创伤性颈内动脉颅内段假性动脉瘤的血管内治疗

目的 回顾性分析单中心血管内治疗创伤性颈内动脉颅内段假性动脉瘤(TIICAP)的安全性及临床疗效.方法 连续回顾2005年9月至2019年9月我中心收治的经脑血管造影检查的颅内动脉瘤患者资料,根据纳入标准选择TIICAP患者.分析患者的手术策略及围手术期抗血小板药物治疗情况,并总结治疗效果和临床与影像学随访结果.结果 共入组29例TIICAP患者,男19例(65.5％),女10例(34.5％),年龄为14～70岁,中位年龄为47(30,53)岁.29例患者均成功实施血管内治疗,其中采用覆膜支架3例,血流导向装置9例,支架辅助弹簧圈栓塞11例,单纯弹簧圈栓塞2例,载瘤动脉闭塞4例.1例行载瘤动脉闭塞患者术前再出血,术后死亡;1例行载瘤动脉闭塞患者术后发生缺血性脑卒中,最终死亡;余27例患者均无并发症发生,顺利出院.23例患者接受影像学随访,13例治愈,5例好转,2例稳定,3例复发(均再次行血管内治疗治愈).24例患者接受临床随访,临床预后均稳定或好转.结论 血管内治疗是处理TIICAP的有效手段,其中血流导向装置、覆膜支架等新技术的优势初现,值得进一步研究.

Endovascular treatment of traumatic intracranial internal carotid artery pseudoaneurysm

Objective: To investigate the safety and clinical efficacy of endovascular treatment for traumatic intracranial internal carotid artery pseudoaneurysm (TIICAP). by retrospective analysis of single center data. Methods: From September 2005 to September 2019, twenty-nine cases of TIICAP were treated by endovascular treatment through femoral artery approach under general anesthesia. Among them, three cases were treated with covered stent, 9 cases with flow diverter, 11 cases by stent-assisted coiling, 2 cases simple embolization, and 4 cases parent artery occlusion. Results: All the procedures were successful, with 1 case of cerebral infarction after parent artery occlusion, he finally died. 1 case of rebleeding before operation, the patient died after the successful procedure. No other complications occurred. All the remaining patients were discharged normally. There was no rebleeding and cerebral infarction during the follow-up period in 24 cases. Imaging follow-up of 23 cases showed that 13 cases were cured, 5 cases showed improved, 2 cases stable, and 3 cases recurred. Conclusion: Endovascular treatment is an effective method for TIICAP. The flow diverter and covered stent are more effective than bare stent.