椎动脉夹层动脉瘤的影像诊断与血管内治疗

目的总结椎动脉夹层动脉瘤的影像学诊断和血管内治疗经验。方法回顾性分析18例椎动脉夹层动脉瘤的磁共振成像和血管造影影像学特点和血管内治疗经过。结果影像特点为MR内膜瓣与壁间血肿,DSA珠线征,双腔征等。12例支架治疗中4例单纯支架后造影复查不显影,8例支架联合弹簧圈栓塞7例造影复查不显影;6例载瘤动脉闭塞4例造影复查不显影,全部病人临床随访症状消失。15例DSA复查随访,夹层动脉瘤不显影,无复发。结论DSA及MR检查对椎动脉夹层动脉瘤具有诊断价值;血管内治疗如支架技术（单纯置入或联合弹簧圈栓塞）以及载瘤动脉闭塞是椎动脉夹层动脉瘤安全、有效的选择。

Imaging diagnosis and endovascular treatment of dissecting aneurysm of vertebral artery

Objective To summarize experiences in imaging diagosis and endovascular treatment of dissecting aneurysm of vertebral artery. Methods Restrospective analysis of imaging features of MR and DSA of 18 dissecting aneurysms of vertebral artery, and the corresponding endovascular treatments were reviewed Results Imaging features such as " intimal flap" or "intramural hematoma" were demonstrated in MR, "pearl and string sign" or "real and false lumen" were demonstrated in DSA, Among 12 cases treated by stent technique, 4 aneurysms disappeared in follow-up DSA after stent alone, 7/8aneurysms disappeared in follow-up DSA after stent combined with coil; 6 cases were cured by balloon occlusion of ipsilateral vertebral artery ,4/6 aneurysms disappeared in follow-up DSA. All patients totally recovered by clinical followed-up,15 cases were follow-up by DSA without recrudescence. Conclusion DSA and MR have become diagnostic value tool to the diagnosis of dissecting aneurysm of vertebral artery. Endovascular treatment ( stent combined with coil/stent alone or ipsilateral vertebral artery occlusion) is safe and effective choice for dissecting aneurysm of vertebral artery.