Parent artery occlusion with Onyx for distal aneurysms of posterior inferior cerebellar artery: a single-centre experience in a series of 15 patients.
Parent artery occlusion with Onyx for distal aneurysms of posterior inferior cerebellar artery: a single-centre experience in a series of 15 patients.
复制标题
使用 Onyx 闭塞载瘤动脉治疗小脑后下动脉远端动脉瘤：针对 15 名患者的单中心经验。
DOI：
10.4103/0028-3886.115066
复制
发表时间：
2013
期刊：
影响因子：
2.7
通讯作者：
Xin Zhang
中科院分区：
文献类型：
--
作者：
Qi Wu;Handong Wang;Qing;Xin Zhang
背景
位于小脑后下动脉远端的动脉瘤是罕见的。这些动脉瘤很难进行手术或血管内治疗，尤其是破裂的动脉瘤。
旨在
研究使用栓塞剂Onyx闭塞载瘤动脉（PAO）治疗PICA远端动脉瘤的临床和影像学疗效。
材料和方法
回顾性审查了15例连续患者的病例记录，其中15例破裂的PICA远端动脉瘤采用Onyx栓塞治疗。随访时间为6 ~ 52个月。行脑血管造影或脑计算机断层血管造影（CTA）进行随访放射学研究。2个动脉瘤起源于扁桃体髓段，9个起源于端腭扁桃体段，4个起源于皮质段。所有患者均接受Onyx治疗，以通过血管内入路闭塞动脉瘤和动脉瘤前方的血管近端部分。
结果
所有患者动脉瘤均完全闭塞。1例患者因术中出血死亡。14例患者恢复良好，末次随访格拉斯哥结局评分为5分。所有存活患者出院前均行头颅CT扫描。3例CT显示小脑梗死，但无任何神经功能缺损。随访期间，14例患者均无再出血或新发神经功能缺损。在所有存活患者中均未观察到动脉瘤再通。
结论
根据本研究，Onyx闭塞近端载瘤动脉和动脉瘤治疗PICA远端动脉瘤是安全有效的。动脉瘤的形态和位置是决定治疗策略的重要因素。
BACKGROUND
Aneurysms located at distal posterior inferior cerebellar artery (PICA) are rare. These aneurysms are difficult for surgical or endovascular treatment, especially for ruptured aneurysms.
AIMS
To investigate the clinical and radiologic efficacy of parent artery occlusion (PAO) with embolic agent Onyx in the treatment of distal PICA aneurysm.
MATERIALS AND METHODS
Case records of 15 consecutive patients with 15 ruptured distal PICA aneurysms treated with Onyx embolization were reviewed retrospectively. The follow-up ranged between 6 and 52 months. Cerebral angiography or cerebra computed tomography-angiogram (CTA) was performed for follow-up radiological study. Two aneurysms had origin from tonsillomedullary segment, nine from telovelotonsillar segments, and four from cortical segments. All patients were treated with Onyx to occlude aneurysm and proximal portion of vessel in front of aneurysm via endovascular approach.
RESULTS
Aneurysm was occluded completely in every patient. One patient died because of intra-procedure haemorrhage. Fourteen patients had good recovery and the last follow-up Glasgow outcome scale was 5. Head CT scan was performed in every survived patient before discharge. CT in 3 patients revealed cerebellar infarctions but without any neurological deficits. None of the 14 patients had rebleeding or fresh neurologic deficits during the follow-up period. Aneurysmal recanalization had not been observed in any of the survived patients.
CONCLUSIONS
Onyx occlusion of proximal parent artery and aneurysm in the treatment of distal PICA aneurysm is safe and effective according to this study. Morphology and location of aneurysm are important to decide the therapeutic strategy.