摘要目的 探讨血管内多支架套叠伴或不伴弹簧圈栓塞技术重建治疗椎基底动脉梭形动脉瘤的可行性、安全性与疗效.方法 回顾性分析2011年9月至2015年9月北京医院神经外科连续收治的17例经多支架套叠伴或不伴弹簧圈栓塞重建治疗的椎基底动脉梭形动脉瘤患者.男性15例,女性2例,平均年龄(47±13)岁,共17个动脉瘤.患者的临床表现包括蛛网膜下腔出血5例,后循环缺血或梗死5例,占位效应合并脑干梗死1例,头痛头晕4例,偶然发现2例.动脉瘤位于椎动脉颅内段11例,椎基底结合部或基底动脉主干6例;动脉瘤平均长径为(18.5±9.2)mm,平均横径为(8.0±2.3)mm.结果 单纯多支架套叠治疗8例,多支架套叠伴弹簧圈栓塞治疗9例.术后即刻造影动脉瘤完全闭塞1例,不完全闭塞16例.1例患者因术后早期出血死亡.余16例患者术后平均临床随访(21±13)个月,改良Rankin评分0～1级15例,4级1例.15例术后平均造影随访(9±5)个月,完全闭塞7例,好转3例,稳定2例,复发3例.结论 多支架套叠伴或不伴弹簧圈栓塞治疗椎基底动脉梭形动脉瘤安全可行,短期疗效满意.

abstractsObjective To explore the feasibility,safety and efficacy of endovascular reconstructive treatment by multiple overlapping stents with or without coils.Methods Totally 17 patients of vertebrobasilar fusiform aneurysms treated by multiple overlapping stents with or without coils between September 2011 and September 2015 in Department of Neurosurgery,Beijing Hospital were retrospectively reviewed.There were 15 male and 2 female patients with mean age of (47 ± 13) years.Clinical manifestations included subarachnoid hemorrhage in 5 patients,cerebral ischemia or infarction in the posterior circulation in 5 patients,mass effect accompanied with brainstem infarction in 1 patients,headache or dizziness in 4,and incidental findings in 2 patients.Aneurysm located in intracranial vertebral artery in 11 patients,vertebrobasilar junction in 2 patients,and basilar trunk in 4 patients.Mean aneurysmal size was 18.5 mm × 8.0 mm (length × width).Results Sole stenting with overlapping stents was performed in 8 patients,and overlapping stents with coils was applied in 9 patients.Post-procedural hemorrhage occurred in a patient with a giant basilar trunk fusiform aneurysm and led to death.The 16 surviving patients were clinically followed up for a mean of 21.1 months.One patient had a modified Rankin score of 4,and the other patients had a good recovery.Among 15 patients with a mean angiographic follow-up of 8.6 months,9 patients had their aneurysms further thrombosed,3 patients were stable,and 3 patients with a recurred aneurysm.Final complete occlusion was achieved in 7 patients.Conclusion Reconstructive treatment by overlapping stents with or without coils is feasible and relative safe in vertebrobasilar fusiform aneurysms.