支架结合弹簧圈治疗破裂椎动脉夹层动脉瘤

目的评估支架结合弹簧圈技术治疗破裂椎动脉夹层动脉瘤（VADA）的可行性、有效性和安全性。方法回顾性分析57例破裂VADA的临床资料,均使用支架结合弹簧圈技术治疗,按使用支架数量分为单支架组（n=32）和多支架组（n=25）,比较两组间即刻和随访的影像学结果及临床结果。结果治疗即刻VADA完全栓塞、近全栓塞和部分栓塞,单支架组分别为4例（12.5%）、7例（21.9%）、21例（65.6%）,多支架组分别为13例（52%）、7例（28%）、5例（20%）。影像学随访12~78个月,单支架组30例,其中VADA完全栓塞19例（63.3%）,显影11例;多支架组24例,其中VADA完全栓塞23例（95.8%）、显影1例。术后即刻与随访期VADA完全栓塞率,多支架组显著高于单支架组（P〈0.05）。死亡3例。改良mRS评分在两组间差异无统计学意义（P〉0.05）。结论长期随访结果显示,支架辅助栓塞治疗破裂椎动脉夹层动脉瘤在技术上是安全有效的,多支架结合弹簧圈栓塞可有效提高即刻及远期的完全栓塞率,降低术后复发及再出血风险。

Endovascular treatment of ruptured vertebral artery dissecting aneurysms with stents and coils

Objective To evaluate the feasibility,efficacy and safety of stent assisted coiling for ruptured intracranial vertebral artery dissection aneurysms（VADA）.Methods Clinical features of 57 ruptured VADA were retrospectively analyzed.Stent-assisted coiling was performed in all the patients.According to number of stents,the patients were grouped into single-stent group（n = 32） and multiple-stent group（n = 25）.The difference was compared between the two groups on angiographic and clinical results.Results The instant results of radiography revealed total occlusion of the VADA was achieved in 4（12.5%） and 13（52%） patients,near total occlusion in 7（21.9%） and 7（28%）,and partial occlusion in 21（65.6%） and 5（20%） in single-stent group and multiple-stent group respectively.Thirty patients in single-stent group and 24 in multiple-stent group were angiographically followed up for 12-78 months.A total occlusion and subtotal occlusion were seen in 19（63.3%） and 11 patients in single-stent group,and in 23（95.8%） and 1 patient in multiple-stent group.The complete occlusion rates immediately postoperation and during follow-up period were significantly higher in multiple-stent group than in single-stent group（P ＆lt; 0.05）.Three patients died.There was no difference in modified Rankin score between the single-stent group and multiple-stent group（P ＆gt; 0.05）.Conclusions Stent-assisted coiling is safe and effective for ruptured intracranial VADA,which is confirmed by long-term follow-up.Application of multiple overlapping stents is effective to elevate the rate of total occlusion,and to reduce the risk of recurrence and rebleeding.