【摘要】 目的探讨不同血管内介入方式治疗已破裂颅内椎动脉夹层动脉瘤的可行性、安全性及临床疗效。方法2009年1月~2014年3月,血管内介入治疗17例患者共17个已破裂颅内椎动脉夹层动脉瘤。9个小脑下后动脉(PICA)近端的夹层动脉瘤采用椎动脉闭塞技术(电解脱弹簧圈联合机械微弹簧圈栓塞)闭塞夹层段椎动脉。2个累及PICA及6个PICA远端夹层动脉瘤采用单支架(n=6)或双支架(n=2)辅助弹簧圈栓塞技术重建夹层段椎动脉。术后评估夹层动脉瘤即刻闭塞程度,进行长期影像学及临床随访评估治疗效果。结果所有夹层动脉瘤均通过椎动脉闭塞或重建技术栓塞,手术技术成功率为100%,未发生术中出血、血栓形成等手术相关并发症。9例接受椎动脉闭塞技术患者术后病变即刻完全闭塞率达100%,1例患者术后出现患侧耳廓疼痛,1例患者出现复视,对症治疗1周内均缓解,1例患者出现患侧外展神经麻痹,2月后自行缓解。8例接受椎动脉重建技术患者术后病变即刻完全闭塞2例,次全闭塞6例,均无后循环缺血症状。所有患者随访6~36月,影像学及临床预后良好。结论根据夹层动脉瘤与PICA关系,选择相应的介入治疗方式治疗已破裂颅内椎动脉夹层动脉瘤是安全、有效的。更多还原

【Abstract】 Objective To explore the feasibility,safety,and effect of different endovascular strategies in treating ruptured intracranial vertebral artery dissection aneurysms.Methods A total of 17 patients with 17 ruptured intracranial vertebral artery dissection aneurysms(VADAs)were treated by endovascular embolization between January 2009 and March2014.9patients with PICA-proximal VADAs were treated by deconstructive technique.Guglielmi detachable coils were used to embolize the aneurysm lumen.Mechanical coils were used to embolize the parent artery.2patients with PICA-involving VADAs and 6patients with PICA-distal VADAs were treated by reconstructive technique.Single stent-assisted coil embolization technique was used to treat 6VADAs and double stent–assisted coil embolization technique was used to2 VADAs.Immediate obliteration grade was evaluated after treatment,imaging and clinical follow up were performed to evaluate the treatment effect.Results All the VADAs were successfully treated by deconstructive or reconstructive technique without bleeding,thrombogenesis,and any other complications.The VADAs of the 9patients who accepted deconstructive treatment were all immediate complete obliteration.1patient suffered from the affected side auricle pain,1patient had double vision,both symptoms turned better after symptomatic treatment in 1week.Abducens nerve paralysis was observed in 1patient and disappeared 2months later without treatment.For the 8patients who accepted reconstructive treatment,2VADAs were immediate complete obliteration,6VADAs were near-complete obliteration.The imaging and clinical manifestations were satisfying during the 6-36 month follow-up.Conclusion Endovascular treatment of ruptured intracranial VADAs according to the location of the PICA is safe and effective.更多还原