摘要
目的探讨大脑前动脉A1段缺如及重度发育不良对前交通动脉瘤介入治疗的影响。方法回顾性分析接受全脑DSA检查的905例患者临床资料,对CTA、常规DSA疑有单侧A1段缺如患者作压迫对侧颈动脉(压颈)造影,判断A1段是否真正缺如,同时分析其中68例前交通动脉瘤患者临床资料、血管内栓塞治疗过程及随访结果。结果 905例患者经CTA或常规DSA检查有40例表现为大脑前动脉A1段缺如,压颈造影后真正缺如30例,10例为重度发育不良。68例前交通动脉瘤患者中单侧A1缺如16例,重度发育不良4例,轻中度发育不良7例。所有前交通动脉瘤患者均成功接受介入栓塞治疗,其中可解脱式弹簧圈单纯栓塞39例,支架辅助栓塞29例;16例A1段缺如和4例重度发育不良患者中有13例接受支架辅助栓塞。术后即刻动脉瘤完全闭塞56例(82.3%),瘤颈残留10例(14.7%),瘤腔残留2例(3%)。术后48例获临床和影像学随访,3例(6.3%)明显复发,其中2例成功接受再次栓塞治疗。结论对CTA和常规DSA造影疑有单侧大脑前动脉A1段缺如的前交通动脉瘤患者,压颈造影能够鉴别A1段是否真正缺如。单侧A1段缺如及重度发育不良的前交通动脉瘤介入治疗时,应确保前交通动脉及双侧A2段通畅,使用支架辅助栓塞有一定帮助。
Objective To investigate the impact of absence and severe dysplasia of A1 segment of anterior cerebral artery on the performance of interventional therapy for anterior communicating artery aneurysm. Methods The clinical data of 905 patients who had received whole brain DSA examination were retrospectively analyzed. For patients with suspected unilateral A1 segment absence on CTA or conventional DSA, angiography with compression on contralateral carotid artery （compression on neck） was employed to determine whether A1 segment was really absent or not. Besides, the clinical data, interventional treatment course and follow-up outcomes in 68 patients with anterior communicating artery aneurysm were analyzed. Results Among the 905 patients who had received CTA or conventional DSA examinations, A1 segment absence was observed in 40. Angiography with compression on contralateral carotid artery revealed that really absent of A1 segment was seen in 30 and severe dysplasia of A1 segment was found in 10. Among the 68 patients with anterior communicating artery aneurysms, 16 were confirmed to have unilateral absence of A1 segment, 4 had severe dysplasia of A1 segment and 7 had mild-moderate degree dysplasia of A1 segment. Interventional embolization therapy was successfully accomplished in all 68 patients with anterior communicating artery aneurysm, among them detachable spring coil was used in 39 patients and stent-assisted embolization was employed in 29 patients. Among the 16 patients with unilateral absence of A1 segment and 4 patients with severe dysplasia of A1 segment, stent-assisted embolization was adopted in 13. Angiography performed immediately after the procedure showed that complete occlusion of the aneurysm was obtained in 56 patients （82.3%）, residual aneurysm neck was observed in 10 patients （14.7%） and residual aneurysm cavity was displayed in 2 patients （3%）. After the treatment, clinical and imaging follow-up was conducted in 48 patients, among them recurrence was seen in 3 patients （6.3%） and embolization therapy was successfully repeated in two of them. Conclusion For patients with suspected unilateral A1 segment absence judged by CTA or conventional DSA, angiography with compression on contralateral carotid artery can identify whether the absence of A1 segment is real or not. In performing interventional embolization of anterior communicating artery aneurysm associated with absence or severe dysplasia of unilateral A1 segment, the operators should make sure that the blood flow in the anterior communicating artery and bilateral A2 segments is unobstructed, for this purpose stent-assisted embolization may be helpful.
出处
《介入放射学杂志》
CSCD
北大核心
2016年第5期430-434,共5页
Journal of Interventional Radiology
关键词
大脑前动脉
缺如
压颈
前交通动脉瘤
anterior cerebral artery
absence
compression of carotid artery
anterior communicating artery aneurysm
