Wang Yihua, Zhao Cuiping, Hao Xiaoguang, Wang Chengwei, Wang Zhigang
Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China ; Department of Neurosurgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China.
Department of Neurology, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China.
Exp Ther Med. 2014 Nov;8(5):1409-1415. doi: 10.3892/etm.2014.1961. Epub 2014 Sep 12.
The current study aimed to summarise the clinical features and classifications of vertebral artery dissecting aneurysms (VADAs) to optimise strategies for endovascular interventional therapy. The clinical features and results of 31 inpatients with VADA were retrospectively analysed. The aneurysms were classified according to their location and association between the aneurysm and posterior inferior cerebellar artery (PICA), and into subtypes according to the developmental state of the contralateral vertebral artery. Different endovascular interventional therapy strategies were selected for each classification. Three types of aneurysm with two subtypes each were identified. An aneurysm located distally to the PICA was termed type I (10/31 patients). Aneurysms with a contralateral vertebral artery were denoted as subtype a (type Ia, 6/31 patients) and aneurysms with hypoplasia of the contralateral vertebral artery were denoted as subtype b (type Ib, 4/31 patients). An aneurysm located at the origin of the PICA was termed type II (13/31 patients), with seven cases classified as IIa and six cases as IIb. An aneurysm located proximally to the PICA was termed type III (8/31 patients), with five cases classified as IIIa and three cases as IIIb. Among the 31 patients, 18 received stent-assisted coiling, two received coiling, 10 received coiling with parent artery occlusion and one patient received conservative treatment. Among the 31 patients with VADA, 21 were occluded completely, nine were partially occluded and one was not occluded. One patient developed a coma following coiling; however, the other 30 patients recovered well. Thus, the classification of an aneurysm based on its location and the developmental state of the contralateral vertebral arteries appears to be an effective and safe approach for the selection of appropriate endovascular interventional therapy strategies.
本研究旨在总结椎动脉夹层动脉瘤（VADA）的临床特征和分类，以优化血管内介入治疗策略。回顾性分析31例VADA住院患者的临床特征及治疗结果。根据动脉瘤的位置、动脉瘤与小脑后下动脉（PICA）的关系进行分类，并根据对侧椎动脉的发育状态分为亚型。针对每种分类选择不同的血管内介入治疗策略。共识别出三种类型的动脉瘤，每种类型又分为两个亚型。位于PICA远端的动脉瘤称为I型（10/31例患者）。对侧椎动脉存在的动脉瘤记为a亚型（Ia型，6/31例患者），对侧椎动脉发育不全的动脉瘤记为b亚型（Ib型，4/31例患者）。位于PICA起始处的动脉瘤称为II型（13/31例患者），其中7例为IIa型，6例为IIb型。位于PICA近端的动脉瘤称为III型（8/31例患者），其中5例为IIIa型，3例为IIIb型。31例患者中，18例接受支架辅助弹簧圈栓塞术，2例接受单纯弹簧圈栓塞术，10例接受弹簧圈栓塞联合载瘤动脉闭塞术，1例患者接受保守治疗。31例VADA患者中，21例完全闭塞，9例部分闭塞，1例未闭塞。1例患者在弹簧圈栓塞术后出现昏迷；然而，其他30例患者恢复良好。因此，基于动脉瘤位置及对侧椎动脉发育状态的分类似乎是选择合适血管内介入治疗策略的有效且安全的方法。
