脉络膜前动脉起始端动脉瘤新分型及其在介入治疗中的初步应用

目的:根据脉络膜前动脉（AChA）起始端动脉瘤与AChA的位置关系，提出新的分型方法，针对不同分型采用个体化的介入方法，并分析其疗效。方法:回顾性分析2016年1月至2018年11月复旦大学附属华山医院收治的34例AChA起始端动脉瘤患者资料。新分型将不涉及AChA的动脉瘤归为Ⅰ型（无关型），涉及AChA归为Ⅱ型（有关...

The role of new classification of anterior choroidal artery originating aneurysm for interventional therapy

Objective To investigate a new classification of anterior choroid artery(AChA)originating aneurysms and to analyze the results of individualized interventional therapy according to the new classification.Methods From January 2016 to November 2018,34 patients with AChA aneurysm were recruited at Huashan Hospital Fudan University.The aneurysms were classified into typeⅠ(independent type)and typeⅡ(dependent type),and typeⅡwas subdivided intoⅡa(neck type),Ⅱb(body type)andⅡc(direct type).Excepting 4 asymptomatic small aneurysms with follow-up,30 cases were treated with interventional aneurysm embolization.The degree of aneurysm embolization was assessed with Raymond classification immediately after surgery and at follow-up by DSA,MRI or CT examination was performed routinely within 3 days after surgery.Neurological functional status was evaluated using modified Rankin scale(mRS)before and after surgery.Among the 3 groups,theχ² test was used to compare the differences.Results According to the new classification,9 aneurysms were classified to typeⅠ,15 aneurysms to typeⅡa,10 aneurysms to typeⅡb.Four asymptomatic patients with small aneurysms(typeⅠin 2 cases,typeⅡa in 1 case and typeⅡb in 1 case)were treated with follow-up,other 30 patients(typeⅠin 7 cases,typeⅡa in 14 cases,typeⅡb in 9 cases)were treated with individualized intervention therapy.Twelve aneurysms(4 cases in typeⅠ,5 cases in typeⅡa,3 cases in typeⅡb)were treated with simple coil,15 aneurysms(typeⅠin 3 cases,Ⅱa in 7 cases,Ⅱb in 5 cases)with stenting combined with coil and 3 aneurysms(typeⅡa in 2 cases,Ⅱb in 1 case)with simple stenting(2 cases with flow diverter).Six aneurysms with typeⅠ(6/7)got Raymond-Ⅰembolism level(dense embolization)after surgery immediately and all the aneurysms with typeⅡgot Raymond-ⅡorⅢembolism level(partial embolization),there were significant differences in the degree of embolism among the 3 groups(χ²=24.643,P<0.001).During the operation,6 AChAs showed poor enhancement(typeⅡa in 1 cases,Ⅱb in 5 cases),and aneurysms with typeⅡb had higher risk in AChA injury(χ²=10.308,P=0.006).All patients were followed up at 12 months after surgery,compared with the preoperative neurological function,2 cases had improvement,1 cases got worse,and the rest had no change.Fifteen cases received DSA follow-up,10 aneurysms were stable,3 aggravating and 2 improving.Conclusions Using the new classification of AChA aneurysm,individualized intervention strategies can be planed more precisely.For typeⅠ,the aneurysm should be packed more densely as far as possible.ForⅡtype,preserving AChoA is the key point.The typeⅡb had highest risk in AChA injury during surgery.