血管内治疗椎动脉夹层动脉瘤的疗效分析  

Therapeutic effectiveness of endovascular treatment for vertebral artery dissecting aneurysms

作　　者：潘奕仲 陆登峰 王飞[1] 任宇博 滕海滢 孙晓欧[1] 陈周青 朱巍巍[1] 王中[1] PAN Yizhong;LU Dengfeng;WANG Fei;REN Yubo;TENG Haiying;SUN Xiaoou;CHEN Zhouqing;ZHU Weiwei;WANG Zhong(Department of Neurosurgery&Brain and Nerve Research Laboratory,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科暨脑神经研究室,江苏苏州215006

出　　处：《中华神经外科疾病研究杂志》2024年第3期46-50,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的对椎动脉夹层动脉瘤(VADA)进行血管内治疗的安全性和有效性进行综合分析。方法回顾性纳入2020年1月至2022年12月期间在苏州大学附属第一医院神经外科接受血管内治疗的45例颅内段椎动脉夹层动脉瘤患者,收集一般资料和临床资料,其中一般资料包括年龄、性别和血管危险因素等,临床资料包括动脉瘤的基本特征(动脉瘤的长径、是否位于椎动脉优势侧、与同侧小脑后下动脉的关系)、治疗结果和随访资料等。随访资料包括CT血管成像(CTA)和/或数字减影血管造影(DSA)等影像学资料以及门诊及电话进行的临床预后资料。术后6个月进行脑血管造影术,随后每1-2年进行影像学及临床随访。结果在45例椎动脉夹层动脉瘤患者中,方案包括载瘤动脉闭塞治疗3例、单纯支架置入术2例、支架辅助弹簧圈栓塞治疗28例、密网孔支架置入术12例。2例VADA破裂患者(均累及小脑后下动脉)行支架辅助弹簧圈栓塞治疗,术后1周内因动脉瘤再次破裂而死亡,死亡率为4.4%。42例患者完成了术后6个月的影像学(DSA)随访,随访时间为6-12个月,中位随访时间为7个月。DSA随访结果显示,38例患者动脉瘤治愈(占90.5%),4例改善(9.5%);43例患者完成了术后6个月的临床随访,结果显示43例(100%)患者均预后良好。结论以上数据表明,VADA患者采用血管内治疗方案安全、有效,但该结论还需在更大规模的队列中进一步验证。Objective To comprehensively analyze both safety and effectiveness of endovascular treatment for vertebral artery dissecting aneurysms(VADA).Methods Forty-five patients with vertebral artery dissecting aneurysms of intracranial segments who underwent endovascular treatment at the Department of Neurosurgery of the First Affiliated Hospital of Soochow University between January 2020 and December 2022 were retrospectively included,and their general and clinical data were collected.The general data contained age,gender,and vascular risk factors,whereas the clinical data included basic characteristics of the aneurysm,treatment results,follow-up data,etc.Fundamental features of the aneurysm contained length of the aneurysm,location of the dominant side of vertebral artery and its relationship with the ipsilateral posterior inferior cerebellar artery.Follow-up data included imaging data such as CT angiography(CTA)and/or digital subtraction angiography(DSA),as well as clinical prognostic data collected in the outpatient clinics or by telephones.Cerebral angiography was performed 6 months after surgery,followed by imaging and clinical follow-up every 1 to 2 years.Results Among these 45 patients,3 patients received occlusion of the aneurysm-carrying artery,2 patients only underwent stenting,28 patients received stent-assisted spring coil embolization and the remanent 12 patients underwent stenting with dense-mesh stents.Among those who underwent stent-assisted spring coil embolization 2 patients with ruptured VADA(both involved with the posterior inferior cerebral artery)died from aneurysm re-rupture within 1 week after the surgery,the mortality rate being 4.4%.42 patients underwent a 6-month DSA postoperative imaging follow-up ranging from 6 to 12 months,with the median follow-up time being 7 months.Outcomes of the DSA follow-up demonstrated that 38 patients with aneurysm were cured(90.5%)and the other 4 manifested improvement(9.5%).43 patients underwent a 6-month postoperative clinical follow-up,the results of which show

关 键 词：椎动脉夹层动脉瘤 血管内治疗 支架辅助 血流导向装置 

分 类 号：R743[医药卫生—神经病学与精神病学]