颅内椎动脉夹层动脉瘤血管内治疗方案的选择及围手术期并发症的相关因素分析

发布时间：2018-05-04 02:35

本文选题：椎动脉 + 夹层动脉瘤　；参考：《首都医科大学》2017年硕士论文

【摘要】：目的:分析影响颅内椎动脉夹层动脉瘤血管内治疗的手术方案选择和手术安全性的相关因素,探讨颅内椎动脉夹层动脉瘤的个体化、规范化治疗策略。方法:回顾性收集我院神经介入科及协作医院自2009年2月到2016年11月142例诊断为颅内椎动脉夹层动脉瘤的患者的临床资料,设定入组排除标准后125例连续性病例共133例椎动脉夹层动脉瘤纳入本研究。重点分析动脉瘤大小、占位大小、狭窄程度、是否破裂、是否累及小脑后下动脉以及对侧椎动脉的代偿是否良好等椎动脉夹层动脉瘤特点数据,将以上特点与治疗方案选择、围手术期缺血性并发症和出血性并发症进行单因素、多因素分析。结果:13例(9.77%)夹层动脉瘤实施了载瘤动脉闭塞术,120例(90.23%)进行了重建性手术;重建性手术中支架辅助弹簧圈栓塞93例(69.92%),单纯支架治疗11例(8.27%),密网支架治疗16例(12%)。术后缺血性并发症10例(8%),术中破裂或术后再出血6例(4.8%),抗血小板药物相关性出血4例(3.2%)。102例(82%)进行了2.03±1.63年的临床电话随访,其中74例(59%)患者进行了0.95±0.87年的影像学随访,良好预后(mRS2)率为85%,复发率为9%。患者在治疗方案选择方面,较高的狭窄率与累及PICA与载瘤动脉闭塞术密切相关。累及PICA和进行载瘤动脉闭塞术是缺血并发症发生的独立危险因素。较高的狭窄率和不完全栓塞是术中出血或术后再次破裂的独立危险因素。结论:对于颅内椎动脉夹层动脉瘤,经过个体化选择进行闭塞性手术或重建性手术的血管内治疗是安全有效的。对于伴发狭窄的颅内椎动脉夹层动脉瘤,如果病变不累及小脑后下动脉,更倾向于选择载瘤动脉闭塞术,但同时须警惕缺血并发症的风险。对伴发较高程度狭窄的椎动脉夹层动脉瘤进行治疗时和无法完全栓塞时应警惕出血并发症的风险。
[Abstract]:Objective: to analyze the factors that affect the choice of operative scheme and the safety of endovascular treatment of intracranial vertebral dissecting aneurysm, and to explore the individualized and standardized treatment strategy of intracranial vertebral dissecting aneurysm. Methods: the clinical data of 142 patients diagnosed as intracranial vertebral artery dissecting aneurysms from February 2009 to November 2016 were retrospectively collected. A total of 133 vertebral dissecting aneurysms were included in the study after the exclusion criteria were established in 125 consecutive cases. The characteristics of the aneurysm, such as the size of the aneurysm, the extent of stenosis, the rupture of the aneurysm, the involvement of the posterior inferior cerebellar artery and the compensatory effect of the contralateral vertebral artery, were analyzed. Ischemic and hemorrhagic complications during perioperative period were analyzed by single factor and multi-factor analysis. Results one hundred and twenty patients with dissecting aneurysms underwent reconstructive operation, 93 of them were embolized with coils, 11 were treated with stents alone, and 16 were treated with dense mesh stents, and 12 patients were treated with stent-assisted coils during reconstructive surgery, 11 patients with dissecting aneurysms were treated with occlusive aneurysms and 90.23patients were treated with stent-assisted coil embolization, 11 patients were treated with stents alone, and 16 patients were treated with dense mesh stents. 10 cases with ischemic complications, 6 cases with intraoperative rupture or postoperative rebleeding, and 4 cases with antiplatelet drug-associated hemorrhage were followed up by telephone for 2.03 卤1.63 years, 74 of whom were followed up for 0.95 卤0.87 years. The rate of good prognosis was 85% and the recurrence rate was 9%. The high rate of stenosis was closely related to the involvement of PICA and aneurysm occlusion. PICA involvement and aneurysm occlusion are independent risk factors for ischemic complications. High stenosis rate and incomplete embolization are independent risk factors for intraoperative bleeding or rerupture. Conclusion: for intracranial vertebral artery dissecting aneurysm, it is safe and effective to choose the endovascular treatment of occlusive operation or reconstruction operation. For intracranial vertebral artery dissecting aneurysms with stenosis, if the lesion does not involve the posterior inferior cerebellar artery, it is more likely to choose the aneurysm artery occlusion, but at the same time, the risk of ischemic complications should be warned. The risk of bleeding complications should be observed in the treatment of vertebral dissecting aneurysms with high degree of stenosis and in cases of incomplete embolization.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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