血管内介入治疗颅内动脉瘤合并缺血性脑血管疾病的临床研究

摘要 目的：探讨血管内介入治疗颅内动脉瘤（IA）合并缺血性脑血管疾病的安全性和有效性。方法：回顾性分析了2018年1月至2020年12月使用血管内介入治疗IA合并缺血性脑血管疾病的32例临床资料。结果：32例中共发现了35枚IA，37处狭窄。IA平均大小为（5.17±3.12）mm，其中位于颈内动脉有26枚（74%），位于椎基底动脉有9枚（26%），7例（22%）患者术前检查发现存在两枚IA。37处狭窄中，位于椎基底动脉有9处（24%），位于颅外段有8处（22%），其余20处狭窄（54%）均位于颈内动脉，术前平均狭窄率为75.7%。所有病例手术过程顺利，术后IA中达到完全栓塞有31枚（89%），4枚残留颈部（11%）。37处狭窄中，术后平均狭窄率为8.8%，所有患者术后造影脑血管远端均通畅。治疗期间1例支架内再狭窄，1例脑血管痉挛，出院时所有病例改良Rankin评分量表（mRS）均小于2分。32位患者均得到术后全脑血管造影（DSA）随访，随访时间为6到18个月（平均为8.8个月），随访期间1例出现支架内再狭窄。结论：血管内介入治疗IA合并缺血性脑血管疾病是安全有效的，值得临床借鉴应用。

Clinical Study of Intravascular Intervention for Intracranial Aneurysm Complicated with Ischemic Cerebrovascular Disease

ABSTRACT Objective: To investigate the safety and effectiveness of endovascular intervention in the treatment of intracranial aneurysm(IA) complicated with ischemic cerebrovascular disease. Methods: The clinical data of 32 patients with IA complicated with ischemic cerebrovascular disease treated by endovascular intervention from January 2018 to December 2020 were retrospectively analyzed. Results: A total of 35 IA and 37 stenoses were found in 32 patients. The average size of IA was (5.17±3.12)mm. Among them,26 aneurysms (74%) were located in the internal carotid artery, 9 aneurysms (26%) were located in the vertebrobasilar artery, and 7 patients (22%) were found to have two intracranial aneurysms before operation. Among 37 stenosis, 9(24%) were located in the vertebrobasilar artery, 8 (22%) were located in the extracranial segment, and the remaining 20 (54%) were located in the internal carotid artery. The average stenosis rate was 75.7% before operation. 31 aneurysms (89%) were completely occluded and 4 aneurysms (11%) remained in the neck. Among 37 stenoses, the average stenosis rate after operation was 8.8%, and the distal cerebral vessels of all patients were unobstructed after operation. During the treatment, there was 1 case of in-stent restenosis and 1 case of cerebral vasospasm. The modified Rankin scale (mRS) was less than 2 in all patients at discharge. All the 32 patients were followed up by digital subtract angiography(DSA) for 6 to 18 months (average 8.8 months). During the follow-up, 1 case had in-stent restenosis. Conclusion: Endovascular intervention is safe and effective in the treatment of IA complicated with ischemic cerebrovascular diseases, which is worthy of clinical reference.