颅内出血性椎动脉夹层的治疗

目的探讨颅内出血性椎动脉夹层的治疗方法。方法回顾分析了2000-2005年40例出血性颅内段椎动脉夹层的治疗。其中支架辅助的弹簧圈栓塞33例,夹层段动脉闭塞6例,夹层近端主干动脉闭塞1例。结果手术无死亡病例。术后随访1-46个月,平均16.3个月。发现夹层动脉通畅,无夹层再出血,无新发后循环梗死。1例支架辅助弹簧圈栓塞患者夹层复发,行补充填塞弹簧圈。结论血管内夹层近端闭塞以及夹层段动脉闭塞是治疗颅内出血性椎动脉夹层的经典术式。支架辅助的弹簧圈栓塞治疗保留了载瘤动脉,避免了术后对侧椎动脉血流负荷量的增加;减少了后循环缺血的危险,扩大了血管内治疗出血性椎动脉夹层的手术适应证。本组结果显示支架辅助弹簧圈栓塞术并未增加夹层再通以及穿支动脉闭塞。本组经验初步表明支架辅助的弹簧圈栓塞是治疗出血性颅内椎动脉夹层的合理选择之一。

Treatment of intracranial vertebral hemorrhagic dissection

Objective To explore and evaluate the treatment modalities for intracranial vertebral hemorrhagic dissection. Methods 40 cases with intracranial vertebral hemorrhagic dissection was reviewed from 2000 to 2005 years, among which 33 cases were treated with stent-assisted coiling, 6 with internal trapping, and 1 with proximal occlusion. Results There was no operation-associated mortality in this series. The parent arteries kept patent and there was no rebleeding or de novo infarction on the posterior circulalion on follow-up control ranged from 1 to 46 months ( mean 16.3 months). Conclusion Proximal occlusion and endovascular trapping are traditional treatment for intracranial vertebral hemorrhagic dissection. However, stent-assisted coiling spare the parent artery, thus extend the indications of endovascular treatment for intracranial vertebral hemorrhagic dissection. The advantages of this modality include reducing the risk of blood insufficiency for the posterior circulation and avoiding overload flow through the contralateral vertebral artery after operation. There were no particularly increased risk of recanalization or perforator occlusion after stent-assisted coiling. The primary experience of this series indicated stent-assisted coiling was a rational treatment modality for intracranial vertebral hemorrhagic dissection.