中国卒中杂志
中國卒中雜誌
중국졸중잡지
CHINESE JOURNAL OF STROKE
2014年
8期
645-653
,共9页
李晓青%马宁%莫大鹏%高峰%孙瑄%徐晓彤%刘恋%宋立刚%赵性泉%缪中荣
李曉青%馬寧%莫大鵬%高峰%孫瑄%徐曉彤%劉戀%宋立剛%趙性泉%繆中榮
리효청%마저%막대붕%고봉%손선%서효동%류련%송립강%조성천%무중영
颅内外动脉狭窄%血管内治疗%动脉瘤
顱內外動脈狹窄%血管內治療%動脈瘤
로내외동맥협착%혈관내치료%동맥류
Cerebral artery stenosis%Endovascular treatment%Unruptured intracranial aneurysm
目的探索颅内外动脉狭窄合并颅内无症状动脉瘤的安全和有效的血管内治疗策略。方法回顾性分析北京天坛医院急诊介入科2012年9月～2013年8月收住的因颅内外动脉狭窄拟行支架治疗且合并颅内无症状动脉瘤的患者26例。对其临床、影像学资料、治疗措施及结果、并发症及预后等进行分析。结果26例患者共发现≥70%的狭窄或闭塞病变54处，动脉瘤30枚（非同流域16枚，狭窄后7枚，狭窄处3枚，狭窄前4枚）。26例患者中21例实施了狭窄病变的支架置入术，共干预25个狭窄/闭塞病变，技术成功率100%。选择个体化的动脉瘤干预措施：16例患者的17枚动脉瘤（非同流域、直径＜5 mm、夹层）建议随访观察；2例患者的2枚动脉瘤（直径＞5 mm、形状不规则）择期行栓塞术；5例患者的6枚动脉瘤（狭窄后、狭窄处、多发性、直径＞5 mm、后交通段）同期行栓塞术或支架覆盖；3例患者的5枚动脉瘤（狭窄后、分叶状、多发性、直径＞5 mm）建议介入治疗但因家属拒绝手术等原因选择随访观察。术后发生脑室出血1例。临床随访10～21个月，所有患者均预后良好，仅发现无症状性支架内再狭窄1例。结论颅内外动脉狭窄合并颅内无症状动脉瘤时根据动脉瘤与狭窄病变的位置关系，动脉瘤大小、形态、位置、数量和患者情况等综合分析后给予个体化血管内治疗安全、有效。
目的探索顱內外動脈狹窄閤併顱內無癥狀動脈瘤的安全和有效的血管內治療策略。方法迴顧性分析北京天罈醫院急診介入科2012年9月～2013年8月收住的因顱內外動脈狹窄擬行支架治療且閤併顱內無癥狀動脈瘤的患者26例。對其臨床、影像學資料、治療措施及結果、併髮癥及預後等進行分析。結果26例患者共髮現≥70%的狹窄或閉塞病變54處，動脈瘤30枚（非同流域16枚，狹窄後7枚，狹窄處3枚，狹窄前4枚）。26例患者中21例實施瞭狹窄病變的支架置入術，共榦預25箇狹窄/閉塞病變，技術成功率100%。選擇箇體化的動脈瘤榦預措施：16例患者的17枚動脈瘤（非同流域、直徑＜5 mm、夾層）建議隨訪觀察；2例患者的2枚動脈瘤（直徑＞5 mm、形狀不規則）擇期行栓塞術；5例患者的6枚動脈瘤（狹窄後、狹窄處、多髮性、直徑＞5 mm、後交通段）同期行栓塞術或支架覆蓋；3例患者的5枚動脈瘤（狹窄後、分葉狀、多髮性、直徑＞5 mm）建議介入治療但因傢屬拒絕手術等原因選擇隨訪觀察。術後髮生腦室齣血1例。臨床隨訪10～21箇月，所有患者均預後良好，僅髮現無癥狀性支架內再狹窄1例。結論顱內外動脈狹窄閤併顱內無癥狀動脈瘤時根據動脈瘤與狹窄病變的位置關繫，動脈瘤大小、形態、位置、數量和患者情況等綜閤分析後給予箇體化血管內治療安全、有效。
목적탐색로내외동맥협착합병로내무증상동맥류적안전화유효적혈관내치료책략。방법회고성분석북경천단의원급진개입과2012년9월～2013년8월수주적인로내외동맥협착의행지가치료차합병로내무증상동맥류적환자26례。대기림상、영상학자료、치료조시급결과、병발증급예후등진행분석。결과26례환자공발현≥70%적협착혹폐새병변54처，동맥류30매（비동류역16매，협착후7매，협착처3매，협착전4매）。26례환자중21례실시료협착병변적지가치입술，공간예25개협착/폐새병변，기술성공솔100%。선택개체화적동맥류간예조시：16례환자적17매동맥류（비동류역、직경＜5 mm、협층）건의수방관찰；2례환자적2매동맥류（직경＞5 mm、형상불규칙）택기행전새술；5례환자적6매동맥류（협착후、협착처、다발성、직경＞5 mm、후교통단）동기행전새술혹지가복개；3례환자적5매동맥류（협착후、분협상、다발성、직경＞5 mm）건의개입치료단인가속거절수술등원인선택수방관찰。술후발생뇌실출혈1례。림상수방10～21개월，소유환자균예후량호，부발현무증상성지가내재협착1례。결론로내외동맥협착합병로내무증상동맥류시근거동맥류여협착병변적위치관계，동맥류대소、형태、위치、수량화환자정황등종합분석후급여개체화혈관내치료안전、유효。
Objective To explore the safe and effective intervention strategies in the treatment of cerebral artery stenosis with unruptured intracranial aneurysm. Methods We performed a retrospective review of all patients with cerebral artery stenosis who underwent stenting in Beijing Tiantan Hospital between September 2012 and August 2013. Twenty six patients were found to have unruptured intracranial aneurysm. The clinical and imaging data, treatment measures and results, complications, and prognosis were analyzed. Results Twenty six patients found 54 narrow/occluded lesions and 30 aneurysms (16 in the other basin, 7 after the narrow, 3 on the narrow, 4 before the narrow). Twenty one patients (25 narrow/occluded lesions) placed stents with the technical success rate of 100%. Choose individualized aneurysm intervention measures: 16 patients (17 aneurysms) (in the other basin, diameter less than 5 mm, artery dissection on the narrow) with follow-up observation; 2 patients (2 aneurysms) (diameter greater than 5 mm, irregular shape) were successfully treated with endovascular coiling later; 5 patients (6 aneurysms) (after the narrow, on the narrow, multiple, diameter greater than 5 mm, C7) were successfully treated with endovascular coiling or stenting at the corresponding period; 3 patients (5 aneurysms) (after the narrow, on the narrow, multiple, diameter greater than 5 mm) were advised to undergo endovascular coiling but chose follow-up observation. Perioperativecomplications occured in 1 case, intraventricular hemorrhage after stenting. Twenty six cases are with good prognosis. In the process of 10~21 months' follow-up, 1 case was found stent restenosis without symptoms. Conclusion Individualized treatment should be performed in cerebral artery stenosis with unruptured intracranial aneurysm according to the relationship between the location of aneurysm and narrow, size, shape, location, quantity, and the clinical situation, etc.
