Posterior circulation perforator aneurysms: a proposed management algorithm
Posterior circulation perforator aneurysms: a proposed management algorithm
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DOI：
10.1136/neurintsurg-2016-012891
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发表时间：
2018-01-01
影响因子：
4.8
通讯作者：
Liu, Kenneth C.
中科院分区：
文献类型：
--
作者：
Buell, Thomas J.;Ding, Dale;Liu, Kenneth C.
由后循环穿支动脉瘤引起的蛛网膜下腔出血（SAH）是一种罕见的疾病，其自然史尚不清楚。诊断可能是困难的，急性管理是不明确的，长期复发SAH率和临床结局data are lacking.Methods我们搜索我们机构的记录PCPA破裂的情况下，分析患者的人口统计学，亨特和赫斯（HH）等级，诊断成像，管理和临床结局。我们进行了电话采访，以计算修改后的兰金量表（mRS）scores.Results，我们确定了9例（6男，3女）破裂的PCPA谁提出的弗吉尼亚大学卫生系统（夏洛茨维尔，弗吉尼亚州，美国）在2010年和2016年之间。中位和平均年龄分别为62岁和63岁。中位HH等级为3。9例PCPA中有7例（78%）在首次成像时血管造影显示为隐匿性，诊断的中位时间为5天。3例保守治疗患者在平均随访35.3个月时的平均mRS评分为0.67（范围0-1）。所有保守治疗的患者均给予抗纤溶治疗，无血栓并发症。6例接受血管内治疗的患者在平均随访49.2个月时的平均mRS评分为2.67（范围0-6）。没有复发SAH的情况下，在study.Conclusions PCPA的罕见性，排除了长期的临床随访到现在。我们的经验表明复发性蛛网膜下腔出血率较低。在进一步的研究进行之前，保守治疗，可能联合抗纤溶治疗，可能是一种可行的治疗方法，具有可接受的长期结局。
Introduction Subarachnoid hemorrhage (SAH) from posterior circulation perforator aneurysms (PCPAs) is rare and its natural history is unknown. Diagnosis may be difficult, acute management is poorly defined, and long-term recurrent SAH rates and clinical outcome data are lacking.Methods We searched our institution's records for cases of PCPA rupture and analyzed patient demographics, Hunt and Hess (HH) grades, diagnostic imaging, management, and clinical outcomes. We conducted telephone interviews to calculate modified Rankin Scale (mRS) scores.Results We identified 9 patients (6 male, 3 female) with a ruptured PCPA who presented to the University of Virginia Health System (Charlottesville, VA, USA) between 2010 and 2016. Median and mean ages were 62 and 63years, respectively. Median HH grade was 3. Seven of nine (78%) PCPAs were angiographically occult on initial imaging and median time to diagnosis was 5days. Three conservatively managed patients had a mean mRS score of 0.67 (range 0-1) at mean follow-up of 35.3months. Antifibrinolytic therapy was administered to all conservatively managed patients without thrombotic complication. Six patients receiving endovascular treatment had a mean mRS score of 2.67 (range 0-6) at mean follow-up of 49.2months. No cases of recurrent SAH were seen in the study.Conclusions The rarity of PCPA has precluded long-term clinical follow-up until now. Our experience suggests low recurrent SAH rates. Until further studies are performed, conservative management, possibly combined with antifibrinolytic therapy, may be a viable treatment with acceptable long-term outcome.