Liu Peixi, Li Zongze, Hu Liuxun, Liu Yingjun, Li Peiliang, Zhu Wei, Tian Yanlong, Mao Ying
1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai.
2National Center for Neurological Disorders, Shanghai.
J Neurosurg. 2022 Jun 3;138(1):215-222. doi: 10.3171/2022.4.JNS22609. Print 2023 Jan 1.
The authors aimed to evaluate the clinical features, endovascular strategy selection, and outcomes of vertebral artery (VA) dissecting aneurysms (VADAs) near the origin of the posterior inferior cerebellar artery (PICA).
Clinical data were obtained from 196 patients with 202 VADAs who had been surgically treated at the authors' hospital between 2005 and 2021. The patients' medical records, imaging data, and follow-up outcomes were retrospectively analyzed.
All 196 patients (148 male, 48 female; mean age 53 years) underwent endovascular therapy for VADA. The most common chief complaints were headache (56.6%), dizziness (40.8%), and other occasional symptoms (18.4%). Twenty-six patients experienced posterior circulation ischemia, and 25 patients experienced subarachnoid hemorrhage (SAH). On DSA images, 37 aneurysms were found in the dominant VA, and 165 aneurysms were found on the nondominant side. Eighty-eight VADAs had stenosis. Regarding the VADA location, there were 59 distal, 51 proximal, 23 ventral, 64 PICA, and 5 obliteration types. Single-stent implantation (10.9%), overlapping stent implantation (23.8%), flow diverter (FD) implantation (11.9%), single stent-assisted coil (SAC) embolization (31.7%), overlapping SAC embolization (12.9%), parent artery occlusion (PAO) (8.4%), and FD-assisted coil embolization (0.5%) were chosen. The follow-up rate was 82.7%. The modified Rankin Scale (mRS) score was 0.5 ± 1.1. Ninety-six patients underwent DSA. The complete occlusion rates were 100%, 81.4%, 56.7%, and 76.5% in the PAO group, SAC reconstruction group, stent implantation group, and FD implantation group, respectively.
Young patients showed a higher probability of SAH, and elderly patients showed a higher probability of posterior circulation infarction. The surgical plan selection should be based on the SAH history, VA dominant side, and PICA origin location.
作者旨在评估小脑后下动脉（PICA）起源附近椎动脉（VA）夹层动脉瘤（VADA）的临床特征、血管内治疗策略选择及治疗结果。
收集2005年至2021年期间在作者所在医院接受手术治疗的196例患者的202个VADA的临床资料。对患者的病历、影像资料及随访结果进行回顾性分析。
196例患者（男148例，女48例；平均年龄53岁）均接受了VADA的血管内治疗。最常见的主要症状为头痛（56.6%）、头晕（40.8%）及其他偶发症状（18.4%）。26例患者出现后循环缺血，25例患者出现蛛网膜下腔出血（SAH）。在数字减影血管造影（DSA）图像上，37个动脉瘤位于优势VA，165个动脉瘤位于非优势侧。88个VADA存在狭窄。关于VADA的位置，有59个远端型、51个近端型、23个腹侧型、64个PICA型及5个闭塞型。治疗方式选择包括单支架植入（10.9%）、重叠支架植入（23.8%）、血流导向装置（FD）植入（11.9%）、单支架辅助弹簧圈（SAC）栓塞（31.7%）、重叠SAC栓塞（12.9%）、载瘤动脉闭塞（PAO）（8.4%）及FD辅助弹簧圈栓塞（0.5%）。随访率为82.7%。改良Rankin量表（mRS）评分为0.5±1.1。96例患者接受了DSA检查。PAO组、SAC重建组、支架植入组及FD植入组的完全闭塞率分别为100%、81.4%、56.7%及76.5%。
年轻患者发生SAH的概率较高，老年患者发生后循环梗死的概率较高。手术方案的选择应基于SAH病史、VA优势侧及PICA起源位置。
