摘要目的:探讨颅内宽颈动脉瘤合并载瘤动脉重度狭窄血管内治疗的安全性及疗效。方法:回顾性研究。纳入郑州大学人民医院脑血管病科2017年1月—2019年12月采用血管内治疗颅内宽颈动脉瘤合并载瘤血管重度狭窄的患者14例，共14个动脉瘤。14例中，男5例、女9例，年龄45～76(61.07±10.43)岁；8例为破裂动脉瘤，6例为未破裂动脉瘤。术前载瘤段血管狭窄率为70%～90%，中位数为70%。根据载瘤段血管狭窄与动脉瘤的解剖位置关系分型为Ⅰ型9例、Ⅱ型4例、Ⅲ型1例。分析患者临床及影像学资料，采用改良Rankin量表(mRS)评分评价患者临床预后，采用Raymond分级标准评估动脉瘤闭塞情况。结果:14例患者均采用先处理载瘤段血管狭窄再进行支架辅助弹簧圈栓塞动脉瘤的治疗方法，手术均成功。术后即刻造影示动脉瘤栓塞程度RaymondⅠ级12个、Ⅱ级2个，术后载瘤血管残余狭窄率20%～30%，中位数为25%。术后3个月14例患者mRS评分0分12例、2分1例、3分1例。11例患者获数字减影血管造影(DSA)随访，中位随访时间6.45(6～10)个月，DSA示Raymond Ⅰ级10例、RaymondⅡ级1例，11例患者均未出现支架内再狭窄或闭塞情况。结论:颅内宽颈动脉瘤合并载瘤血管重度狭窄病变复杂，采用先处理载瘤段血管狭窄再进行动脉瘤栓塞的治疗方法可能是安全、有效的，还需大样本病例的长期随访研究。

abstractsObjective:To investigate the safety and efficacy of endovascular treatment for wide-necked intracranial aneurysms concomitant with severe parent artery stenosis.Methods:Fourteen patients (5 male and 9 female, aged 45-76[(61.07±10.43)] years) with 14 wide-necked intracranial aneurysms concomitant with severe parent artery stenosis who underwent endovascular treatment at the Department of Cerebrovascular Disease of Zhengzhou University People's Hospital from January 2017 to December 2019 were retrospectively enrolled in this study. Among the 14 patients, 8 harbored ruptured aneurysms and 6 harbored unruptured aneurysms. The median of preprocedural parent artery stenosis rate was 70% (70%-90%). According to the location of stenosis and aneurysm, the lesions were classified into types Ⅰ(9 cases), Ⅱ(4 cases), and Ⅲ(1 cases). The Raymond grading scale was used to evaluate the aneurysm occlusion, and the modified Rankin scale (mRS) was used to evaluate clinical status.Results:Stenosis was treated prior to the stent-assisted coiling of the aneurysm, and the procedure were successful in 14 patients. Immediately after the procedure, complete occlusion (grade Ⅰ of Raymond grading scale) was observed in 12 aneurysms, and entry remnant (grade Ⅱ) was observed in 2 aneurysms. The median of postprocedural parent artery stenosis rate was 25% (20%-30%). Clinical follow-up was performed in all 14 patients at 3 months, and the mRS scores were 0 in 12 patients, 2 in one patient, and 3 in one patient. A total of 11 patients received imaging follow-up at a median of 6.45 (6-10) months. Digital subtraction angiography(DSA) showed that complete occlusion (grade Ⅰ of Raymond grading scale) in 10 aneurysms, and entry remnant (grade Ⅱ) in 1 aneurysm. In-stent restenosis or occlusion was not observed in all 11 patients.Conclusions:Treating the stenosis of the parent artery first followed by the coiling of aneurysms is a safe and effective approach for wide-necked intracranial aneurysms concomitant with severe parent artery stenosis. Long-term follow-up studies with large sample sizes are needed.