Trivelato F P, Salles Rezende M T, Castro G D, Manzato L B, Santoro Araújo J F, Ulhôa A C
Neurovascular Institute, Hospital das Clínicas of Federal University of Minas Gerais, Felício Rocho Hospital and Mater Dei Hospital, Rua Timbiras 3616, Barro Preto, 30140-062, Belo Horizonte, MG, Brazil,
Clin Neuroradiol. 2014 Sep;24(3):255-61. doi: 10.1007/s00062-013-0247-5. Epub 2013 Aug 4.
Isolated posterior inferior cerebellar artery dissecting aneurysms are rare lesions. Their underlying pathology, presentation, and natural history are poorly understood. Their treatment is controversial, and few data are available regarding the best treatment. We conducted the first study comparing selective coiling and parent artery occlusion for the treatment of isolated PICA dissecting aneurysms.
All patients harboring isolated PICA dissecting aneurysms treated between January 2006 and October 2012, in a single center, were retrospectively evaluated. Patients were consecutively submitted either to selective coiling or parent artery occlusion. The safety and durability (recanalization and rebleeding rates) of each treatment were established. In order to compare the results of both treatment modalities, we also performed a literature search of all cases of isolated PICA dissecting aneurysms endovascularly treated.
Fourteen patients harboring isolated PICA dissecting aneurysms were assigned to endovascular treatment in our center (eight to selective coiling vs six to parent artery occlusion). There was no statistical difference between both groups regarding complications. No patient experienced rebleeding. One recanalization was observed in the selective coiling group. Based on literature review (83 cases), selective coiling and parent artery occlusion showed similar success rate in preventing rebleeding. Parent artery occlusion was significantly associated with a higher risk of ischemic complication (p = 0.013).
Both selective coiling and parent artery occlusion are highly effective in preventing rebleeding in isolated PICA dissecting aneurysms. Although total complication rate is similar between both modalities, parent artery occlusion is significantly associated to a higher risk of ischemic events.
孤立性小脑后下动脉夹层动脉瘤是罕见的病变。其潜在病理、临床表现和自然病史了解甚少。其治疗存在争议，关于最佳治疗方法的数据也很少。我们开展了第一项比较选择性栓塞和载瘤动脉闭塞治疗孤立性小脑后下动脉夹层动脉瘤的研究。
对2006年1月至2012年10月在单一中心接受治疗的所有孤立性小脑后下动脉夹层动脉瘤患者进行回顾性评估。患者连续接受选择性栓塞或载瘤动脉闭塞治疗。确定了每种治疗方法的安全性和持久性（再通和再出血率）。为了比较两种治疗方式的结果，我们还对所有接受血管内治疗的孤立性小脑后下动脉夹层动脉瘤病例进行了文献检索。
在我们中心，14例孤立性小脑后下动脉夹层动脉瘤患者接受了血管内治疗（8例接受选择性栓塞，6例接受载瘤动脉闭塞）。两组在并发症方面无统计学差异。没有患者发生再出血。在选择性栓塞组观察到1例再通。基于文献综述（83例），选择性栓塞和载瘤动脉闭塞在预防再出血方面成功率相似。载瘤动脉闭塞与缺血性并发症风险较高显著相关（p = 0.013）。
选择性栓塞和载瘤动脉闭塞在预防孤立性小脑后下动脉夹层动脉瘤再出血方面均非常有效。虽然两种方式的总并发症率相似，但载瘤动脉闭塞与缺血性事件风险较高显著相关。
