血管内支架技术治疗破裂的椎动脉夹层动脉瘤

目的 评价血管内支架技术治疗破裂的椎动脉夹层动脉瘤的安全性及有效性. 方法 回顾性分析第三军医大学西南医院神经外科自2004年7月至2007年1月收治的采用支架技术治疗的9例椎动脉夹层动脉瘤患者的临床资料,其中3例行单纯支架植入术,6例行支架辅助微弹簧圈栓塞术. 结果 9例患者均在首次治疗中成功植入支架或行支架辅助微弹簧圈栓塞术,椎动脉均保留通畅,无动脉瘤破裂、血栓形成等并发症发生.所有患者获4～39个月临床随访,随访过程中无再出血表现.6例患者获3～18个月造影随访,其中2例行支架辅助弹簧圈栓塞术者随访发现动脉瘤再通或增大,再次行血管内孤立术及椎动脉近端闭塞术;2例行单纯支架植入术者随访造影示动脉瘤闭塞;另1例不全闭塞. 结论 血管内支架技术能保存患侧椎动脉畅通,是一种安全有效的治疗方法,但术后应严密随访,远期疗效仍有待进一步观察.

Safety and efficacy of endovascular stenting for treatment of ruptured vertebral artery dissecting aneurysms

Objective To evaluate the safety and efficacy of endovascular stent placement in the management of ruptured vertebral artery dissecting ancurysms. Methods A retrospective analysis was conducted in 9 patients with ruptured vertebral artery dissecting aneurysms treated in our department between July, 2004 and January, 2007 by means of endovascular stenting. Of these cases, 3 were treated with exclusive stent placement and 6 with stent-assisted coiling. Results Stent deployment and coil embolization were carried out successfully in all the cases. The vertebral arteries with stent placement remained patent after the surgery, and stent thrombosis or aneurysmal rupture occurred in none of the cases. During the follow-up for 4 to 39 months, no clinical evidence of rebleeding was found in these patients. Follow-up angiography was performed in 6 of the patients 3-18 months after the surgery, and two patients treated with stent-assisted coiling showed aneurysm recurrence or enlargement and underwent secondary internal trapping or proximal occlusion; two patients receiving endovascular stenting showed complete embolization of the anenrysm, and one patient showed partial embolization. Conclusion Endovascular stent placement is safe and effective for management of raptured vertebral artery dissecting aneurysms and allows the involved artery to remain patent after the surgery. Close follow-up is necessitated in these patients, and the long-term effect of this treatment remains to be further observed.