Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage
Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage
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DOI：
10.3171/jns.2003.99.6.0960
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发表时间：
2003-12-01
影响因子：
4.1
通讯作者：
Ushio, Y
中科院分区：
文献类型：
--
作者：
Hamada, J;Kai, Y;Ushio, Y
物体。本研究的目标是实现一种算法，并评估急性期椎动脉夹层动脉瘤(VA)破裂患者的多模式(血管内和显微外科)治疗。在4年的时间里，作者治疗了19个夹层动脉瘤破裂的急性期，出血后3天内。指导管理决策的因素是对测试咬合的耐受性和夹层的位置。该算法考虑了这些因素来选择治疗方案，即用电解可拆卸线圈(GDC)捕获VA；捕获VA并重建小脑后下动脉(PICA)；捕获VA和VA-大脑后动脉(PCA)吻合；以及捕获VA、VA-PCA吻合和PICA血运重建。在15个未累及PICA的动脉瘤中，14个采用GDC夹闭VA，1个采用VA-PCA搭桥术。另外4例累及PICA的动脉瘤均采用VA夹闭加PICA血运重建术。治疗后随访期内未见复发出血或缺血。虽然1例患者的延髓外侧综合征发展为永久性并发症，但另18例患者在发病6个月后恢复良好。决定VA夹层动脉瘤破裂的适当治疗的因素是对试验闭塞的耐受性和夹层的位置。当使用该算法时，可以获得良好的患者结果。
Object. The goal of this study was to implement an algorithm for and assess the multimodal (endovascular and microsurgical) treatment of patients with ruptured dissecting aneurysms of the vertebral artery (VA) during the acute stage.Methods. During a 4-year period, the authors treated 19 ruptured dissecting aneurysms of the VA during the acute stage, within 3 days after the hemorrhage. Factors guiding management decisions were tolerance of the test occlusion and the site of the dissection. The algorithm takes into account these factors to select among treatment options, that is, trapping of the VA with Guglielmi Detachable Coils (GDCs); trapping of the VA and revascularization of the posterior inferior cerebellar artery (PICA); trapping of the VA and VA-posterior cerebral artery (PCA) anastomosis; and trapping of the VA, VA-PCA anastomosis, and revascularization of the PICA. Of the 15 aneurysms without PICA involvement, 14 were treated by trapping of the VA with GDCs and one by trapping of the VA and a VA-PCA bypass. The other four aneurysms with PICA involvement were treated by VA trapping and PICA revascularization. There was no episode of recurrent hemorrhage or ischemia during the posttreatment follow-up period. Although lateral medullary syndrome developed as a permanent complication in one patient, a good recovery was made by the other 18 patients by 6 months after the ictus.Conclusions. The factors that determine the appropriate treatment for ruptured dissecting aneurysms of the VA are tolerance of a test occlusion and the site of dissection. Favorable patient outcomes can be achieved when this algorithm is used.