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小脑后下动脉远端椎动脉夹层动脉瘤破裂的治疗:支架置入还是动脉瘤夹闭?

Treatment of ruptured vertebral artery dissecting aneurysms distal to the posterior inferior cerebellar artery: stenting or trapping?

作者信息

Fang Yi-Bin, Zhao Kai-Jun, Wu Yi-Na, Zhou Yu, Li Qiang, Yang Peng-Fei, Huang Qing-Hai, Zhao Wen-Yuan, Xu Yi, Liu Jian-Min

机构信息

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China,

出版信息

Cardiovasc Intervent Radiol. 2015 Jun;38(3):592-9. doi: 10.1007/s00270-014-0981-3. Epub 2014 Oct 24.

Abstract

PURPOSE

The treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.

METHODS

A retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.

RESULTS

The immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).

CONCLUSIONS

Our preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.

摘要

目的

椎动脉夹层动脉瘤(VADA)破裂的治疗仍存在争议。我们的目标是评估小脑后下动脉远端破裂的VADA(小脑后下动脉以上的VADA,这是最常见的类型)采用血管内圈套术和支架辅助弹簧圈栓塞术(SAC)的安全性、有效性及长期预后。

方法

对我院连续治疗的39例小脑后下动脉以上破裂的VADA患者进行回顾性研究,其中20例采用血管内圈套术治疗,19例采用SAC治疗。对临床和血管造影数据进行回顾性比较。

结果

圈套术组VADA的即刻完全闭塞率为80%,随访时(平均45个月)提高至88.9%。在3例圈套治疗的病例中检测到小脑后下动脉(PICA)意外闭塞。VADA不完全闭塞或PICA意外闭塞主要发生在最靠近PICA的VADA。在支架置入组,即刻完全闭塞率为47.4%,随访时(平均39个月)提高至100%。圈套术组VADA的即刻完全闭塞率更高(p<0.05),但后期完全闭塞率在支架置入组略高(p>0.05)。

结论

我们的初步结果表明,血管内圈套术和支架辅助弹簧圈栓塞术在技术上均可用于治疗小脑后下动脉以上破裂的VADA。尽管无统计学意义,但圈套术组与手术相关的并发症发生率更高。当VADA靠近PICA时,我们建议采用SAC治疗病变。

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