Department of Radiology, Bach Mai Hospital, Hanoi, Vietnam.
Department of Neurology, Bach Mai Hospital, Hanoi, Vietnam.
Med Arch. 2020 Feb;74(1):61-64. doi: 10.5455/medarh.2020.74.61-64.
Deconstructive versus reconstructive technique remains controversial on the management of acute basilar tip artery dissection.
We introduced a case report of massive dissecting aneurysm in the basilar tip artery treated with intra-aneurysm and basilar artery coiling.
A 30-year-old male presented with sudden headache and severe vomiting. Radiographic study showed a large unruptured dissecting aneurysm in the basilar tip artery involving bilateral P1 segment. This aneurysm was treated with intra-aneurysm and basilar artery coiling. Patient was discharge after 7 days without any neurological deficits. Post-operatively, the patient received 75 mg aspirin and 75 mg clopidogrel PO per day for 3 months - then 75 mg aspirin per day for up to 1 year. Angiographic follow-up at 3 months showed a complete occlusion of aneurysmal sac and basilar tip artery without any deficits (mRS 0). Cerebral arteriography at 6 months follow-up confirmed a stable occlusion of aneurysmal sac with a minor recurrence of aneurysm in left P1 segment.
Intra-aneurysm and basilar artery coiling is valuable alternative technique to treat complex basilar tip dissecting aneurysm in case of infeasible reconstructive technique. Clinical presentation, aneurysm characteristics and collateral circulation have to be investigated on each case to adopt this technique.
在急性基底动脉尖部动脉夹层的处理中，解构技术与重建技术仍然存在争议。
我们介绍了一例基底动脉尖部巨大夹层动脉瘤患者，采用瘤内和基底动脉线圈技术进行治疗。
一名 30 岁男性突发头痛和剧烈呕吐。影像学研究显示基底动脉尖部有一个大的未破裂夹层动脉瘤，累及双侧 P1 段。该动脉瘤采用瘤内和基底动脉线圈技术进行治疗。患者在 7 天后出院，无任何神经功能缺损。术后，患者每天口服 75mg 阿司匹林和 75mg 氯吡格雷 3 个月，然后每天口服 75mg 阿司匹林长达 1 年。3 个月的血管造影随访显示动脉瘤囊和基底动脉完全闭塞，无任何缺损（mRS 0）。6 个月的脑血管造影随访证实动脉瘤囊稳定闭塞，左侧 P1 段动脉瘤有轻微复发。
在重建技术不可行的情况下，瘤内和基底动脉线圈技术是治疗复杂基底动脉尖部夹层动脉瘤的一种有价值的替代技术。在每个病例中，都需要对临床表现、动脉瘤特征和侧支循环进行调查，以采用这种技术。
