颅内外动脉狭窄合并颅内无症状动脉瘤的血管内治疗策略研究

目的 探索颅内外动脉狭窄合并颅内无症状动脉瘤的安全和有效的血管内治疗策略。 方法 回顾性分析北京天坛医院急诊介入科2012年9月～2013年8月收住的因颅内外动脉狭窄拟行支 架治疗且合并颅内无症状动脉瘤的患者26例。对其临床、影像学资料、治疗措施及结果、并发症及预 后等进行分析。 结果 26例患者共发现≥70%的狭窄或闭塞病变54处，动脉瘤30枚（非同流域16枚，狭窄后7枚，狭窄 处3枚，狭窄前4枚）。26例患者中21例实施了狭窄病变的支架置入术，共干预25个狭窄/闭塞病变，技 术成功率100%。选择个体化的动脉瘤干预措施：16例患者的17枚动脉瘤（非同流域、直径＜5 mm、 夹层）建议随访观察；2例患者的2枚动脉瘤（直径＞5 mm、形状不规则）择期行栓塞术；5例患者的 6枚动脉瘤（狭窄后、狭窄处、多发性、直径＞5 mm、后交通段）同期行栓塞术或支架覆盖；3例患者 的5枚动脉瘤（狭窄后、分叶状、多发性、直径＞5 mm）建议介入治疗但因家属拒绝手术等原因选择随 访观察。术后发生脑室出血1例。临床随访10～21个月，所有患者均预后良好，仅发现无症状性支架内 再狭窄1例。 结论 颅内外动脉狭窄合并颅内无症状动脉瘤时根据动脉瘤与狭窄病变的位置关系，动脉瘤大小、 形态、位置、数量和患者情况等综合分析后给予个体化血管内治疗安全、有效。

Endovascular Treatment of Cerebral Artery Stenosis with Unruptured Intracranial Aneurysm

Objective To explore the safe and effective intervention strategies in the treatment of cerebral artery stenosis with unruptured intracranial aneurysm. Methods We performed a retrospective review of all patients with cerebral artery stenosis who underwent stenting in Beijing Tiantan Hospital between September 2012 and August 2013. Twenty six patients were found to have unruptured intracranial aneurysm. The clinical and imaging data, treatment measures and results, complications, and prognosis were analyzed. Results Twenty six patients found 54 narrow/occluded lesions and 30 aneurysms （16 in the other basin, 7 after the narrow, 3 on the narrow, 4 before the narrow）. Twenty one patients （25 narrow/occluded lesions） placed stents with the technical success rate of 100%. Choose individualized aneurysm intervention measures： 16 patients （17 aneurysms） （in the other basin, diameter less than 5 mm, artery dissection on the narrow） with follow-up observation; 2 patients （2 aneurysms） （diameter greater than 5 mm, irregular shape） were successfully treated with endovascular coiling later; 5 patients （6 aneurysms） （after the narrow, on the narrow, multiple, diameter greater than 5 mm, C7） were successfully treated with endovascular coiling or stenting at the corresponding period; 3 patients （5 aneurysms） （after the narrow, on the narrow, multiple, diameter greater than 5 mm） were advised to undergo endovascular coiling but chose follow-up observation. Perioperativecomplications occured in 1 case, intraventricular hemorrhage after stenting. Twenty six cases are with good prognosis. In the process of 10-21 months＇ follow-up, 1 case was found stent restenosis without symptoms. Conclusion Individualized treatment should be performed in cerebral artery stenosis with unruptured intracranial aneurysm according to the relationship between the location of aneurysm and narrow, size, shape, location, quantity, and the clinical situation, etc.