个体化血管内介入治疗椎动脉夹层动脉瘤

目的观察个体化血管内介入治疗椎动脉夹层动脉瘤(VADA)的临床效果。方法回顾性分析38例VADA患者(43枚动脉瘤)。其中10例(10枚)动脉瘤破裂出血,对6枚采用动脉瘤填塞及载瘤动脉闭塞术,4枚以单支架辅助弹簧圈栓塞。对未破裂33枚动脉瘤均行载瘤动脉重建术,以单支架辅助弹簧圈栓塞3枚,双支架辅助弹簧圈栓塞25枚,三支架辅助弹簧圈栓塞5枚。结果血管内介入治疗所有43枚VADA均获成功,对28枚实现完全及次全栓塞、15枚实现部分栓塞。术后随访12个月,34例(38枚动脉瘤)接受全程复查,其中21枚治愈、11枚改善、6枚稳定,未见复发,无新发脑出血或脑缺血症状;改良Rankin量表(mRS)评分0～1分30例,2分2例,3分1例,4分1例。结论根据具体情况采用个体化血管内介入治疗VADA安全、有效,且预后较好。

Individualized endovascular interventional treatments of vertebral artery dissection aneurysms

Objective To observe the clinical effects of individualized endovascular interventional treatments of vertebral artery dissecting aneurysm (VADA). Methods Totally 38 patients with 43 VADA were retrospectively analyzed. Ten ruptured aneurysms were detected, 6 were treated with embolization of aneurysm and occlusion of parent artery, while the other 4 were treated with single stent-assisted coiling. Meanwhile, 33 unruptured aneurysms were treated with tumor-carrier artery reconstruction, 3 with single-stent-assisted coiling, 25 with double-stent-assisted coils and 5 with three-stent-assisted coils. The immediate embolization effect was observed. Following-up was performed to observe the curative effect and prognosis. Results All 43 VADA were successfully treated with endovascular interventional treatments. Immediately after operation, complete or incomplete occlusion were obtained in 28 aneurysms, while partial occlusion was obtained in 15 aneurysms. During 12 months'' following-up, 34 patients with 38 aneurysms underwent reexaminations, and 21 were cured, 11 improved and 6 remained stable. No recurrence, nor new symptoms of cerebral hemorrhage or cerebral ischemia was observed. The modified Rankin scale (mRS) score ranged from 0 to 1 score in 30 patients, 2 score in 2 patients, 3 score in 1 and 4 score in 1 case. Conclusion The performance of individualized endovascular interventional treatment of VADA was safe and effective according to the characteristics of lesions, which might achieve good prognosis.