目的 探讨不同的血管内介入治疗方式治疗破裂椎动脉颅内段夹层动脉瘤的疗效及安全性。 方法 回顾性分析自2020年1月至2023年6月中国科学技术大学附属第一医院神经外科收治的25例破裂椎动脉颅内段夹层动脉瘤患者（25个动脉瘤）资料。所有患者均根据动脉瘤位置等情况采用动脉瘤及载瘤动脉闭塞或支架辅助弹簧圈栓塞治疗，采用Raymond分级评估动脉瘤术后即刻栓塞程度，记录患者围手术期不良事件发生情况。随访6~48个月，根据DSA复查结果判断动脉瘤有无复发；采用改良Rankin量表（mRS）评分评估患者预后，0~2分为预后良好，3~6分为预后不良。 结果 25例均为单侧破裂椎动脉颅内段夹层动脉瘤，动脉瘤及载瘤动脉闭塞（闭塞夹层节段）10例，支架辅助弹簧圈栓塞15例。术后即刻Ⅰ级栓塞19例，Ⅱ级栓塞4例，Ⅲ级栓塞2例。术中无破裂出血及支架内血栓形成事件，术后死亡3例，死亡原因分别为术后再出血1例，术后出现小脑梗死合并呼吸衰竭1例，基础疾病多合并重症肺炎死亡1例。存活的22例患者中预后良好18例，预后不良4例。5例患者复发（均为支架辅助弹簧圈栓塞患者），4例接受再次介入治疗；1例瘤颈处少量显影，且再次复查相对稳定，定期随访中。 结论 本研究结果初步显示，非优势椎动脉且不累及大脑后下动脉的动脉瘤可选择动脉瘤及载瘤动脉闭塞的治疗方式，复发率较支架辅助弹簧圈栓塞治疗患者低。 Objective To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA)。 Methods A retrospective analysis was performed 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery， First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023， were chosen。 Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms， degrees of aneurysm immediate embolization were evaluated by Raymond grading， and perioperative adverse events were recorded。 The patients were followed up for 6-48 months， and aneurysm recurrence was determined according to DSA results prognoses were assessed by modified Rankin Scale (mRS)， with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis。 Results All 25 patients had unilateral ruptured IVADA， 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization。 Immediately after surgery， 19 patients (76%) had grading I embolization， 4 (16%) grading II embolization， and 2 (8%) grading III embolization。 No aneurysm rupture or stent related thrombosis was observed during procedure 3 patients (12%) died after procedure， with postoperative rebleeding in 1， postoperative cerebellar infarction with respiratory failure in 1， and severe pneumonia in 1。 In the 22 survivals， 18 had good prognosis and 4 had poor prognosis。 In the 5 relapsed patients (all accepted stent-assisted embolization)， 4 underwent re-intervention， and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up。 Conclusion Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery， whose recurrence rate is lower than that of stent-assisted coil embolization。
Safety and strategy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm
Objective To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA). Methods A retrospective analysis was performed 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery, First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023, were chosen. Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms, degrees of aneurysm immediate embolization were evaluated by Raymond grading, and perioperative adverse events were recorded. The patients were followed up for 6-48 months, and aneurysm recurrence was determined according to DSA results prognoses were assessed by modified Rankin Scale (mRS), with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis. Results All 25 patients had unilateral ruptured IVADA, 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization. Immediately after surgery, 19 patients (76%) had grading I embolization, 4 (16%) grading II embolization, and 2 (8%) grading III embolization. No aneurysm rupture or stent related thrombosis was observed during procedure 3 patients (12%) died after procedure, with postoperative rebleeding in 1, postoperative cerebellar infarction with respiratory failure in 1, and severe pneumonia in 1. In the 22 survivals, 18 had good prognosis and 4 had poor prognosis. In the 5 relapsed patients (all accepted stent-assisted embolization), 4 underwent re-intervention, and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up. Conclusion Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery, whose recurrence rate is lower than that of stent-assisted coil embolization.
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