在血流分流时代,治疗椎体动脉瘤的传统和老式血管内技术依然有效

IF 0.7 Q4 CLINICAL NEUROLOGY Egyptian journal of neurosurgery Pub Date : 2024-09-13 DOI:10.1186/s41984-024-00317-1
Gaurav Chauhan, Vivek Singh, Surya Nandan Prasad, Rajendra V. Phadke, Zafar Neyaz
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摘要

椎动脉夹层动脉瘤(VADA)的血管内治疗非常复杂,因此需要针对不同病例采取不同的治疗策略。我们目前的研究描述了除血流分流器(FD)外,血管内治疗 VADA 的各种最佳策略。14 名患者表现为急性 SAH,4 名患者有肿块症状。VADA分为3组,即对侧椎动脉占优势的A组(5人)、共占优势的B组(8人)或C组发育不良的C组(5人)。根据动脉瘤与小脑后下动脉(PICA)的位置,A 组和 B 组(n = 13)又分为三个亚型:动脉瘤位于小脑后下动脉近端,I 型(n = 5);涉及小脑后下动脉,II 型(n = 1);位于小脑后下动脉远端,III 型(n = 4)。不同类型的患者采用的治疗策略也不尽相同,有的采用解构法,有的采用重建法,支架和线圈的使用方式也不尽相同。为了选择最安全、最佳的血管内治疗方案,必须在术前进行血管造影检查,确定动脉瘤的解剖位置、对侧椎动脉的优势、附近穿孔动脉的状态以及 PICA 的位置。
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Conventional and old endovascular techniques for vertebral aneurysms still work in the era of flow diversion
Endovascular management for vertebral artery dissecting aneurysms (VADA) is quite intricate which thereby necessitate different strategies per case. Our current study described various optimal strategies available for endovascular management of VADA other than flow diverter (FD). 14 Patients presented with acute SAH and 4 patients with symptoms of mass effect. VADA were classified in 3 groups, viz contralateral vertebral artery is dominant group A (n = 5), co-dominant group B (n = 8) or group C hypoplastic (n = 5). Group A and B (n = 13) was further subdivided into three subtypes depending on location of aneurysm with respect to posterior inferior cerebellar artery (PICA), aneurysm proximal to the PICA, type I (n = 5); involving the PICA, type II (n = 1); and distal to the pica, type III (n = 4). Treatment strategy varied with type whether deconstructive or reconstructive methods using stents and coils in different fashion. Preprocedural angiographic work up delineating the anatomical location of the aneurysm, contralateral vertebral artery dominancy and nearby perforator status along with location of PICA is imperative in selecting the safest and optimal endovascular therapy option.
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