Phogat Vivek, Gandhi Ashok, Srivastava Trilochan, Mishva Keshav
Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
J Cerebrovasc Endovasc Neurosurg. 2020 Dec;22(4):211-215. doi: 10.7461/jcen.2020.E2019.11.001. Epub 2020 Nov 19.
Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) and vertebral artery are rare entities but with varied treatment options. PSAs can be spontaneous or secondary to trauma, infections, malignancies or iatrogenic. To find out the efficacy of various endovascular interventions in the management of ICA and vertebral PSAs.
The study included 14 patients diagnosed with intracranial PSAs who underwent endovascular interventions in SMS Medical College, Jaipur (Rajasthan) between June 2015 to January 2019. The clinical and radiological findings (computed tomography angiography and digital subtraction angiography) were reviewed and the consequent endovascular intervention carried out and their results were analyzed.
Total 14 patients were studied out of which 8 (57.1%) were anterior circulation PSAs and 6 (42.9%) were posterior circulation PSAs There were 10 (71.4%) females and 4 (28.5%) males between the age of 9 to 65 years. Only 2 patients with PSA had past history of trauma. Coiling was done in 8 patients (57.1%), stenting in 2 patients (14.2%), parent artery occlusion in 1 patient (7.1%), glue embolization in 1 patient (7.1%) while coiling with glue in 1 patient (7.1%) and flow diverter in 2 patients (14.2%). Immediate and complete occlusion was achieved in 11 (78.6%) patients while 3 (21.4%) patients had subtotal occlusion. 11 patients under follow up till June 2019 did not report recurrence or new neurological deficit.
Endovascular interventions is minimally invasive and safe treatment strategy for intracranial PSAs. The ultimate choice of technique depends on clinical and imaging characteristics.
颈内动脉（ICA）和椎动脉假性动脉瘤（PSA）较为罕见，但治疗选择多样。PSA可自发形成，也可继发于创伤、感染、恶性肿瘤或医源性因素。旨在探讨各种血管内介入治疗在颈内动脉和椎动脉PSA治疗中的疗效。
该研究纳入了14例诊断为颅内PSA的患者，这些患者于2015年6月至2019年1月在斋浦尔（拉贾斯坦邦）的SMS医学院接受了血管内介入治疗。回顾了临床和影像学检查结果（计算机断层血管造影和数字减影血管造影），并对随后进行的血管内介入治疗及其结果进行了分析。
共研究了14例患者，其中8例（57.1%）为前循环PSA，6例（42.9%）为后循环PSA。患者年龄在9至65岁之间，女性10例（71.4%），男性4例（28.5%）。只有2例PSA患者有既往创伤史。8例患者（57.1%）进行了弹簧圈栓塞，2例患者（14.2%）进行了支架置入，1例患者（7.1%）进行了供血动脉闭塞，1例患者（7.1%）进行了胶水栓塞，1例患者（7.1%）进行了弹簧圈联合胶水栓塞，2例患者（14.2%）进行了血流导向装置置入。11例（78.6%）患者实现了即刻完全闭塞，3例（21.4%）患者为次全闭塞。截至2019年6月，11例接受随访的患者未报告复发或出现新的神经功能缺损。
血管内介入治疗是颅内PSA微创且安全的治疗策略。技术的最终选择取决于临床和影像学特征。
