Anxionnat René, de Melo Neto João Ferreira, Bracard Serge, Lacour Jean Christophe, Pinelli Catherine, Civit Thierry, Picard Luc
Department of Neuroradiology, Nancy University Hospital, Nancy, France.
Neurosurgery. 2003 Aug;53(2):289-300; discussion 300-1. doi: 10.1227/01.neu.0000073417.01297.93.
To analyze the treatment options in hemorrhagic intracranial dissections.
This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT).
EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died.
EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.
分析出血性颅内夹层动脉瘤的治疗选择。
本研究对16年间治疗的27例患者的29个夹层动脉瘤进行回顾性分析，主要采用血管内治疗（EVT）。
29个夹层动脉瘤中有12个在急性期接受了EVT，其中6个在夹层部位使用弹簧圈进行闭塞，6个采用近端球囊闭塞。1例进行了包裹治疗。其余16个夹层动脉瘤因解剖学原因未治疗，3例患者死亡，1例死于再出血。对13例存活患者进行的血管造影随访显示，1例最初误诊，5例病变恶化，其中5例导致延迟EVT，1例进行了手术夹闭。其中1个位于优势椎动脉的夹层动脉瘤在随后破裂后使用支架和弹簧圈进行治疗，以保持母血管通畅。4例与EVT相关的缺血性并发症导致2例患者中度残疾。EVT后未发生再出血，但1例患者因初始临床状态差死亡；其他患者病情改善。在10例保守治疗的患者中，4例死亡，3例因初始临床状态差，1例因再出血，6例患者临床结局良好。27例患者中，3例发生再出血，1例因再出血死亡。17例患者（63%）恢复良好，6例（22%）中度残疾，4例（15%）死亡。
EVT可有效预防再出血。在可能的情况下，在夹层部位使用弹簧圈闭塞是目前的首选方法。另一种选择是使用球囊闭塞母动脉，在特定情况下使用支架可保持血管通畅。
