血管内治疗基底动脉瘤

目的探讨经血管内治疗基底动脉瘤的有效性、安全性。方法 30例患者中基底动脉顶端动脉瘤6例,基底动脉干动脉瘤24例;其中夹层动脉瘤10例,梭形动脉瘤9例,囊状动脉瘤11例;未破裂动脉瘤14例,发生过破裂出血16例。在全身麻醉下进行血管内治疗,观察其安全性和治疗效果。结果 30例技术成功率100%,术后均未发生再出血,无新增神经功能缺失,无死亡病例,随访3个月至2 a,原有症状均明显改善。夹层动脉瘤10例中,单纯支架置入4例,支架辅助弹簧圈栓塞6例,动脉瘤未见显影,支架位置理想,无狭窄;囊状动脉瘤11例中完全栓塞8例,次全栓塞2例,部分栓塞1例,支架均到达理想的预定位置,未狭窄,瘤体未见显影;梭形动脉瘤9例中单纯支架置入6例,双支架置入3例,瘤体未见显影,支架位置理想,无狭窄。数字减影血管造影(DSA)复查9例,其中6例基底动脉梭形动脉瘤行支架置入者瘤体明显减小;2例基底动脉顶端宽颈动脉瘤行支架辅助弹簧圈部分栓塞,其中1例瘤腔基本消失,1例瘤体大小无变化;1例基底动脉中下段囊状宽颈动脉瘤单纯支架置入者未发现支架内狭窄,4个月后复查DSA示动脉瘤明显缩小,支架内血流通畅。结论血管内介入治疗为基底动脉瘤的治疗提供了微创和较为安全、有效的治疗方法。

Endovascular treatment for basilar artery aneurysm

Objective To explore the validity,security of endovascular treatment for basilar artery aneurysm.Methods The security and therapeutic effect were detected by endovascular treatment on 30 patients with basilar artery aneurysm with general anesthesia,among which 6 at the top and 24 at the arterialtrunk;10 with dissecting aneurysm,9 fusiform aneurysm,and 11 Saccular Aneurysm;14 with unruptured aneurysm and 16 ruptured.Results Of the 30 cases,the technical success rate was 100 percent,and no rehaemorrhagia occurred,no new-neurological deficits and death were discovered after surgeries.The symptoms were all released obviously according to a 3-month to 2-year follow-up.Among the 10 cases with dissecting aneurysm,4 of them were implanted pure stent and 6 microcoil assisted by stent,through which the aneurysm was not seen enhancing,locations of stents were reasonable,and there was no constriction.Within the 11 cases of saccular aneurysm,8 were entire embolism,2 were minor entire embolism,and only one case was partial embolism.Stents were all located at expected places,there was no constriction,and the aneurysm was not seen enhancing.6 were imbedded pure stent in the 9 cases of fusiform aneurysm,and the rest 3 were implanted double bracket,by means of which the aneurysm was not seen enhancing,stents were scheduled at ideal locations,and there was no constriction.As to the 9 cases performed digital subtraction arteriography review:tumors of the 6 patients with fusiform aneurysm who were implanted stents,reduced apparently;with respect to the 2 cases with basilar artery aneurysm at the top who were imbedded microcoil assisted by stent and suffering partial embolism,one tumor cavity generally disappeared while the size of the other changed little;there was no stent stenosis.In the case of basilar artery distal saccular wide-necked aneurysms with stent implantation alone,after four months,the aneurysm obviously decreased though digital subtraction arteriography,and the blood stream in stent was smooth.Conclusion Endovascular interventional treatment supplies a minimally invasive and relatively safe and efficient therapeutic method for basilar artery aneurysm.