CAJ | 학술논문

目的评估血管内治疗小脑后下动脉起始部动脉瘤的有效性和安全性. 方法郑州大学人民医院脑血管介入治疗中心自2007年7月至2013年12月收治小脑后下动脉起始部动脉瘤患者24例,根据动脉瘤形态分为简单型(Ⅰ型)和复杂型(Ⅱ型),根据双侧小脑上动脉和对侧小脑后下动脉的发育、供血情况每型又分为a亚型和b亚型,依据不同分型选择合适的血管内介入治疗策略. 结果本组动脉瘤Ⅰ型11例,采用单纯弹簧圈栓塞术10例,闭塞载瘤动脉1例;其中Ⅰa型5例,结果4例完全栓塞,1例近完全栓塞;Ⅰb型6例,结果3例完全栓塞,1例近完全栓塞,部分栓塞2例.Ⅱ型13例,其中Ⅱa型6例,采用单纯弹簧圈栓塞术2例,双微导管栓塞技术1例,闭塞载瘤动脉1例,支架辅助栓塞治疗2例,结果完全栓塞2例,近完全栓塞2例,部分栓塞2例;Ⅱb型7例,采用单纯弹簧圈栓塞术2例,闭塞载瘤动脉1例,支架辅助栓塞治疗4例,结果完全栓塞2例(包括闭塞载瘤动脉1例),近完全栓塞3例,部分栓塞2例.1例栓塞过程中出血,1例闭塞小脑后下动脉动脉后出现短期吞咽困难.随访改良的Rankin量表(MRS)评分0～2分22例,3分2例. 结论血管内治疗小脑后下动脉起始部动脉瘤有较高的技术难度,术前合理的分型可为血管内治疗提供依据.
목적 평고혈관내치료소뇌후하동맥기시부동맥류적유효성화안전성. 방법 정주대학인민의원뇌혈관개입치료중심자2007년7월지2013년12월수치소뇌후하동맥기시부동맥류환자24례,근거동맥류형태분위간단형(Ⅰ형)화복잡형(Ⅱ형),근거쌍측소뇌상동맥화대측소뇌후하동맥적발육、공혈정황매형우분위a아형화b아형,의거불동분형선택합괄적혈관내개입치료책략. 결과 본조동맥류Ⅰ형11례,채용단순탄황권전새술10례,폐새재류동맥1례;기중Ⅰa형5례,결과4례완전전새,1례근완전전새;Ⅰb형6례,결과3례완전전새,1례근완전전새,부분전새2례.Ⅱ형13례,기중Ⅱa형6례,채용단순탄황권전새술2례,쌍미도관전새기술1례,폐새재류동맥1례,지가보조전새치료2례,결과완전전새2례,근완전전새2례,부분전새2례;Ⅱb형7례,채용단순탄황권전새술2례,폐새재류동맥1례,지가보조전새치료4례,결과완전전새2례(포괄폐새재류동맥1례),근완전전새3례,부분전새2례.1례전새과정중출혈,1례폐새소뇌후하동맥동맥후출현단기탄인곤난.수방개량적Rankin량표(MRS)평분0～2분22례,3분2례. 결론 혈관내치료소뇌후하동맥기시부동맥류유교고적기술난도,술전합리적분형가위혈관내치료제공의거.
Objective Surgical treatment of aneurysms of the postero-inferior cerebellar artery (PICA) is difficult and complication of lower cranial nerve palsies is common.These lesions can be approached easily with endovascular technique.But,endovascular treatment for proximal aneurysms of the PICA is complicated not only by the aneurysm shape,but also by the concerns of occlusion of perforating arteries origining from the brainstem.Aim of this study is to evaluate the treatment modality and outcome of these patients.Methods Between July 2007 and December 2013,records were reviewed of 24 proximal aneurysms of the PICA treated with endovascular techniques.The aneurysms were typed according to the morphology and collateral circulation for PICA (type Ⅰ:simple type; type Ⅱ:complex type).Different endovascular interventional therapy strategies were selected according to the typing.Results Of the 24 patients,type Ⅰ was noted in 11 patients,including 10 adopted simple coil embolization and 1 adopted parent artery occlusion; type Ⅰa included 5 patients,enjoying results of 4 complete occlusion and 1 subtotal occlusion; type Ⅰb included 6 patients,enjoying results of 3 complete occlusion,1 subtotal occlusion and 2 partial occlusion; type Ⅱ was noted in 13 patients; type Ⅱa included 6 patients,and 2 adopted simple coil embolization,1 adopted dual micro-catheter embolization,1 adopted parent artery occlusion and 2 adopted stent-assisted embolization,enjoying results of 2 complete occlusion,2 subtotal occlusion and 2 partial occlusion; type Ⅱb included 7 patients,2 adopted simple coil embolization,1 adopted parent artery occlusion and 4 adopted stent-assisted embolization,enjoying results of 2 complete occlusion,3 subtotal occlusion and 2 partial occlusion; procedural rupture occurred in 1 aneurysm mainly caused by the microcatheter,leading to no death and permanent disability.One patient treated with deliberate PICA origin occlusion developed temporary dysphagia.The mean follow-up was 26 months,with modified Rankin Scale (mRS) scores of 0-2 in 22 patients and mRS scores of 3 in 2.Conclusion Proximal PICA aneurysms were challenging for endovascular treatment,and treatment can be more effective and safer when appropriate endovascular interventional therapy is selected according to the typing of aneurysm.