANG Xiao-dong(Department of Neurosurgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing,400010,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400010

出　　处：《现代生物医学进展》2023年第9期1747-1754,共8页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(82102316)。

摘　　要：目的:探讨血管内介入治疗颅内动脉瘤(IA)合并缺血性脑血管疾病的安全性和有效性。方法:回顾性分析了2018年1月至2020年12月使用血管内介入治疗IA合并缺血性脑血管疾病的32例临床资料。结果:32例中共发现了35枚IA,37处狭窄。IA平均大小为(5.17±3.12)mm,其中位于颈内动脉有26枚(74%),位于椎基底动脉有9枚(26%),7例(22%)患者术前检查发现存在两枚IA。37处狭窄中,位于椎基底动脉有9处(24%),位于颅外段有8处(22%),其余20处狭窄(54%)均位于颈内动脉,术前平均狭窄率为75.7%。所有病例手术过程顺利,术后IA中达到完全栓塞有31枚(89%),4枚残留颈部(11%)。37处狭窄中,术后平均狭窄率为8.8%,所有患者术后造影脑血管远端均通畅。治疗期间1例支架内再狭窄,1例脑血管痉挛,出院时所有病例改良Rankin评分量表(m RS)均小于2分。32位患者均得到术后全脑血管造影(DSA)随访,随访时间为6到18个月(平均为8.8个月),随访期间1例出现支架内再狭窄。结论:血管内介入治疗IA合并缺血性脑血管疾病是安全有效的,值得临床借鉴应用。Objective:To investigate the safety and effectiveness of endovascular intervention in the treatment of intracranial aneurysm(IA)complicated with ischemic cerebrovascular disease.Methods:The clinical data of 32 patients with IA complicated with ischemic cerebrovascular disease treated by endovascular intervention from January 2018 to December 2020 were retrospectively analyzed.Results:A total of 35 IA and 37 stenoses were found in 32 patients.The average size of IA was(5.17±3.12)mm.Among them,26 aneurysms(74%)were located in the internal carotid artery,9 aneurysms(26%)were located in the vertebrobasilar artery,and 7 patients(22%)were found to have two intracranial aneurysms before operation.Among 37 stenosis,9(24%)were located in the vertebrobasilar artery,8(22%)were located in the extracranial segment,and the remaining 20(54%)were located in the internal carotid artery.The average stenosis rate was 75.7%before operation.31 aneurysms(89%)were completely occluded and 4 aneurysms(11%)remained in the neck.Among 37 stenoses,the average stenosis rate after operation was 8.8%,and the distal cerebral vessels of all patients were unobstructed after operation.During the treatment,there was 1 case of in-stent restenosis and 1 case of cerebral vasospasm.The modified Rankin scale(mRS)was less than 2 in all patients at discharge.All the 32 patients were followed up by digital subtract angiography(DSA)for 6 to 18 months(average 8.8 months).During the follow-up,1 case had in-stent restenosis.Conclusions:Endovascular intervention is safe and effective in the treatment of IA complicated with ischemic cerebrovascular diseases,which is worthy ofclinical reference.

关 键 词：缺血性脑血管疾病 颅内外血管狭窄 颅内动脉瘤 血管内介入治疗 

分 类 号：R743[医药卫生—神经病学与精神病学] R739.4[医药卫生—临床医学]