Moret J, Ross I B, Weill A, Piotin M
Service de Neuro-radiologie Interventionnelle, Fondation Ophthalmologique Rothschild, Paris, France.
AJNR Am J Neuroradiol. 2000 Feb;21(2):262-8.
The traditional endovascular approach to a cerebral aneurysm is anterograde, with the embolization and balloon protection catheters introduced via the parent vessel. Unfortunately, this approach may be restrictive, because these catheters cannot always be navigated at an optimal angle into the arterial branch that needs balloon protection or the part of the aneurysm that needs coiling. The purpose of this study was to determine the efficacy of a retrograde approach.
Twelve patients, seven women and five men, 28 to 65 years old (mean age, 45 years), were treated via the retrograde approach between March 1998 and February 1999. Three patients were treated for acutely ruptured aneurysms following subarachnoid hemorrhage. The rest had asymptomatic, unruptured aneurysms.
We were able to accomplish endovascular treatment in 10 cases. In the other two, the attempted retrograde route of access could not be achieved. The treatment afforded complete embolization in nine of the 10 patients. Symptomatic distal clot embolization occurred in one patient who had some residual, albeit improving, deficits at discharge. No other patients worsened with the treatment. There were two intraprocedural aneurysmal ruptures. None of the aneurysms restudied within 6 months (eight of 12) showed evidence of recanalization.
Our results indicate that it is possible to safely and effectively access a cerebral aneurysm via a retrograde approach. We believe that the anatomic benefits afforded by this technique outweigh the potential risks associated with the catheterization of another major cerebral arterial feeder.
传统的脑动脉瘤血管内治疗方法是顺行性的，栓塞和球囊保护导管通过供血血管引入。不幸的是，这种方法可能具有局限性，因为这些导管并非总能以最佳角度进入需要球囊保护的动脉分支或需要栓塞的动脉瘤部分。本研究的目的是确定逆行方法的疗效。
1998年3月至1999年2月期间，对12例患者采用逆行方法进行治疗，其中女性7例，男性5例，年龄28至65岁（平均年龄45岁）。3例患者在蛛网膜下腔出血后因急性破裂动脉瘤接受治疗。其余患者患有无症状、未破裂的动脉瘤。
10例患者成功完成血管内治疗。另外2例患者未能实现尝试的逆行入路。10例患者中有9例实现了完全栓塞。1例患者出现有症状的远端血栓栓塞，出院时仍有一些残留但有所改善的神经功能缺损。没有其他患者因治疗而病情恶化。术中发生2例动脉瘤破裂。6个月内复查的动脉瘤（12例中的8例）均未显示再通迹象。
我们的结果表明，通过逆行方法安全有效地治疗脑动脉瘤是可行的。我们认为，该技术带来的解剖学优势超过了与另一主要脑动脉供血支插管相关的潜在风险。
