【摘要】 目的探讨累及小脑后下动脉椎动脉夹层动脉瘤(VADA)Ⅱ型的治疗方法和各种介入治疗的疗效。方法收集70例VADAⅡ型病例,根据临床症状分为对照组(药物随访,12例)和介入治疗组(58例)。介入治疗组依据治疗方法分为闭塞组(14例)和血管重建组(44例)。血管重建组再根据支架方向的不同分为血管重建(单纯支架)A亚组、血管重建(支架方向VA-VA)B亚组和血管重建(支架方向VA-PICA)C亚组。回顾性分析和比较各组VADAⅡ型患者的临床资料、术后疗效和随访(平均2年)结果,结合复习文献资料进行探讨。结果 2年随访结果:对照组、闭塞组、血管重建A亚组和血管重建B亚组+C亚组的治愈率+改善率分别为18.2%、69.2%(9/13例)、47.1%(8/17例)和80.0%(16/20例);并发症发生率分别为18.2%(2/11例)、15.4%(2/13例)、11.8%(2/17例)和5.0%(1/20例)。血管重建组的单支架、双/多支架和密网支架治愈率+改善率分别为57.1%(12/21例)、69.2%(9/13例)和100%(3/3例);并发症发生率分别为9.5%(2/21例)、7.7%(1/13例)和0。结论 VADAⅡ型介入治疗的疗效较药物随访好;支架辅助动脉瘤栓塞的疗效较闭塞和单纯支架治疗好,但并发症发生率差异无显著性;不同数量和类型的支架,其疗效及并发症是否有差异需进一步研究。更多还原

【Abstract】 Aim To study the treatment methods for PICA-involving(type Ⅱ) vertebral artery dissecting aneurysm(VADA) and compare the efficacy of different endovascular procedures.Methods Between 2013 and 2015,70 patients with type Ⅱ VADA were treated at the authors’ institution.According to clinical symptoms,12 patients were received conservative drug treatment[drug follow-up(control) group]and 58 patients were treated with endovascular methods(intervention group),which were further divided into a vocclusion sub-group(14 patients) and a vascular reconstructive sub-group(44 patients).Results The cure and improvement rate of different treatment methods were 18.2%(conservative treatment),69.2%(occlusion),47.2%(stent) and 80%(stent-assisted embolization) after a a-year follow-up.Recurrence rate was 18.2%,15.4%,11.8%and 5.0%in the four groups,respectively.Among the different numbers and types of stent methods,the cure and improvement rate were 57.1%(single-stent),69.2%(dual/multi-stent) and 100%(flow-diverting stent).Recurrence rate was 9.5%,7.7%and zero in the three groups,respectively.Conclusion Endovascular treatment group had better outcome compared with conservative drug treatment group.And stent-assisted aneurysm embolization had a more favorable result compared with stent implantation.Further study with larger case series is necessary to validate whether different stent approaches have difference on efficacy and complications.更多还原