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| 创伤性颈内动脉颅内段假性动脉瘤的血管内治疗 |
| 赵瑞△,路智文△,邓晓东,邹超,左乔,赵开军,戴冬伟,方亦斌,李强,黄清海,洪波,许奕,刘建民* |
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(海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 回顾性分析单中心血管内治疗创伤性颈内动脉颅内段假性动脉瘤（TIICAP）的安全性及临床疗效。方法 连续回顾2005年9月至2019年9月我中心收治的经脑血管造影检查的颅内动脉瘤患者资料，根据纳入标准选择TIICAP患者。分析患者的手术策略及围手术期抗血小板药物治疗情况，并总结治疗效果和临床与影像学随访结果。结果 共入组29例TIICAP患者，男19例（65.5%），女10例（34.5%），年龄为14~70岁，中位年龄为47（30，53）岁。29例患者均成功实施血管内治疗，其中采用覆膜支架3例，血流导向装置9例，支架辅助弹簧圈栓塞11例，单纯弹簧圈栓塞2例，载瘤动脉闭塞4例。1例行载瘤动脉闭塞患者术前再出血，术后死亡；1例行载瘤动脉闭塞患者术后发生缺血性脑卒中，最终死亡；余27例患者均无并发症发生，顺利出院。23例患者接受影像学随访，13例治愈，5例好转，2例稳定，3例复发（均再次行血管内治疗治愈）。24例患者接受临床随访，临床预后均稳定或好转。结论 血管内治疗是处理TIICAP的有效手段，其中血流导向装置、覆膜支架等新技术的优势初现，值得进一步研究。 |
| 关键词: 颈内动脉 创伤性假性动脉瘤 血管内治疗 血流导向装置 弹簧圈栓塞 支架 |
| DOI：10.16781/j.0258-879x.2021.02.0133 |
| 投稿时间：2020-09-06修订日期：2020-12-18 |
| 基金项目:国家重点研发计划（2016YFC1300700），国家自然科学基金（81671137，81571126，8187093），2016年中国脑卒中高危人群干预适宜技术研究及推广项目（GN-2016R0012）. |
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| Endovascular treatment of traumatic intracranial internal carotid artery pseudoaneurysm |
| ZHAO Rui△,LU Zhi-wen△,DENG Xiao-dong,ZOU Chao,ZUO Qiao,ZHAO Kai-jun,DAI Dong-wei,FANG Yi-bin,LI Qiang,HUANG Qing-hai,HONG Bo,XU Yi,LIU Jian-min* |
(Stroke Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To retrospectively analyze the safety and clinical efficacy of endovascular treatment for traumatic intracranial internal carotid artery pseudoaneurysm (TIICAP) in a single center. Methods The data of patients with intracranial aneurysms, who underwent cerebral angiography from Sep. 2005 to Sep. 2019 in our Stroke Center, were reviewed consecutively. Patients with TIICAP were selected according to the inclusion criteria. The operative methods and perioperative antiplatelet drug treatment strategies were analyzed, and the therapeutic effect and clinical and imaging followup results were summarized. Results A total of 29 patients with TIICAP were enrolled, including 19 (65.5%) males and 10 (34.5%) females, with a median age of 47 (30, 53) years (range, 14-70 years). Endovascular treatment was successfully performed in the 29 cases, including 3 cases treated with covered stent implantation, 9 with flow diverter implantation, 11 with stent-assisted coiling embolization, 2 with coiling embolization and 4 with parent artery occlusion. One patient receiving parent artery occlusion suffered from rebleeding before operation, and died after operation. One patient receiving parent artery occlusion had ischemic stroke and died after operation. None of the remaining 27 patients had complications. Twenty-three patients were followed up by imaging. Thirteen of them were cured, 5 were improved, 2 were stable and 3 had recurrence, and the 3 recurrence cases were cured by endovascular treatment again. Twenty-four patients had clinical follow-up data, and the clinical outcomes were stable or improved. Conclusion Endovascular treatment is an effective method for TIICAP. The preliminary superiorities of novel techniques, including flow diverter and covered stent, deserve further confirmation. |
| Key words: internal carotid artery traumatic pseudoaneurysm endovascular treatment flow diverter coil embolization stent |
