椎动脉夹层动脉瘤的血管内治疗

目的 总结不同部位椎动脉夹层动脉瘤的诊疗经验.方法 回顾性分析82例椎动脉夹层动脉瘤的临床资料,并根据小脑后下动脉(PICA)与瘤体的关系进行分类,Ⅰ类:PICA起始部远离瘤体；Ⅱ类:PICA起始部发自瘤体上下缘；Ⅲ类:PICA 起始部发自瘤体.所有病人均采用血管内治疗.结果 随访82例,时间3～18个月.Ⅰ类动脉瘤40例,其中行动脉瘤及载瘤动脉闭塞术23例,术后随访未见动脉瘤复发；行支架结合微弹簧圈治疗术17例,术后动脉瘤完全及近全栓塞12例,随访动脉瘸保持稳定13例.Ⅱ类动脉瘤27例均行支架结合微弹簧圈治疗,术后动脉瘤完全及近全栓塞17例,随访动脉瘤保持稳定18例.Ⅲ类动脉瘤15例,行支架结合微弹簧圈治疗7例,术中均行部分栓塞,随访动脉瘤保持稳定4例；行单纯支架植入术8例,术后随访仅3例动脉瘤保持稳定.结论根据PICA和动脉瘤体的关系进行分类,充分考虑PICA的位置关系,可指导椎动脉夹层动脉瘤的血管内治疗.

Endovascular treatment for dissecting aneurysms in vertebral artery

Objective To summarize the experiences of diagnosis and treatment of dissecting aneurysms in vertebral artery. Methods Clinical data of 82 patients with dissecting aneurysms in vertebral artery were analyzed retrospectively. According to the relationship between posterior inferior cerebellar artery （PICA） and the aneurysms, all the aneurysms were classified into 3 types： PICA origin is far away from aneurysms as Type Ⅰ, PICA origin is in the margin of the aneurysms as type Ⅱand PICA origin is in the middle of the aneurysms as type Ⅲ. All the aneurysms were treated by endovascular technique. Results All the patients were followed up for 3 to 18 months. Type Ⅰ： The occlusion of parent artery and aneurysms was performed in 23 patients and no aneurysms recurred during follow-up period. Stent combined with micro-coils was performed in 17 patients. The complete and subtotal embolization were achieved in 12 patients after operation and no aneurysms remained stable in 13. Type Ⅱ： Stent combined with micro-coils was performed in 27 patients. The complete and subtotal embolization were achieved in 17 patients after operation and aneurysms remained stable in 18 during follow-up period. Type Ⅲ： Stent combined with micro-coils was performed in 7 patients who underwent partial embolization and aneurysms remained stable in 4 during follow-up period. Stent implantation was performed in 8 patients and aneurysms remained stable in 3 during follow-up period. Conclusions Classification is made according to the relationship between PICA and aneurysms and site of PICA is taken into full consideration in order to provide guidance for the endovascular treatment of dissecting aneurysms in vertebral artery.