颅内后循环动脉瘤血管内治疗策略及疗效分析
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摘要
目的随访观察血管内治疗颅内后循环动脉瘤的临床疗效,进一步探讨后循环动脉瘤血管内治疗策略及安全性。方法回顾性分析2013年7月至2017年6月采用血管内介入方法治疗的26例后循环动脉瘤患者临床资料。其中蛛网膜下腔出血23例;5例为多发性动脉瘤,1例为伴发硬脑膜动静脉瘘。瘤体位于椎-基底动脉12例,基底动脉顶端4例,大脑后动脉2例,小脑上动脉4例,小脑后下动脉4例。结果所有患者手术均获成功。采用支架辅助技术13例,单纯弹簧圈闭塞动脉瘤及载瘤动脉5例,单纯弹簧圈选择性栓塞2例,微导管辅助栓塞2例,Onyx-18胶闭塞动脉瘤及载瘤动脉1例,单纯支架成形3例。术后1例出现间歇性呛咳症状,1例吞咽功能障碍,均经康复治疗后好转;1例术后20 d死亡;其他患者无新发神经功能缺损。出院时改良Rankin量表(m RS)评分0分20例,1分5例,6分1例。术后随访3~12个月,24例恢复良好,1例m RS评分明显改善,无患者需二次栓塞治疗。结论颅内后循环动脉瘤多为复杂性动脉瘤,血管内治疗安全有效。术中需根据动脉瘤位置、形态、大小、数量及侧支循环等选择相应治疗方案。
Objective To evaluate the curative effect of endovascular therapy in treating intracranial posterior circulation aneurysms, and to make a further discussion on its therapeutic strategy and safety.Methods The clinical data of 26 patients with intracranial posterior circulation aneurysm, who were treated with endovascular therapy during the period from July 2013 to June 2017, were retrospectively analyzed.Among the 26 patients, subarachnoid hemorrhage was found in 23 patients; 5 patients had multiple aneurysms and dural arteriovenous fistula was complicated in one of them. The aneurysms were located at the vertebral-basilar artery(n=12), the apex of basilar artery(n=4), posterior cerebral artery(n=2), superior cerebellar artery(n =4), and posterior inferior cerebellar artery(n =4). Results Successful procedure was accomplished in all patients. Stent-assisted technique was used in 13 patients, obstruction of both aneurysm and parent artery with simple coils was employed in 5 patients, selective embolization with spring coils only was performed in 2 patients, microcatheter-assisted embolization was used in 2 patients, obstruction of both aneurysm and parent artery with Onyx-18 glue was adopted in one patient, and simple endovascular stent angioplasty was carried out in 3 patients. After treatment, one patient developed intermittent coughing and another patient developed swallowing dysfunction, the symptoms were improved in both patients after rehabilitation. One patient died at 20 days after treatment. No newly-developed neurologic impairment occurred in other patients. At discharge from hospital, modified Rankin scale(m RS) score testing showed that 0 point was seen in 20 patients, one point in 5 patients, and 6 points in one patient. The patients were followed up for 3-12 months, and 24 patients recovered well, in one patient the m RS score was significantly improved, and no patient needed to receive secondary embolization therapy. Conclusion Most intracranial posterior circulation aneurysms are complex ones, and endovascular treatment is safe and effective for them.The formulation of proper and suitable therapeutic scheme should be based on the location, shape, size,quantity and collateral circulation of the aneurysm.
Objective To evaluate the curative effect of endovascular therapy in treating intracranial posterior circulation aneurysms, and to make a further discussion on its therapeutic strategy and safety.Methods The clinical data of 26 patients with intracranial posterior circulation aneurysm, who were treated with endovascular therapy during the period from July 2013 to June 2017, were retrospectively analyzed.Among the 26 patients, subarachnoid hemorrhage was found in 23 patients; 5 patients had multiple aneurysms and dural arteriovenous fistula was complicated in one of them. The aneurysms were located at the vertebral-basilar artery(n=12), the apex of basilar artery(n=4), posterior cerebral artery(n=2), superior cerebellar artery(n =4), and posterior inferior cerebellar artery(n =4). Results Successful procedure was accomplished in all patients. Stent-assisted technique was used in 13 patients, obstruction of both aneurysm and parent artery with simple coils was employed in 5 patients, selective embolization with spring coils only was performed in 2 patients, microcatheter-assisted embolization was used in 2 patients, obstruction of both aneurysm and parent artery with Onyx-18 glue was adopted in one patient, and simple endovascular stent angioplasty was carried out in 3 patients. After treatment, one patient developed intermittent coughing and another patient developed swallowing dysfunction, the symptoms were improved in both patients after rehabilitation. One patient died at 20 days after treatment. No newly-developed neurologic impairment occurred in other patients. At discharge from hospital, modified Rankin scale(m RS) score testing showed that 0 point was seen in 20 patients, one point in 5 patients, and 6 points in one patient. The patients were followed up for 3-12 months, and 24 patients recovered well, in one patient the m RS score was significantly improved, and no patient needed to receive secondary embolization therapy. Conclusion Most intracranial posterior circulation aneurysms are complex ones, and endovascular treatment is safe and effective for them.The formulation of proper and suitable therapeutic scheme should be based on the location, shape, size,quantity and collateral circulation of the aneurysm.
引文
[1]Eller JL,Dumont TM,Mokin M,et al.Endovascular treatment of posterior ciculation aneurysms[J].Neurol Res,2014,36:339-343.
[2]李进一,管生,徐浩文,等.颅内椎动脉夹层动脉瘤介入治疗个体因素分析[J].介入放射学杂志,2016,25:377-381.
[3]Lindner SH,Bor AS,Rinkel GJ.Differences in risk factors according to the site of intracranial aneurysms[J].J Neurol Neurosurg Psychiatry,2010,81:116-118.
[4]王泽群,何旭英,李西锋,等.介入栓塞基底动脉顶端动脉瘤临床治疗策略[J].介入放射学杂志,2016,25:294-297.
[5]Madaelil TP,Wallace AN,Chatterjee AN,et al.Endovascular parent vessel sacrifice in ruptured dissecting vertebral and posterior inferior cerebellar artery aneurysms:clinical outcomes and review of the literature[J].J Neurointerv Surg,2016,8:796-801.
[6]李钊硕,李天晓,薛绛宇,等.介入治疗基底动脉夹层动脉瘤效果分析[J].介入放射学杂志,2016,25:478-482.
[7]Kim M,Levy EI,Meng H,et al.Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm[J].Neurosurgery,2007,61:1305-1312.
[8]Suh SH,Kim BM,Chung TS,et al.Reconstructive endovascular treatment of intracranial fusiform aneurysms:a 1-stage procedure with stent and balloon[J].AJNR Am J Neuroradiol,2010,31:155-160.
[9]Guerrero WR,Ortega-Gutierrez S,Hayakawa M,et al.Endovascular treatment of ruptured vertebrobasilar dissecting aneurysms using flow diversion embolization devices:singleinstitution experience[J].World Neurosurg,2018,109:e164-e169.
[10]Malek AM,Higashida RT,Phatouros CC,et al.Stent angioplasty for cervical carotid artery stenosis in high-risk symptomatic NASCET-ineligible patients[J].Stroke,2000,31:3029-3033.
[11]Lim SH,Shin HS,Lee SH,et al.Endovascular treatment of vertebral artery dissecting aneurysms that cause subarachnoid hemorrhage:consideration of therapeutic approaches relevant to the angioarchitecture[J].J Korean Neurosurg Soc,2015,58:175-183.
[12]Hamada J,Morioka M,Yano S,et al.Clinical features of aneurysms of the posterior cerebral artery:a 15-year experience with 21 cases[J].Neurosurgery,2005,56:662-670.
[13]Sawlani V,Handique A,Phadke RV.Endovascular parent artery occlusion in a fusiform aneurysm of posterior cerebral artery[J].Clin Radiol,2004,59:954-960.
[14]Jin SC,Park ES,Kwon DH,et al.Endovascular and microsurgical treatment of superior cerebellar artery aneurysms[J].J Cerebrovasc Endovasc Neurosurg,2012,14:29-36.
[15]Williamson RW,Wilson DA,Abla AA,et al.Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms:a comparative analysis[J].J Neurosurg,2015,123:441-445.
[2]李进一,管生,徐浩文,等.颅内椎动脉夹层动脉瘤介入治疗个体因素分析[J].介入放射学杂志,2016,25:377-381.
[3]Lindner SH,Bor AS,Rinkel GJ.Differences in risk factors according to the site of intracranial aneurysms[J].J Neurol Neurosurg Psychiatry,2010,81:116-118.
[4]王泽群,何旭英,李西锋,等.介入栓塞基底动脉顶端动脉瘤临床治疗策略[J].介入放射学杂志,2016,25:294-297.
[5]Madaelil TP,Wallace AN,Chatterjee AN,et al.Endovascular parent vessel sacrifice in ruptured dissecting vertebral and posterior inferior cerebellar artery aneurysms:clinical outcomes and review of the literature[J].J Neurointerv Surg,2016,8:796-801.
[6]李钊硕,李天晓,薛绛宇,等.介入治疗基底动脉夹层动脉瘤效果分析[J].介入放射学杂志,2016,25:478-482.
[7]Kim M,Levy EI,Meng H,et al.Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm[J].Neurosurgery,2007,61:1305-1312.
[8]Suh SH,Kim BM,Chung TS,et al.Reconstructive endovascular treatment of intracranial fusiform aneurysms:a 1-stage procedure with stent and balloon[J].AJNR Am J Neuroradiol,2010,31:155-160.
[9]Guerrero WR,Ortega-Gutierrez S,Hayakawa M,et al.Endovascular treatment of ruptured vertebrobasilar dissecting aneurysms using flow diversion embolization devices:singleinstitution experience[J].World Neurosurg,2018,109:e164-e169.
[10]Malek AM,Higashida RT,Phatouros CC,et al.Stent angioplasty for cervical carotid artery stenosis in high-risk symptomatic NASCET-ineligible patients[J].Stroke,2000,31:3029-3033.
[11]Lim SH,Shin HS,Lee SH,et al.Endovascular treatment of vertebral artery dissecting aneurysms that cause subarachnoid hemorrhage:consideration of therapeutic approaches relevant to the angioarchitecture[J].J Korean Neurosurg Soc,2015,58:175-183.
[12]Hamada J,Morioka M,Yano S,et al.Clinical features of aneurysms of the posterior cerebral artery:a 15-year experience with 21 cases[J].Neurosurgery,2005,56:662-670.
[13]Sawlani V,Handique A,Phadke RV.Endovascular parent artery occlusion in a fusiform aneurysm of posterior cerebral artery[J].Clin Radiol,2004,59:954-960.
[14]Jin SC,Park ES,Kwon DH,et al.Endovascular and microsurgical treatment of superior cerebellar artery aneurysms[J].J Cerebrovasc Endovasc Neurosurg,2012,14:29-36.
[15]Williamson RW,Wilson DA,Abla AA,et al.Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms:a comparative analysis[J].J Neurosurg,2015,123:441-445.