【摘要】目的 总结椎基底动脉夹层动脉瘤的诊断和血管内治疗经验。 方法 采用血管内介入治疗椎基底动脉夹层动脉瘤 45例，其中支架辅助弹簧圈栓塞31例，单纯支架置入8例，夹层责任动脉单纯弹簧圈闭塞6例。 结果 44例病人于治疗后1～46个月获造影随访，平均16.3个月。临床症状均不同程度改善，无再出血。26例支架辅助弹簧圈即刻致密栓塞的病人，动脉瘤未再显影;5例即刻大部栓塞者中，瘤体扩大、复发1例。7例单纯支架置入病人中，可见进行性血栓形成3例，无明显变化3例，另1例双BX支架重叠置入者支架狭窄变形，椎动脉闭塞。6例责任动脉闭塞病人，闭塞效果均切实。 结论 血管内治疗是椎基底动脉夹层动脉瘤理想的选择。
【关键词】 颅内动脉瘤 基底动脉 支架 栓塞 治疗性
Endovascular management for vertebrobasilar dissecting aneurysms
Abstract: Objective To summarize experiences in diagnosis and endovascular management for vertebrobasilar dissecting aneurysms (VDAs). Methods Endovascular interventional procedures were adopted in totally 45 VDA patients, including stent-coil embolization in 31, stent implantation alone in 8, and simple embolization with coils in 6. Results Forty-four cases were followed-up angiographically from 1 month to 46 months (mean 16.3). All clinical symptoms were improved to different extents, and no hemorrhage recurred. Follow-up showed disappearance of all the aneurysms in 26 patients whose aneurysm was densely packed by stent-assisted coiling. Recurrence was found in 1 case of 5 partially packed aneurysms. In the 7 cases treated by stent implantation alone, progressive thrombosis and no regrowth of the aneurysm were found in 3 cases each, and the rest one which had double BX-stent placement suffered vertebral artery occlusion owing to stent deformation. Stable occlusion was demonstrated in 6 patients whose parent artery was embolized with coil alone. Conclusion Endovascular treatment is the ideal choice to treat the VDAs.
Key words: intracranial aneursm; basilar artery; stents; embolization, therapeutic
2000年12月~2006年3月，我科运用血管内介入技术治疗椎基底动脉夹层动脉瘤 (VDA) 45例，现总结报告如下。
1 对象与方法
1.1 一般资料 男28例，女17例;年龄20～70岁，平均40.5岁。高血压病史14例，头颈部外伤史1例。临床表现为头痛42例，眩晕3例;合并短暂意识丧失6例，伴行走不稳、吞咽困难和对侧浅感觉减退2例。
1.2 神经影像检查 均行头颅CT及DSA检查。术前行MRI检查23例，MRA检查11例。头颅CT示环池蛛网膜下腔出血或合并脑室积血42例，无特殊表现3例。MRI显示双腔征1例，内膜瓣2例，动脉壁内血肿1例;MRA显示均呈瘤样扩张，其中近端伴狭窄4例。42例
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