Department of Neurosurgery, Holy Family Hospital, The Catholic University of Korea, Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi-do 429-717, Republic of Korea.
Acta Neurochir (Wien). 2010 Sep;152(9):1477-86; discussion 1486. doi: 10.1007/s00701-010-0693-7. Epub 2010 May 28.
Spontaneous vertebrobasilar dissecting aneurysm (VBD) is a very challenging disease with an unpredictable clinical course and controversies on treatment strategy. The present study reports radiological and clinical outcomes of stent-alone treatment (SAT) for VBD.
Twenty-four VBDs treated with SAT are included in the present study. Clinical and angiographic data were reviewed retrospectively.
A total of 24 lesions in 22 patients with a mean follow-up period of 16.21 months were included. Of the 24 individual lesions, 23 were intracranial vertebral artery lesions and 1 lesion was located in the basilar artery. There were six cases of ruptured dissections with the other cases having various symptoms. The immediate post-SAT angiographic outcomes included 5 lesions with good remodeling over 90% recovery and 19 poorly remodeled lesions. The latest angiographic outcomes included 17 cases of good remodeling (remodeling rate over 90%), 6 cases of poor remodeling (remodeling rate below 70%), and 1 case with morphological aggravation. The overlapping stent technique was used in seven cases and it was significantly associated with good angiographic results. None of the rupture cases underwent re-rupture post SAT. There was one case of a symptomatic complication of a femoral arteriovenous fistula.
The SAT could be a feasible alternative for the treatment of VBD. The overlapping technique was significantly associated with good angiographic outcome. We expect that technological development of the intracranial stent will allow better procedural outcomes of SAT.
自发性椎基底动脉夹层动脉瘤（VBD）是一种极具挑战性的疾病，其临床病程不可预测，治疗策略存在争议。本研究报告了单纯支架治疗（SAT）治疗 VBD 的影像学和临床结果。
本研究纳入了 24 例接受 SAT 治疗的 VBD 患者。回顾性分析了临床和血管造影数据。
共纳入 22 例患者的 24 处病变，平均随访时间为 16.21 个月。24 个单独的病变中，颅内椎动脉病变 23 个，基底动脉病变 1 个。有 6 例破裂性夹层，其余病例有不同的症状。SAT 后的即刻血管造影结果包括 5 处病变良好重塑，恢复超过 90%，19 处病变重塑不良。最新的血管造影结果包括 17 处病变良好重塑（重塑率超过 90%），6 处病变重塑不良（重塑率低于 70%），1 处病变形态加重。7 例采用重叠支架技术，与良好的血管造影结果显著相关。SAT 后无破裂病例再破裂。有 1 例股动静脉瘘症状性并发症。
SAT 可能是 VBD 治疗的一种可行选择。重叠技术与良好的血管造影结果显著相关。我们期望颅内支架技术的发展将允许更好的 SAT 手术结果。
