Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: case report
Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: case report
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DOI：
10.1016/j.surneu.2004.05.037
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发表时间：
2005-03-01
影响因子：
--
通讯作者：
Batjer, HH
中科院分区：
文献类型：
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作者：
O'Shaughnessy, BA;Getch, CC;Batjer, HH
背景：作者介绍了一名患者，该患者在接受显微手术和神经血管内亨特策略相结合的治疗后，经历了远端基底动脉夹层动脉瘤的晚期（5 年随访）形态学进展。除了推测该病变演变的可能原因外，还讨论了支架置入术的作用。 病例描述：患者因自发性基底动脉夹层而发生蛛网膜下腔出血，时年 37 岁。出血时，血管造影发现动脉瘤有极轻微的扩大，因此她接受了非手术治疗。 5个月后重新成像时，发现动脉瘤大量增大。该患者接受了显微外科和神经血管内技术相结合的分阶段双侧椎动脉牺牲治疗。 1周后，将优势椎动脉在小脑后下动脉远端进行夹式结扎，而对侧椎动脉则在1周后进行颈椎线圈闭塞。结论：尽管患者仍无症状，但初次出血5年后的后续血管造影显示动脉瘤进一步增大，以及新发现的向下突出的子囊，直径为5圈。显然，某些动脉瘤存在，涉及血流动力学减弱的间接方法无法阻止进展。随着支架技术的进一步完善，此类病变可能会得到更有效的治疗。 (c) 2005 Elsevier Inc. 保留所有权利。
Background: The authors present a patient who experienced late (5-year follow-up) morphological progression of a dissecting aneurysm of the distal basilar artery after treatment with a combined microsurgical and neuroendovascular Hunterian strategy. In addition to postulating about the possible reasons underlying the evolution of this lesion, the role of stenting is discussed.Case Description: The patient was 37 years old when she suffered a subarachnoid hemorrhage from spontaneous basilar artery dissection. At the time of the hemorrhage, minimal aneurysmal enlargement was noted angiographically, and she was therefore treated nonoperatively. On reimaging 5 months later, massive enlargement of the aneurysm was noted. The patient was treated with staged bilateral vertebral artery sacrifice using a combination of microsurgical and neuroendovascular techniques. The dominant vertebral artery was clip-ligated distal to the posteroinferior cerebellar artery, whereas the contralateral vertebral artery was coil-occluded cervically 1 week later.Conclusions: Despite the patient remaining asymptomatic, follow-up angiography 5 years after the initial hemorrhage revealed further enlargement of the aneurysm as well as a newly discovered inferiorly projecting daughter sac measuring 5 turn in diameter. Clearly, certain aneurysms exist for which indirect approaches involving hemodynamic attenuation fail to prevent progression. With greater refinements in stent technology, such lesions may be more effectively treated. (c) 2005 Elsevier Inc. All rights reserved.