Gurian J H, Viñuela F, Gobin Y P, Waston V E, Duckwiler G R, Gulielmi G
Neuroradiology/Endovascular Therapy Service, University of California Los Angeles Center for the Health Sciences, USA.
Neurosurgery. 1995 Dec;37(6):1216-20; discussion 1220-1. doi: 10.1227/00006123-199512000-00025.
We report a patient with rupture of a giant distal vertebral artery aneurysm after balloon occlusion of the parent vertebral artery. We were able to occlude the residual lumen by endosaccular embolization and trapping with Guglielmi detachable coils via the anterior circulation. We suspect that either alterations in flow patterns or partial thrombosis of the aneurysm may have contributed to at least two subarachnoid hemorrhages within 2 days after the initial embolization. We still considered endovascular parent vessel sacrifice to be an excellent therapeutic option, particularly in distal vertebral aneurysms. We recommend a detailed evaluation of angiographic flow patterns and aneurysm patency during test occlusion. If the aneurysm continues to fill from the collateral circulation, or if marked alterations in flow patterns are present, aneurysm trapping or concurrent endosaccular embolization and parent vessel sacrifice may be necessary. Certainly, continued surveillance is required as long as any residual aneurysm is present.
我们报告了1例在椎动脉主干球囊闭塞后发生巨大椎动脉远端动脉瘤破裂的患者。我们通过前循环，采用 Guglielmi 可解脱弹簧圈进行瘤内栓塞和圈套术，成功闭塞了残余瘤腔。我们怀疑，血流模式的改变或动脉瘤的部分血栓形成，可能是初次栓塞后2天内至少发生2次蛛网膜下腔出血的原因。我们仍然认为血管内牺牲载瘤血管是一种很好的治疗选择，尤其是对于椎动脉远端动脉瘤。我们建议在试验性闭塞期间，对血管造影的血流模式和动脉瘤通畅情况进行详细评估。如果动脉瘤持续从侧支循环供血，或者存在明显的血流模式改变，则可能需要进行动脉瘤圈套术或同时进行瘤内栓塞和牺牲载瘤血管。当然，只要存在任何残余动脉瘤，就需要持续监测。
