摘要
目的:总结椎-基底动脉夹层动脉瘤（VBDA）介入栓塞治疗的效果。方法:回顾性分析2014年4月至2018年4月厦门大学附属中山医院收治的37例VBDA患者（32枚VBDA病灶）的临床资料，包括一般资料、动脉瘤特征和围术期并发症发生情况等，记录患者出院时及随访6个月时的临床预后，采用改良Rankin量表（mRS）评价患者术后预后情况。结果:37例患者中男性24例，女性13例，年龄为54（24~78）岁。接受介入治疗29例，拒绝手术8例。32枚VBDA病灶中25枚接受支架辅助弹簧圈栓塞治疗，3枚行单纯弹簧圈栓塞治疗，4枚行动脉瘤及载瘤动脉闭塞术。所有患者均在早期行介入治疗（＜72 h）。术后随访过程中共有4枚出现复发，再次行介入治疗，其余均保持稳定。椎动脉夹层动脉瘤随访中预后极好13例，好3例，差1例，死亡0例；基底动脉夹层动脉瘤随访中预后极好7例，好2例，差3例，死亡0例。椎动脉夹层动脉瘤入院时Hunt-Hess分级越低者预后越好（H=7.566，P=0.006），基底动脉夹层动脉瘤入院时Hunt-Hess分级、世界神经外科联盟（WFNS）分级越低者预后越好（H=5.666，P=0.017）。另外，VBDA患者入院时Hunt-Hess分级为0～Ⅲ级组预后极好的比例明显高于Ⅳ～Ⅴ组，比例分别为90.0% vs 22.2%，P=0.001。结论:VBDA的介入治疗是安全有效的，可降低术后再出血风险，没有明显的手术并发症，并有良好的随访结果，且术前较低的Hunt-Hess分级能获得良好的临床结果。另外，早期栓塞不影响临床结果，但降低了再出血的风险。
Abstract
Objective:To evaluate the efficacy of endovascular treatment of vertebrobasilar dissecting aneurysm (VBDA).Methods:Thirty-seven patients with dissecting aneurysms in the vertebrobasilar artery admitted to Zhongshan Hospital Affiliated to Xiamen University from April 2014 to April 2018 were analyzed retrospectively. The demographic data, the characteristics of aneurysms, and the incidence of perioperative complications in the patients were collected. The clinical prognosis of the patients at discharge and 6 months of follow-up were recorded, and the modified Rankin scale (mRS) was used to evaluate the postoperative outcomes.Results:Among the 37 patients, there were 24 men and 13 women with a mean age of 54 years (range 24-78 years). Endovascular treatments were applied in a total of 29 patients, and the other 8 refused surgery. The study included 32 VBDA, of which 25 were treated with stent-coil embolization, 3 with pure coil embolization, and 4 with permanent occlusion of vertebral artery dissecting aneurysms and/or vertebral artery. All patients underwent early endovascular treatment (＜72 h). During the postoperative follow-up, 4 cases recurred and underwent interventional treatment again, and the rest remained stable. In the follow-up of the vertebral artery and the basilar artery dissecting aneurysm, the prognosis was excellent in 13 cases and 7 cases; good in 3 cases and 2 cases; poor in 1 case and 3 cases; and no cases of deaths have been reported, respectively; and the lower the Hunt-Hess grade at admission for vertebral artery dissection aneurysm, the better the prognosis (H=7.566, P=0.006), and the lower the Hunt-Hess grade and the World Federation of Neurosurgical Societies (WFNS）grade at admission for basilar artery dissection aneurysm, the better the prognosis (H=5.666, P=0.017). In addition, the proportion of VBDA patients with Hunt-Hess grade 0 -Ⅲ at admission was a better outcome than that in the Ⅳ-Ⅴ group,with 90.0% vs 22.2%, P=0.001, respectively.Conclusion:Endovascular interventional procedures of vertebrobasilar dissecting aneurysms are applicable to most patients. They can prevent rebleeding safely and effectively without significant complications, showing a good follow-up outcome. Low preoperative Hunt-Hess grade can predict favorable clinical outcomes. In addition, early embolization can not affect clinical outcomes, but reduce the risk of rebleeding.
基金项目
福建省自然科学基金(2019J01562)
贵阳市高层次创新型青年卫生人才培养计划项目([2021]筑卫健科技合同字第24号)
万方数据