破裂小脑后下动脉瘤的血管内治疗效果分析

目的 评价血管内介入治疗破裂小脑后下动脉瘤的安全性和有效性.方法 回顾性连续纳入2012年6月至2019年10月在皖南医学院弋矶山医院神经外科血管内治疗的39例破裂小脑后下动脉瘤患者,分析其临床及影像学资料.应用Raymond-Roy分级(R-R分级)评价即刻栓塞程度(Ⅰ级为动脉瘤完全栓塞,Ⅱ级为瘤颈残留,Ⅲ级为动脉瘤...

Efficacy analysis of endovascular treatment for ruptured posterior inferior cerebellar artery aneurysm

Objective To evaluate the safety and effectiveness of endovascular approach for ruptured posterior inferior cerebellar artery(PICA)aneurysm.Methods From June 2012 to October 2019,39 consecutive patients with ruptured PICA aneurysms and treated by endovascular approach in the Department of Neurosurgery,Yijishan Hospital of Wanan Medical College were recruited.Clinical and radiological records were collected retrospectively.Clinical and radiological outcomes were followed up and analyzed.Raymond-Roy(R-R)occlusion classification was used to evaluate the immediate angiographic outcome.R-R grading evaluation immediately after embolization degree(ClassⅠ:complete obliteration;ClassⅡ:residual neck;ClassⅢ:residual aneurysm).Perioperative complications of the patients were recorded.Postoperative imaging follow-up was performed by DSA,and clinical prognosis was evaluated by Glasgow outcome scale(GOS)score at discharge and during follow-up(GOS score 4-5 for good prognosis and 1-3 for poor prognosis).Results Parent artery occlusion was performed in 16 distal PICA aneurysms and 1 proximal PICA aneurysm.Coiling alone was performed in 3 distal aneurysms and 11 proximal aneurysms.Stent-assisted coiling was performed in 6 proximal aneurysms.Simple stent implantation was performed in 2 proximal aneurysms The immediate angiographic outcomes in patients treated with parent artery occlusion showed those aneurysms and parent artery were occluded completely.Among the remaining 22 patients,R-RⅠwas achieved in 12 procedures(54.5%),R-RⅡin 6 procedures(27.3%)and R-RⅢin 4 procedures(18.2%).The rate of perioperative mortality was 10.3%(4/39),and all occurred in patients with Hunt-HessⅣ-Ⅴ(8 cases).The rate of good outcome at discharge was 76.9%(30/39).Except 4 deaths before discharge and 3 cases lost to follow-up,32 patients were followed up for 2 to 49 months(median 6 months).No recurrent bleeding occurred during follow-up,and 30 cases(93.8%)had good prognosis.The recurrence rate by parent artery occlusion and coil embolization was 2/11 and 3/9,respectively.There was no recurrence in patients treated with stent-assisted coiling.Conclusions Endovascular approach is a safe and effective method for PICA aneurysm.Treatment strategy should be made based on location of aneurysm and direction of parent artery.Patients should receive angiographic follow-up regularly after procedure.