Treatment strategies of ruptured intracranial aneurysms associated with moyamoya disease
Treatment strategies of ruptured intracranial aneurysms associated with moyamoya disease
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DOI：
10.1080/02688697.2020.1781058
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发表时间：
2020-06-19
影响因子：
1.1
通讯作者：
Wang, Chengwei
中科院分区：
文献类型：
--
作者：
Zhao, Xu;Wang, Xiaofei;Wang, Chengwei
目的：本研究的目的是介绍我们治疗烟雾病（MMD）相关颅内动脉瘤破裂的经验，并讨论其治疗策略和血管重建术的时机。患者和方法：本研究纳入了13例与烟雾病相关的颅内动脉瘤破裂患者。根据动脉瘤的位置采取不同的治疗策略。回顾性分析其临床和放射学特征、治疗选择和结果。结果：5例前循环大动脉动脉瘤中，3例栓塞，2例夹闭。5例后循环大动脉动脉瘤患者中，3例行血管内栓塞术。3例外周动脉瘤，1例行血管内栓塞，1例行动脉瘤切除术，1例行单纯血运重建术。对于经血管内栓塞或手术治疗的动脉瘤患者，在第一次手术后28 ~ 87天进行分阶段血运重建术。2例直接治疗的动脉瘤患者，血运重建时间分别为出血后20天和54天。在随访期间，患者复发性颅内出血，但不是由先前的动脉瘤引起的。其他患者无复发性颅内出血或缺血性脑卒中。所有11个被夹闭或栓塞的动脉瘤均被完全闭塞。其余三个未直接治疗的动脉瘤中，一个自行消失，而另外两个保持稳定。11例行血运重建术的患者均证实直接和间接旁路通畅。结论：我们目前的治疗策略和血管重建术的时机可能对烟雾病并发颅内动脉瘤破裂的患者有益。
Objective:The purpose of this study was to present our experience in the management of ruptured intracranial aneurysms associated with moyamoya disease (MMD), and to discuss their treatment strategies and the timing of revascularization surgery. Patients and methods:Thirteen patients who had ruptured intracranial aneurysms associated with MMD were enrolled in this study. Different treatment strategies were adopted based on the location of the aneurysms. Their clinical and radiologic features, treatment selection and outcomes were retrospectively reviewed. Results:Among the five patients with major artery aneurysms in anterior circulation, three were embolized and two clipped. Among the five patients with major artery aneurysms in posterior circulation, three were treated by endovascular coiling. Among the three peripheral aneurysms, one was treated by endovascular embolization, one by aneurysmectomy, and the other one by revascularization alone. For the patients whose aneurysms were treated by endovascular embolization or surgery, a staged revascularization was performed on day 28 to day 87 after the first operation. For the two patients with aneurysms untreated directly, the timing of revascularization was 20 days and 54 days after hemorrhage, respectively. During the follow-up recurrent intracranial hemorrhage occurred in a patient, but not caused by the previous aneurysm. No other patients suffered recurrent intracranial hemorrhage or ischemic stroke. Complete occlusion was achieved in all the 11 aneurysms that had been clipped or embolized. Of the remaining three aneurysms that had not been directly treated, one disappeared spontaneously, whereas the other two remained stable. The direct and indirect bypasses were confirmed patent in the 11 patients who had undergone revascularization. Conclusion:Our current treatment strategies and timing of revascularization may provide a benefit for the patients with MMD accompanied by ruptured intracranial aneurysms.