椎基底动脉瘤的血管内治疗

目的探讨椎-基底动脉系统动脉瘤血管内治疗方法和疗效。方法回顾分析28例椎-基底动脉系统动脉瘤行血管内治疗病例,其中,基底动脉顶端动脉瘤12例;基底动脉主干动脉瘤7例;椎动脉瘤6例;小脑后下动脉瘤3例。行电解可脱性弹簧圈(GDC)动脉瘤囊内栓塞25例,对其中的宽颈、梭形动脉瘤等复杂动脉瘤辅以血管支架、球囊辅助的瘤颈成形技术完成治疗;另对3例大、巨型椎动脉瘤行载瘤动脉闭塞术。结果25例行GDC动脉瘤囊内栓塞病例,达完全致密栓塞11例,90%以上填塞14例,其中1例置入支架的基底动脉梭形动脉瘤病例,术后半年复查,发现支架发生移位。1例巨型椎动脉瘤于载瘤动脉闭塞术后2 d出现脑干缺血症状,给予气管切开、呼吸机维持呼吸,术后4 w死于肺部感染。术后半年,GOS预后评分良好27例。结论血管内治疗是治疗椎-基底动脉瘤,尤其是后循环各种宽颈动脉瘤、梭形动脉瘤的有效方法,采用恰当的操作策略是提高治疗质量的关键。

Endovascular treatment for vertebrobasilar aneurysms

Objective To study the technique and outcome of endovascular treatment for vertebrobasilar(aneurysms).Methods A total of 28 cases,including 12 basilar artery tip aneurysms,7 basilar artery aneurysms,6 vertebral artery aneurysms,3 posterior-inferior cerebella artery aneurysms which were treated with endovascular technique were analyzed retrospectively.Twenty-five aneurysms were embolized with Gugliemi detachable coil(GDC),and the techniques of the remodeling and stent-placement were used in the complicated aneurysms,such as wide neck or fusiform aneurysms.Three vertebral artery aneurysms were treated by the parent artery(embolization).All patients were evaluated by GOS in half a year after operation.Results In the series,total(occlusion) was obtained in 11 aneurysms and more than 90% occlusion in 14 cases.No immediate related(complications) occurred to the procedure.However,the stent migration appeared in one case 6 months after(treatment).Twenty-seven patients were evaluated as excellent and good by GOS,and one case died after treated by parent artery embolization with brain stem infarction.Conclusion As one of the main treatments for(vertebrobasilar) aneurysms,the endovascular method has its own advantages.Proper endovascular therapeutic strategy is the key for good and(excellent) outcome.