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目的探讨支架治疗破裂椎-基底动脉夹层动脉瘤的围手术期再出血风险及预后。方法收集23例患者共23枚椎-基底动脉夹层动脉瘤的临床资料,对比研究支架植入后破裂和未破裂动脉瘤的围手术期及预后情况。结果破裂的椎-基底动脉夹层动脉瘤共12例,均以自发性蛛网膜下腔出血(SAH)为主要临床表现,未破裂夹层动脉瘤共11例。单纯支架植入10例,支架辅助弹簧圈栓塞13例,支架植入均成功。破裂组和未破裂组介入治疗相关并发症的发生率分别为8.3%(1/12)和0%(0/11),破裂组出现1例术后24 h内非动脉瘤部位出血。随访的椎-基底动脉夹层动脉瘤,未破裂组:动脉瘤完全闭塞率为90.9%(10/11),部分闭塞率为9.1%(1/11);破裂组:动脉瘤完全闭塞率为50%(6/12),部分闭塞率为41.7%(5/12),无复发病例。随访过程中均无新发神经功能障碍出现。结论破裂椎-基底动脉夹层动脉瘤急性期术中应用支架不会显著增加围手术期再出血的风险,并可以改善患者的预后。推荐将支架作为破裂椎-基底动脉夹层动脉瘤治疗的重要手段。
Objective To investigate the risk and prognosis of perioperative hemorrhage after stent treatment of dissecting vertebral-basilar artery dissecting aneurysm. Methods The clinical data of 23 vertebro-basilar artery dissection aneurysms of 23 patients were collected. The perioperative and prognosis of ruptured and unruptured aneurysms after stenting were compared. Results A total of 12 cases of ruptured vertebrobasilar artery aneurysm were complicated with spontaneous subarachnoid hemorrhage (SAH). The unruptured dissection aneurysm was found in 11 cases. Simple stent implantation in 10 cases, stent-assisted coil embolization in 13 cases, stent implantation were successful. The incidences of interventional-related complications in ruptured and non-ruptured groups were 8.3% (1/12) and 0% (0/11), respectively, and in the rupture group, 1 occurred within 24 hours of non-aneurysmal hemorrhage. The follow-up vertebrobasilar artery aneurysm without rupture group had a complete occlusion rate of 90.9% (10/11) and a partial occlusion rate of 9.1% (1/11). In rupture group, the complete aneurysm occlusion rate was 50 % (6/12), partial occlusion rate was 41.7% (5/12), no recurrence. No new neurological dysfunction occurred during follow-up. Conclusion The application of scaffold during the acute stage of ruptured vertebral-basilar artery aneurysm will not significantly increase the risk of perioperative rebleeding and improve the prognosis of patients. Stent is recommended as an important means of treatment of ruptured vertebral-basilar artery aneurysm.