[1]徐军,李海校,毛崇丹,等.椎动脉V4段夹层动脉瘤的个体化治疗[J].中国临床神经外科杂志,2024,29(09):522-526531.[doi:10.13798/j.issn.1009-153X.2024.09.003]
　XU Jun,LI Hai-xiao,MAO Chong-dan,et al.Individualized therapy for patients with dissecting aneurysms of the V4 segment of the vertebral artery[J].,2024,29(09):522-526531.[doi:10.13798/j.issn.1009-153X.2024.09.003]
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椎动脉V4段夹层动脉瘤的个体化治疗()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年09期
页码:
522-526531
栏目:
论著
出版日期:
2024-09-30

文章信息/Info

Title:
Individualized therapy for patients with dissecting aneurysms of the V4 segment of the vertebral artery
文章编号:
1009-153X（2024）09-0522-05
作者:
徐军; 李海校; 毛崇丹; 吕成林; 徐宝占; 崔玉光; 丰育功
266100 山东青岛，潍坊医学院附属青岛市第八人民医院神经外科（徐　军、李海校、毛崇丹、吕成林、徐宝占、崔玉光）；266000 山东青岛，青岛大学附属医院神经外科（丰育功）
Author(s):
XU Jun1;  LI Hai-xiao1;  MAO Chong-dan1;  Lü Cheng-lin1;  XU Bao-zhan1;  CUI Yu-guang1;  FENG Yu-gong2
1. Department of Neurosurgery, Weifang Medical College Affiliated Qingdao 8th People's Hospital, Qingdao 266100, China; 2. Department of Neurosurgery, Affiliated Hospitalof Qingdao University, Qingdao 266000, China
关键词:
颅内夹层动脉瘤; 椎动脉V4段; 临床特征; 血管内治疗
Keywords:
Intracranial dissecting aneurysms;  V4 segment of vertebral artery;  Clinical characteristics;  Endovascular therapy
分类号:
R 743.9; R 815.2
DOI:
10.13798/j.issn.1009-153X.2024.09.003
文献标志码:
A
摘要:
目的 探讨椎动脉V4段夹层动脉瘤的临床特点、治疗方法及其疗效。方法 回顾性分析2017年1月至2023年6月收治的10例椎动V4段脉夹层动脉瘤的临床资料。结果 10例均发生急性出血，术前 Hunt-Hess分级Ⅰ级1例，Ⅱ级5例，Ⅲ级4例1例。单纯弹簧圈栓塞治疗3例，支架辅助弹簧圈栓塞治疗2例，弹簧圈栓塞+载瘤动脉闭塞治疗5例；术后即刻造影显示动脉瘤完全或次全闭塞率为100%，随访期间未发现动脉瘤复发。1例因术后支架内急性血栓形成死亡，其余9例术后恢复良好（GOS评分4~5分）。结论 椎动脉V4段夹层动脉瘤为中青年脑卒中的重要病因，临床表现各异。对于有手术指征的病人，首选血管内治疗，具体治疗方案需根据病人具体情况进行个体化选择。
Abstract:
Objective To explore the clinical characteristics, treatment methods, and therapeutic effects of dissecting aneurysms of the V4 segment of the vertebral artery. Methods The clinical data of 10 patients with dissecting aneurysms of the V4 segment of the vertebral artery admitted from January 2017 to June 2023 were retrospectively analyzed. Results All 10 patients presented with acute hemorrhage. Before the operation, 1 patient was classified as Hunt-Hess grade Ⅰ, 5 as grade Ⅱ, and 4 as grade Ⅲ. Three patients were treated with simple coil embolization, 2 with stent-assisted coil embolization, and 5 with coil embolization plus occlusion of the parent artery. Immediate postoperative angiography showed that the complete or near-complete occlusion rate of aneurysms was 100%. No recurrence of aneurysms was found during the follow-up period. One patient died due to acute thrombosis within the stent after the operation, and the remaining 9 patients recovered well after the operation (GOS score of 4~5). Conclusions Dissecting aneurysms of the V4 segment of the vertebral artery are an important cause of stroke in young and middle-aged people, with diverse clinical manifestations. For patients with surgical indications, endovascular treatment is the preferred option, and the specific treatment plan needs to be individualized based on the patient's specific situation.

参考文献/References:

[1]SCHOB S, BECHER A, BHOGAL P, et al. Segment occlusion vs.reconstruction--a single center experience with endovascular strategies for ruptured vertebrobasilar dissecting aneurysms[J]. Front Neurol, 2019, 10: 207.
[2]ZENG QW. Progress in interventional treatment of vertebral artery dissection aneurysms[J]. Chin J Pract Nerv Dis, 2018, 21(15): 1629-1633.曾庆威. 椎动脉夹层动脉瘤的介入治疗进展[J]. 中国实用神经疾病杂志，2018，21（15）：1629-1633.
[3]AKAMATSU Y, SATO K, ENDO H, et al. Ruptured vertebral artery dissecting aneurysm concurrent with spontaneous cervical internal carotid artery dissection: a report of three cases and literature review[J]. World Neurosurg, 2017, 107: 1048.e1-1048.e6.
[4]ZHONG X, LI X, SHAO S, et al. A case of infectious intracranial dissecting aneurysm[J]. Neurol India, 2017, 65(2): 405.
[5]ZHAO X, WANG H, LIU J, et al. Endovascular treatment of verte-bral artery dissecting aneurysm: a single-center experience[J]. ExpTher Med, 2019, 18(6)：4838-4844.
[6]WANG Y, CHENG W, LIAN Y. The headache and neck pain in ischemic stroke patients caused by cervicocerebral artery dissection:a case-control study[J]. J Stroke Cerebrovasc Dis, 2019, 28(3): 557-561.
[7]AKDAL G, ?Z?ELIK P, KIRKIM G, et al. Vertebral artery dissection from neck self -manipulation presenting with acute severe bilateral hearing loss[J]. J Neurol, 2020, 267(1): 285-287.
[8]LLOYD S, HASAN RM, RICHARD P, et al. Subarachnoid haemo-rrhage due to intracranial vertebral artery dissection presenting with atypical caudaequina syndrome features: case report[J]. BMC Neurol, 2019, 19: 262.
[9]KIM MK, LIM YC. Conservative management of unruptured sponta-neous intracranial vertebral artery dissection[J]. World Neurosurg, 2019, 126: e402-e409.
[10]MOON K, ALBUQUERQUE FC, COLE T, et al. Stroke prevention by endovascular treatment of carotid and vertebral artery dissections[J]. J Neurointerv Surg, 2017, 9(10): 952-957.
[11]LEE HJ, CHO WC, CHOI JH, et al. Comparison of parent arteryocclusion and stent-assisted treatments in ruptured vertebral artery dissecting aneurysms[J]. World Neurosurg, 2022, 167: e533-e540.
[12]AIHARA M, NAITO I, SHIMIZU T, et al. Predictive factors ofmedullary infarction after endovascular internal trapping using coils for vertebral artery dissecting aneurysms[J]. J Neurosurg, 2018, 129(1): 107-113.
[13]KANEMATSU Y, SATOMI J, KORAI M, et al. Flow alteration therapy for ruptured vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery[J]. Neurol Med Chir (Tokyo), 2018, 58(8): 341-349.
[14]MASAHIRO H, TOSHINORI M, KOJI S, et al. Stent-assisted coil embolization for ruptured intracranial dissecting aneurysms involving essential vessels[J]. World Neurosurg, 2018, 119: e728-e733.
[15]URASYANANDANA K, SONGSANG D, AURBOONYAWAT T,et al. Treatment outcomes in cerebral artery dissection and literature review[J]. Interv Neuroradiol, 2018, 24(3): 254-262.
[16]IMAHORI T, SHOSE H, OKAMURA Y, et al. Deploying 5 overlapping Enterprise stents and coiling for treating hemorrhagic vertebral artery dissecting aneurysm[J]. World Neurosurg, 2019, 132: 177-181.
[17]RYOSUKE M, ICHIRO N, KOJIO, et al. Stent-assisted coil embolization of unruptured vertebral artery dissecting aneurysms with the low-profile visualized intraluminal support stent, with five techniques: technical note and case report[J]. Surg Neurol Int, 2019, 10: 105.

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备注/Memo

备注/Memo:
（2023-12-16收稿，2024-04-16修回）
更新日期/Last Update: 2024-09-30