Luo Chao-Bao, Chang Cheng-Yen, Teng Michael Mu-Huo, Chang Feng-Chi
Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2005 Dec;68(12):578-84. doi: 10.1016/S1726-4901(09)70097-8.
Ruptured intradural vertebral dissecting aneurysm (VDA) is associated with a high risk of rebleeding and a high incidence of mortality if left untreated because of its natural history. We report our experience of endovascular treatment of ruptured VDAs using electrodetachable coils.
Over 7 years, 10 patients with spontaneously ruptured intradural VDAs were managed by endovascular embolization in our institute. All patients received endovascular trapping of the dissecting aneurysm and proximal occlusion by electrodetachable coils.
There were 5 men and 5 women, with a mean age of 48 years. Of the 10 VDAs, 8 were located in the supra-posterior inferior cerebellar artery (PICA) area, and 2 were in the infra-PICA area. Six affected vertebral arteries were dominant (n = 3) or co-dominant (n = 3) in the vertebrobasilar system. Nine ruptured VDAs and their parent arteries were successfully occluded by a single session of endovascular embolization by electrodetachable coils. In the tenth patient, the dissecting aneurysm showed subtotal occlusion because of involvement of the vertebrobasilar junction. The mean number and coil length were 7 and 58 cm, respectively. There were no significant periprocedural complications or recurrent bleeding. All patients demonstrated good clinical recovery (n = 9) or improvement (n = 1) after embolization over a mean follow-up of 15 months (range, 6-24 months).
Endovascular embolization is a useful and safe method in the treatment of ruptured VDAs even when the affected vertebral arteries are dominant or co-dominant in vertebrobasilar flow. Trapping procedures and direct occlusion of the dissecting segment with preservation of the PICA by detachable coils should be performed as early as possible in the management of VDAs.
硬脊膜内椎动脉夹层动脉瘤（VDA）破裂后，若不治疗，因其自然病程，再出血风险高且死亡率高。我们报告使用电解可脱弹簧圈对破裂VDA进行血管内治疗的经验。
7年间，我院对10例硬脊膜内VDA自发破裂患者进行了血管内栓塞治疗。所有患者均接受了夹层动脉瘤的血管内圈套术及近端电解可脱弹簧圈闭塞术。
男性5例，女性5例，平均年龄48岁。10个VDA中，8个位于小脑后下动脉（PICA）上后下区域，2个位于PICA下区域。6条受累椎动脉在椎基底动脉系统中为优势动脉（n = 3）或共优势动脉（n = 3）。9个破裂的VDA及其供血动脉通过单次电解可脱弹簧圈血管内栓塞成功闭塞。第10例患者，由于椎动脉基底动脉交界处受累，夹层动脉瘤呈次全闭塞。平均弹簧圈数量和长度分别为7个和58 cm。围手术期无明显并发症或再出血。平均随访15个月（6 - 24个月），所有患者栓塞后临床恢复良好（n = 9）或改善（n = 1）。
血管内栓塞是治疗破裂VDA的一种有用且安全的方法，即使受累椎动脉在椎基底动脉血流中为优势或共优势动脉。在VDA的治疗中，应尽早采用圈套术并用可脱弹簧圈直接闭塞夹层段同时保留PICA。
