Kyeung Ko Jun, Weon Lee Sang, Hwa Choi Chang, Lee Tae Hong
Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Department of Neurosurgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
Interv Neuroradiol. 2019 Oct;25(5):539-547. doi: 10.1177/1591019919846616. Epub 2019 May 14.
Fusiform dissecting aneurysms involving the dominant vertebral artery with poor collaterals are challenging to treat. The purpose of this study was to present an initial experience with a fill and tunnel technique for reconstructive endovascular treatment of these conditions.
A total of 13 patients, 11 men and 2 women, each with a fusiform vertebral artery dissecting aneurysm not amenable to internal trapping of the parent artery, underwent reconstructive endovascular treatment using a fill and tunnel technique between January 2012 and December 2015. The safety, feasibility, and clinical and angiographic outcomes of these procedures were retrospectively evaluated.
The average maximum diameter of the fusiform aneurysms was 12.1 mm. Five were ruptured. Three aneurysms were treated with a single stent and the remaining 10 aneurysms required double-stent placement. Treatment was technically successful in all 13 patients, achieving complete occlusion ( = 10, 76.9%) and near-complete occlusion ( = 3, 23.1%). No procedure-related complications occurred in any patient. There were no delayed thromboembolic or hemorrhagic complications during the follow-up period (mean, 19.0 months). Angiographic follow-ups (mean, 9.1 months) showed stable occlusion in 90.9% (10/11) and asymptomatic in-stent occlusion in one patient (9.1%, 1/11). At the end of the observation period (mean, 19.0 months), all patients had excellent clinical outcomes (modified Rankin Scale (mRS) 0, 92.3%, 12/13), except one (mRS 4), resulting from poor preoperative status.
This retrospective study demonstrated that endovascular reconstruction using a fill-and-tunnel technique was a technically safe, feasible, and clinically effective treatment method for fusiform vertebral artery dissecting aneurysms with ipsilateral dominance.
累及优势椎动脉且侧支循环不良的梭形夹层动脉瘤治疗具有挑战性。本研究的目的是介绍采用填充和隧道技术对这些情况进行重建性血管内治疗的初步经验。
2012年1月至2015年12月期间，共有13例患者（11例男性，2例女性），均患有无法通过阻断载瘤动脉进行治疗的梭形椎动脉夹层动脉瘤，接受了采用填充和隧道技术的重建性血管内治疗。对这些手术的安全性、可行性以及临床和血管造影结果进行了回顾性评估。
梭形动脉瘤的平均最大直径为12.1毫米。5例为破裂动脉瘤。3例动脉瘤采用单枚支架治疗，其余10例动脉瘤需要放置双枚支架。所有13例患者的治疗在技术上均获成功，实现了完全闭塞（n = 10，76.9%）和近乎完全闭塞（n = 3，23.1%）。所有患者均未发生与手术相关的并发症。随访期间（平均19.0个月）未出现延迟性血栓栓塞或出血并发症。血管造影随访（平均9.1个月）显示90.9%（10/11）的患者闭塞稳定，1例患者（9.1%，1/11）支架内闭塞无症状。在观察期末（平均19.0个月），除1例因术前状态差导致改良Rankin量表（mRS）评分为4外，所有患者临床结局均良好（mRS 为0，92.3%，12/13）。
这项回顾性研究表明，采用填充和隧道技术进行血管内重建对于同侧优势的梭形椎动脉夹层动脉瘤是一种技术安全、可行且临床有效的治疗方法。
