LVIS支架在PICA起始部、基底动脉夹层动脉瘤中的应用
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摘要
目的探讨LVIS支架治疗椎动脉小脑下后动脉(PICA)起始部、基底动脉夹层动脉瘤的疗效。方法回顾性分析29例夹层动脉瘤病人的临床资料,动脉瘤位于椎动脉PICA起始部(椎动脉组)14例,基底动脉(基底动脉组)15例。栓塞结果依据Raymond分级评估,临床结果依据mRS评分评价。分析围手术期并发症及随访结果。结果动脉瘤完全栓塞5例,部分栓塞24例。椎动脉组和基底动脉组发生并发症各2、5例,其中死亡各1、2例,两组并发症发生率差异无统计学意义(P=0.390)。26例通过DSA检查及术后随访5~25个月,椎动脉组无进展病例,基底动脉组进展5例,差异显著(P=0.039);椎动脉组mRS评分预后良好12例,基底动脉组8例,预后良好率无明显差异(P=0.077)。结论基底动脉夹层动脉瘤容易进展,要严格随访,更有效的治疗方式需进一步探讨。
Objective To investigate the effect of LVIS stent for treating dissecting aneurysm at the origin of posterior inferior cerebellar artery( PICA) and the basilar artery. Methods Clinical data of 29 patients with dissecting aneurysm were analyzed retrospectively, including the aneurysm at the origin of PICA(vertebral artery group) in 14 and basilar artery aneusysm(basilar artery group) in 15. The embolism results were evaluated by Raymond classification, and clinical results evaluated by mRS. Otherwise, the periprocedural complications and follow-up results were recorded. Results Complete embolism was achieved in 5 patients and partial embolism in 24. The complications occurred in 2 patients in the vertebral artery group and in 5 in the basilar artery group, and died 1 and 2 respectively. No significant difference was found in complication rate between the two groups(P = 0.390). Twenty-six patients were performed DSA and followed up from 5 to 25 months, no progress was found in the vertebral artery group, and 5 patients had progress in the basilar artery group, and significant difference was found between the two groups(P = 0.039). Good prognosis was achieved 12 patients in vertebral artery group and 8 in basilar artery group by mRS, and there was no statistical difference between the two group(P = 0.077). Conclusion Basilar artery dissecting aneurysms are prone to progressing, and need to make strict follow-up.Otherwise, more effective treatment should be explored.
Objective To investigate the effect of LVIS stent for treating dissecting aneurysm at the origin of posterior inferior cerebellar artery( PICA) and the basilar artery. Methods Clinical data of 29 patients with dissecting aneurysm were analyzed retrospectively, including the aneurysm at the origin of PICA(vertebral artery group) in 14 and basilar artery aneusysm(basilar artery group) in 15. The embolism results were evaluated by Raymond classification, and clinical results evaluated by mRS. Otherwise, the periprocedural complications and follow-up results were recorded. Results Complete embolism was achieved in 5 patients and partial embolism in 24. The complications occurred in 2 patients in the vertebral artery group and in 5 in the basilar artery group, and died 1 and 2 respectively. No significant difference was found in complication rate between the two groups(P = 0.390). Twenty-six patients were performed DSA and followed up from 5 to 25 months, no progress was found in the vertebral artery group, and 5 patients had progress in the basilar artery group, and significant difference was found between the two groups(P = 0.039). Good prognosis was achieved 12 patients in vertebral artery group and 8 in basilar artery group by mRS, and there was no statistical difference between the two group(P = 0.077). Conclusion Basilar artery dissecting aneurysms are prone to progressing, and need to make strict follow-up.Otherwise, more effective treatment should be explored.
引文
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[10]LI H,LI X F,ZHANG X,et al.Treatment of unruptured vertebral dissecting aneurysms:internal trapping or stentassisted coiling[J].Int J Neurosci,2016,126(3):243-248.
[11]LIN N,BROUILLARD A M,KRISHNA C,et al:Use of coils in conjunction with the pipeline embolization device for treatment of intracranial aneurysms[J].Neurosurgery,2015,76(2):142-149.
[12]CHUNG Y,LEE S H,CHOI S K,et al.Triple stent therapy for the treatment of vertebral dissecting aneurysms:Efficacy and safety[J].World Neurosurg,2017,99:79-88.
[13]SHI L,XU K,SUN X,et al.Therapeutic progress in treating vertebral dissecting aneurysms involving the posterior inferior cerebellar artery[J].Int J Med Sci,2016,13(7):540-555.
[14]WANG J,LIU X F,LI B M,et al.Application of parallel stent placement in the treatment of unruptured vertebrobasilar fusiform aneurysms[J].J Neurosurg,2017,126(1):45-51.
[2]KIM B M,SHIN Y S,BAIK M W,et al.Pipeline embolization device for large/Giant or fusiform aneurysms:An initial multi-center experience in korea[J].Neurointervention,2016,11(1):10-17.
[3]SOENMEZ O,BRINJIKJI W,MURAD M H,et al.Deconstructive and reconstructive techniques in treatment of vertebrobasilar dissecting aneurysms:A systematic review and meta-analysis[J].Am J Neuroradiol,2015,36(7):1293-1298.
[4]阿西木江·阿西尔,卡合尔曼·卡德尔,买买提力·艾沙,等.基底动脉瘤的血管内治疗[J].中国微侵袭神经外科杂志,2016,21(1):27-30.
[5]AHMED O,STOREY C,KALAKOTI P,et al.Treatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device[J].Interv Neuroradiol,2015,21(4):434-440.
[6]ZHANG X,LI W,LV N,et al.Endovascular management of ruptured basilar artery dissection with two overlapping low-profile visualized intraluminal support stents[J].Interv Neuroradiol,2016,22(6):659-661.
[7]SERRONE J C,GOZAL Y M,GROSSMAN A W,et al.Vertebrobasilar fusiform aneurysms[J].Neurosurg Clin N Am,2014,25(3):471-484.
[8]WANG K,TIAN Z,CHEN J,et al.Risk Factors of recurrence after stent(s)-assisted coiling of intracranial vertebrobasilar dissecting aneurysms:A multicenter study[J].Front Neurol,2017,8:482.
[9]ZHAO K J,FANG Y B,HUANG Q H,et al.Reconstructive treatment of ruptured intracranial spontaneous vertebral artery dissection aneurysms:Long-term results and predictors of unfavorable outcomes[J].PLo S ONE.2013,8(6):e67169.
[10]LI H,LI X F,ZHANG X,et al.Treatment of unruptured vertebral dissecting aneurysms:internal trapping or stentassisted coiling[J].Int J Neurosci,2016,126(3):243-248.
[11]LIN N,BROUILLARD A M,KRISHNA C,et al:Use of coils in conjunction with the pipeline embolization device for treatment of intracranial aneurysms[J].Neurosurgery,2015,76(2):142-149.
[12]CHUNG Y,LEE S H,CHOI S K,et al.Triple stent therapy for the treatment of vertebral dissecting aneurysms:Efficacy and safety[J].World Neurosurg,2017,99:79-88.
[13]SHI L,XU K,SUN X,et al.Therapeutic progress in treating vertebral dissecting aneurysms involving the posterior inferior cerebellar artery[J].Int J Med Sci,2016,13(7):540-555.
[14]WANG J,LIU X F,LI B M,et al.Application of parallel stent placement in the treatment of unruptured vertebrobasilar fusiform aneurysms[J].J Neurosurg,2017,126(1):45-51.