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目的探讨未破裂大脑后动脉夹层动脉瘤的临床特点及其血管内治疗效果。方法回顾性分析2012年1月至2014年12月首都医科大学附属北京天坛医院连续血管内诊治的20例未破裂大脑后动脉夹层动脉瘤的临床资料,并进行影像学和临床随访。结果 20例大脑后动脉夹层动脉瘤中,男11例(55.0%),女9例(45.0%),年龄(46.2±15.5)岁。位于P1段4例(20.0%),P2段12例(60.0%),P1-P2段2例(10.0%),P3段2例(10.0%)。单纯弹簧圈栓塞3例(15.0%),载瘤动脉闭塞11例(55.0%),支架辅助弹簧圈栓塞6例(30.0%)。术后即刻影像学结果,Raymond分级:1级15例(75.0%),2级5例(25.0%)。术后并发症:缺血事件2例(10.0%),术后出现肌力1级1例,3级1例,均经对症治疗3个月后好转。16例(80.0%)影像学随访10.5(6.5)个月,Raymond分级:1级13例(81.3%),2级2例(12.5%),术后复发(3级)1例(6.2%)行2次支架辅助栓塞,6个月影像学随访无再复发。20例(100.0%)临床随访12(9.3)个月,改良的rankin量表(modified Rankin scale,m RS)0分9例(45.0%),m RS 1分5例(25.0%),m RS 2分5例(25.0%),m RS 3分1例(5.0%),预后良好率为95.0%。结论大脑后动脉夹层动脉瘤多位于P2段,根据部位选择合适的血管内栓塞方法,临床效果满意。
Objective To investigate the clinical characteristics and the therapeutic effect of endovascular treatment of unruptured posterior cerebral artery aneurysm. Methods The clinical data of 20 patients with unruptured posterior cerebral artery aneurysm of the posterior cerebral artery treated by continuous endovascular treatment at Beijing Tiantan Hospital, Capital Medical University from January 2012 to December 2014 were retrospectively analyzed. The imaging and clinical follow-up were performed. Results Among the 20 cases of posterior cerebral artery aneurysm, 11 (55.0%) were male and 9 (45.0%) were female, with a mean age of 46.2 ± 15.5 years. There were 4 cases (20.0%) in section P1, 12 cases (60.0%) in section P2, 2 cases (10.0%) in section P1-P2 and 2 cases (10.0%) in section P3. There were 3 cases (15.0%) with simple coil embolization, 11 cases (55.0%) with carrier artery occlusion, and 6 cases (30.0%) with stent-assisted coil embolization. Immediate postoperative imaging results, Raymond classification: 15 cases of grade 1 (75.0%), 2 cases of 5 cases (25.0%). Postoperative complications were as follows: 2 cases (10.0%) of ischemic events, 1 case of grade 1 in grade 1 and 1 case of grade 3 after operation, which improved after 3 months of symptomatic treatment. Sixteen patients (80.0%) were followed up for 10.5 months (6.5 months). The Raymond classification was grade 1 in 13 cases (81.3%), grade 2 in 2 patients (12.5%) and postoperative recurrence in patients in grade 1 Line 2 stent-assisted embolization, 6-month follow-up imaging no recurrence. Twenty patients (100.0%) were followed up for 12 months (9.3 months). The modified rankin scale (m RS) score was 9 (45.0%) in 0 and 5 (25.0% 2 cases and 5 cases (25.0%), m RS 3 cases and 1 case (5.0%), the good prognosis was 95.0%. Conclusions The posterior cerebral artery aneurysms are mostly located in the P2 segment. The appropriate endovascular embolization method is selected according to the site, and the clinical effect is satisfactory.