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目的:评价血管内介入治疗椎动脉夹层动脉瘤的技术方法及临床疗效。方法:应用血管内介入治疗技术对29例椎动脉夹层动脉瘤的患者进行治疗,回顾性分析临床资料、血管内治疗方法以及临床疗效。结果:29例患者中有19例直接闭塞动脉瘤和载瘤动脉,5例行支架置入,5例行支架辅助弹簧圈栓塞。术后21例患者接受随访,随访时间为3～24个月,平均8个月。其中14例闭塞动脉瘤和载瘤动脉患者复查示动脉瘤未显影,3例支架辅助弹簧圈栓塞患者中1例复发,2例单支架置入患者复查示1例动脉瘤完全消失而另1例仍有动脉瘤残留,2例双支架置入患者复查示1例动脉瘤完全消失,另1例动脉瘤缩小。结论:将载瘤动脉连同动脉瘤完全闭塞是血管内治疗以破裂出血起病的椎动脉夹层动脉瘤最有效的方法。如果动脉瘤位于优势椎动脉,或动脉瘤体累及小脑后下动脉,使用支架置入技术是可供的选择。
Objective: To evaluate the technique and clinical efficacy of endovascular interventional treatment of dissecting aneurysm of vertebral artery. Methods: Twenty - nine patients with intervertebral aneurysm were treated by endovascular interventional therapy. The clinical data, endovascular treatment and clinical efficacy were retrospectively analyzed. RESULTS: Twenty-nine of the 29 patients had a direct occlusion of the aneurysm and the parent artery, 5 received stent placement, and 5 received stent-assisted coil embolization. Twenty-one patients were followed up for 3-24 months (average 8 months). Of the 14 patients with occlusive aneurysm and parent artery, the aneurysms were underexposed, 1 of 3 patients with stent-assisted coil embolization recurred, and 2 of the patients with single stent placement showed complete disappearance of one aneurysm and the other 1 patient There are still aneurysm residues, 2 cases of double stent implantation in patients with recanalization showed aneurysm disappeared completely, and the other 1 aneurysm reduced. CONCLUSIONS: Completely occlusion of the parent artery with aneurysm is the most effective method of endovascular treatment of dissecting aneurysms of the vertebral artery with rupture of the hemorrhage. If the aneurysm is located in the dominant vertebral artery, or the aneurysm affects the posterior inferior cerebellar artery, stent placement techniques are available.