椎-基底动脉延长扩张症(VBD)是一种缺乏特异性临床表现且预后不良的复杂性颅内血管疾病,其病理改变、发病机制尚不完全明确,治疗策略仍有争议.目前VBD的治疗方式主要包括内科对症治疗、外科手术和血管内介入治疗.该文通过回顾VBD的相关文献,对VBD的病变特征及治疗策略的研究进展进行了综述.

目的 探讨国产Numen弹簧圈治疗未破裂颅内动脉瘤的安全性和有效性.方法 2017年4月至2019年2月海军军医大学第一附属医院等10家临床试验中心共同完成前瞻性、多中心、开放性、随机对照、非劣效性临床试验——CATCH试验,纳入其中240例未破裂颅内动脉瘤亚组进行分析;根据术中使用的弹簧圈类型将患者分为Numen组与Axium组.主要有效性观察指标为术后6个月动脉瘤的成功闭塞率(Raymond分级为Ⅰ或Ⅱ级);次要有效性指标为术后6个月、12个月的动脉瘤完全闭塞率(Raymond分级为I级)以及术后6个月的动脉瘤再通率.安全性指标为术后6个月、12个月的动脉瘤再治疗率和严重不良事件的发生率.结果 全分析集中,与Axium组(117例)比较,Numen组(123例)原发性高血压患者占比低(P=0.030),而性别、年龄等基线资料的差异均无统计学意义(均P＞0.05).符合方案集(Numen组103例,Axium组98例)中,两组术后6个月动脉瘤成功闭塞率[93.2％(96/103)对比95.9％(94/98)]、完全闭塞率[65.0％(67/103)对比63.3％(62/98)]以及再通率[5.9％(6/101)对比2.1％(2/97)]的差异均无统计学意义(均P＞0.05);术后12个月动脉瘤完全闭塞率的差异无统计学意义[均为74.4％(67/90),x2=0.00,P=1.000];术后即刻动脉瘤栓塞密度的差异无统计学意义[(41.90±22.32)％对比(45.72± 19.51)％,t=-1.30,P=0.198].全分析集中,两组患者有效性指标的差异亦均无统计学意义(均P＞0.05).安全性分析集(Numen组123例,Axium组117例)中,术后12个月,Axium组患者中1例接受再治疗(1/112,0.9％),116例Numen组患者中无一例接受再治疗,两组间差异无统计学意义(P=0.491);截至术后12个月,Numen组与Axium组严重不良事件发生率的差异无统计学意义[13.0％(16/123)对比 17.9％(21/117),x2=1.18,P=0.289];两组患者的病死率均为 0.结论 Numen弹簧圈与Axium弹簧圈治疗未破裂颅内动脉瘤的安全性和有效性相近,是一种安全、有效的治疗选择.

近年来,神经电生理技术已广泛应用于各类脑血管疾病手术监测中,其可从电生理角度反映神经传导通路的完整性,避免或减少术中神经功能的损伤,为指导疾病手术治疗提供新方法.作者对术中各种神经电生理监测模式的应用方法、预警标准、影响因素及其在不同脑血管疾病手术方案的决策,包括对假阴性和假阳性结果的判读及相应的避免措施等进行文献复习及分析,提示术中应用合理的电生理监测模式、规范的监测方法、配合合适的麻醉方案有助于提高监测的准确性和可靠性,表明在脑血管疾病手术中应用合适的神经电生理监测模式可以有效提高手术的安全性.

目的 探讨Onyx胶联合弹簧圈栓塞治疗创伤性颈内动脉海绵窦瘘(TCCF)的安全性、有效性,并总结治疗经验.方法 回顾性分析2009年1月至2020年6月于我院脑血管病中心接受Onyx胶联合弹簧圈栓塞治疗的50例Barrow A型TCCF患者资料.评估Onyx胶联合弹簧圈栓塞术后患者的影像学及临床结果,通过临床随访及影像学随访评估预后.结果 50例TCCF患者中男27例(54％)、女23例(46％),年龄为17～78岁,平均年龄为(45±15)岁.所有患者均有不同程度的症状(突眼、球结膜充血、眼球活动受限、颅内杂音等).栓塞术后即刻造影显示46例(92％)瘘口消失,4例(8％)瘘口少量残留;术后患者相关症状均有不同程度的缓解或消失.2例(4％)患者发生围手术期并发症.随访时间4(2～9)个月,随访期间复查造影示所有患者瘘口均完全消失,除3例遗留视力障碍、1例遗留眼肌麻痹症状外,余患者症状均消失.结论 Onyx胶联合弹簧圈栓塞治疗TCCF安全、有效,是治疗TCCF的理想方式之一.

目的 回顾性分析单中心血管内治疗创伤性颈内动脉颅内段假性动脉瘤(TIICAP)的安全性及临床疗效.方法 连续回顾2005年9月至2019年9月我中心收治的经脑血管造影检查的颅内动脉瘤患者资料,根据纳入标准选择TIICAP患者.分析患者的手术策略及围手术期抗血小板药物治疗情况,并总结治疗效果和临床与影像学随访结果.结果 共入组29例TIICAP患者,男19例(65.5％),女10例(34.5％),年龄为14～70岁,中位年龄为47(30,53)岁.29例患者均成功实施血管内治疗,其中采用覆膜支架3例,血流导向装置9例,支架辅助弹簧圈栓塞11例,单纯弹簧圈栓塞2例,载瘤动脉闭塞4例.1例行载瘤动脉闭塞患者术前再出血,术后死亡;1例行载瘤动脉闭塞患者术后发生缺血性脑卒中,最终死亡;余27例患者均无并发症发生,顺利出院.23例患者接受影像学随访,13例治愈,5例好转,2例稳定,3例复发(均再次行血管内治疗治愈).24例患者接受临床随访,临床预后均稳定或好转.结论 血管内治疗是处理TIICAP的有效手段,其中血流导向装置、覆膜支架等新技术的优势初现,值得进一步研究.

目的 分析脑膜中动脉(MMA)栓塞治疗慢性硬脑膜下血肿的有效性和安全性.方法 回顾性连续纳入2018年3月至2020年5月在海军军医大学(第二军医大学)长海医院脑血管病中心接受MMA栓塞治疗的慢性硬脑膜下血肿患者19例,分析MMA栓塞术后3个月血肿复发和进展情况,以及技术成功率和技术相关并发症的发生率.结果 19例患者中男17例、女2例,年龄为51～85岁,平均年龄为(67.4±7.9)岁.共21例侧慢性硬脑膜下血肿,其中6例侧行单纯MMA栓塞,15例侧行MMA栓塞联合钻孔引流(MMA栓塞后钻孔引流7例侧,钻孔引流后MMA栓塞8例侧).21例侧血肿MMA栓塞术均获得成功,其中17例侧使用Onyx胶栓塞,4例侧使用Glubran胶栓塞.19例患者均无技术相关并发症.19例患者均接受临床和影像学随访,术后临床症状均明显缓解,术后3个月均未见血肿复发和进展.结论 MMA栓塞是慢性硬脑膜下血肿一种新的治疗方法,安全性高,血肿复发率低,但该结论仍需大样本随机对照试验验证.

目的 观察脑膜中动脉(MMA)栓塞治疗急性外伤性硬脑膜外血肿(ATEDH)的有效性和安全性.方法 回顾性分析2010年1月至2020年1月在海军军医大学(第二军医大学)长海医院脑血管病中心接受MMA栓塞治疗的40例ATEDH患者资料.患者于发病24 h内行局部麻醉下数字减影血管造影(DSA)+MMA栓塞术,介入栓塞术后根据患者意识状态、血肿体积予药物保守治疗、钻孔引流术或开颅血肿清除术.随访至术后6个月,观察患者术后病情、血肿吸收情况及并发症发生情况.结果 40例ATEDH患者中男21例、女19例,年龄为16～68岁,入院时格拉斯哥昏迷量表(GCS)评分为13～15分者25例,9～12分者15例.40例患者脑血管造影均显示MMA为出血源,均在介入栓塞术后出血立即停止.8例患者采用单纯MMA栓塞治疗,32例MMA栓塞后行钻孔引流术,无患者因病情进展接受开颅血肿清除术.出院时40例ATEDH患者的GCS评分均为15分,头痛、恶心、呕吐等临床症状与入院时相比均明显好转.术后6个月复查时,40例患者均未见血肿进展或复发,扩展的格拉斯哥结局量表评分均为8分.随访过程中,所有患者均未发生手术相关的感染、缺血性脑卒中、神经功能障碍等并发症.结论 MMA栓塞可以有效控制ATEDH进展,减少再出血风险,能有效避免患者进一步接受创伤较大的外科侵入性干预.

目的 评价急性缺血性卒中行机械取栓的疗效与安全性.方法 回顾性分析513例行机械取栓治疗的急性缺血性卒中病例资料,根据临床预后分为良好预后组(n=299)和不良预后组(n=214).主要评价指标为90 d预后良好率,次要评价指标为血管成功再通率、挽救技术比例、并发症及病死率等.结果 机械取栓术后血管成功再通率(mTICI 2b～3级)为93.8％(481/513),术后90 d预后良好率(mRS 0～2分)为58.3％(299/513),颅内出血率为22.0％(113/513),其中症状性颅内出血率为9.6％(49/513),病死率为12.9％(66/513).多因素回归分析表明:术前NIHSS<22分、代偿评分≥2分、血管再通达mTICI 2b～3级及术后无出血,与良好预后密切相关(均P<0.05).结论 机械取栓能明显改善颅内大血管闭塞和(或)远端血管闭塞的临床预后.低NIHSS评分、良好代偿、血管成功再通及无出血是机械取栓90 d预后良好的独立预测因素.

目的 探讨颅内破裂微小动脉瘤血管内治疗的安全性及有效性.方法 回顾性分析2016年1月至2017年12月收治的53例颅内破裂微小动脉瘤的临床及随访资料,均采用血管内治疗.结果 动脉瘤最大直径平均(2.19±0.55)mm.单纯弹簧圈栓塞27例,球囊辅助栓塞2例,支架辅助栓塞24例;术后即刻造影显示动脉瘤致密栓塞24例(45.3％),瘤颈残留16例(30.2％),瘤体显影13例(24.5％).共3例(5.7％)发生围术期并发症,其中1例(1.9％)为术中破裂,1例(1.9％)为术中血栓形成,1例(1.9％)为术后早期再出血.39例影像学随访3·13个月,平均平均(6.1±2.4)个月,动脉瘤不显影32例(82.1％);稳定3例(7.7％);复发4例(10.3％),均再治疗.51例临床随访6～28个月,平均(14.9±6.6)个月,改良Rankin量表评分0～2分50例(98.0％),3分1例(2.0％).结论 对于颅内破裂微小动脉瘤,血管内治疗具有较高的围手术期安全性,以及较高的短期治愈率和临床预后良好率.

脑出血是一种严重的中枢神经系统出血性损伤,出血后炎性反应在其发病后损害及修复中发挥重要作用.小胶质细胞是神经系统固有免疫细胞,脑出血后小胶质细胞激活,可分泌抗炎因子如白细胞介素10、神经生长因子-1及促炎因子白细胞介素1、肿瘤坏死因子α等,在脑出血继发损伤中起到促炎致损及抑炎修复的双向作用.调节小胶质细胞功能状态,增强其组织保护功能,可以促进脑出血后血肿清除,减弱炎性反应,减轻继发性损伤.作者就脑出血后小胶质细胞的激活与功能作用及相关分子机制进行综述,以期为脑出血治疗提供新思路.

Objective:To investigate the role of bone morphogenetic protein 2(BMP2) signaling pathway in the development of intracranial aneurysms and its mechanism in regulating the apoptosis of vascular smooth muscle cells (VSMCs).Methods:The healthy male SD rats were divided into 2 groups according to the random number table method, which were the model group ( n=32) and the sham operation group ( n=32). In the model group, the intracranial aneurysm model was established by ligating the left external carotid artery, the left pterygopalatine artery and the right common carotid artery of the rat. The vessels were not ligated in sham operation group. The rats in both groups were sacrificed at 3 months after operation, and the model establishment was judged by electron microscopy observation and hematoxylin-eosin (HE) staining. BMP2 and downstream phosphorylated Smad1/5(p-Smad 1/5) expression in VSMCs of the rats′ anterior communicating artery complex in both groups were detected by immunohistochemical staining and Western blotting respectively. VSMCs of the rat′s cerebral arteries were further cultured in vitro and divided into 3 groups: control group, BMP2 group(add BMP2 100 ng/ml) and Smad6+ BMP2 group(trasfect Smad6 overexpression vector+ add BMP2 100 ng/ml). The apoptosis of VSMCs in each group was detected by TUNEL (terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling), and the expression of Caspase3, BMP2 and downstream phosphorylated Smad1/5 of VSMCs in each group was detected by Western blotting. Results:Compared with the sham group, the rat′s cerebral arteries had different degrees of lesions in the model group, and VSMCs of the blood vessel wall had obvious remodeling and apoptosis by electron microscopy observation and HE staining, indicating that the disease model was established successfully. The immunohistochemical staining showed that the relative expression levels of Caspase3 (0.25 ± 0.03 vs. 0.06 ± 0.01) and BMP2 (0.12 ± 0.03 vs. 0.06 ± 0.01) were increased significantly in the model group compared with the sham group (both P < 0.05). Compared with the sham group, the Western blotting results showed that BMP2 (0.50 ± 0.04 vs. 0.75 ± 0.07) and p-Smad1/5 (0.27±0.04 vs. 0.73±0.07) relative expression in the model group was increased significantly (both P < 0.05). The TUNEL detection showed that the apoptosis rates of VSMCs in BMP2 group (4.35% ± 0.65% vs. 74.63% ± 6.05%) and Smad6+ BMP2 group (4.35% ± 0.65% vs. 45.92% ± 1.08%) were significantly increased compared with those in the control group (both P <0.01), while the VSMCs apoptosis rate in the Smad6 + BMP2 group was less than that in the BMP2 group ( P < 0.01). Western blotting results showed that the relative expression levels of p-Smad1/5 and Caspase3 in the BMP2 group and Smad6 + BMP2 group were both increased compared with those in the control group (both P < 0.01), while the expression levels of p-Smad1/5 and Caspase3 in the Smad6 + BMP2 group were lower than those in the BMP2 group(both P <0.05). Conclusions:BMP2 and downstream p-Smad1/5 are closely related to the apoptosis of VSMCs in intracranial aneurysms. The apoptosis of VSMCs mediated by BMP/Smad signaling pathway may be one of the mechanisms of the occurrence and development of intracranial aneurysms.

Objective To evaluate the safety and efficacy of flow diverter (FD) in the treatment of vertebral artery dissecting aneurysms (VADA).Methods The clinical and imaging data of perioperative period and follow-up were retrospectively collected and analyzed from 22 patients with VADA treated with FD at Department of Neurosurgery,Changhai Hospital,Navy Medical University from August 2010 to March 2019.Of the 22 aneurysms,4 were recurrent aneurysms,1 was acute ruptured aneurysm and 17 were unruptured aneurysms.Modified Rankin scale (mRS) was used to comprehensively evaluate the patients after surgery,and Okelly-Marotta (OKM) grading scale was to evaluate aneurysm embolization.Results All 24 FDs were implanted successfully in 22 VADA (with 19 Tubridge FDs and 5 Pipeline FDs).The technical success rate was 100％.Ten aneurysms were treated with FD combined with coil embolization.The immediate results of embolization were classified according to Raymond's classification,with 2 cases of grade Ⅱ and 8 cases of grade Ⅲ.Twelve aneurysms were treated with only FD and significant intra-aneurysmal contrast hemostasis was retained immediately after operation in all 12 cases.No procedure-related hemorrhagic or ischemic complications occurred during the perioperative period.As for clinical follow-up 13.0(8.3-67.9)months,22 patients had the mRS score of 0.No novel neurological deficits were reported.The short-term imaging follow-up at 6.0(4.7-7.1)months involved 20 cases and the complete occlusion rate was 13/20.The complete occlusion rates were 17/20 for last follow-up at 7.7(6.0-24.4)months and 8/8 for long-term follow-up at 26.5 (23.3-31.4) months,respectively.No recurrence was demonstrated.Eight PICAs covered by FD and 3 PICAs harboring aneurysms were all patent during follow-up.One case developed severe in-stent stenosis at 3.5-month follow-up post FD placement in which balloon dilatation and angioplasty with stenting was performed.Twenty-two months later,the stenosis of the lumen returned to normal and the aneurysm was completely occluded.Conclusion FD treatment of VADA seems to have high surgical safety and satisfactory results.Long-term efficacy needs to be further evaluated in large case series.

目的 评价应用Tubridge和Pipeline血流导向装置治疗复杂颅内动脉瘤的安全性和有效性.方法 回顾性连续纳入我科2010年8月至2017年12月应用血流导向装置治疗的99例患者共101个复杂颅内动脉瘤的临床资料,其中91个为首次治疗,10个为复发动脉瘤.动脉瘤平均最大径为(19.6±6.6)mm,94个位于前循环,7个位于后循环.61例患者的61个动脉瘤应用Tubridge血流导向装置治疗,38例患者的40个动脉瘤应用Pipeline血流导向装置治疗.术后予以临床随访与影像学随访.结果 99例患者的101个动脉瘤共置入血流导向装置116枚(Tubridge 74枚、Pipeline 42枚),均成功输送并释放.术后1例患者发生迟发性出血并死亡,2例发生缺血性并发症.88个动脉瘤获得了影像学随访,其中短期随访(0～6个月)完全闭塞率为66.7％(42/63)、中长期随访(7～18个月)完全闭塞率为73.5％(36/49)、长期随访(>18个月)完全闭塞率为89.3％(25/28).全部动脉瘤末次影像学随访完全闭塞率为72.7％(64/88),Tubridge组和Pipeline组分别为73.6％(39/53)和71.4％(25/35),差异无统计学意义(P>0.05).结论 应用Tubridge血流导向装置与Pipeline血流导向装置治疗复杂颅内动脉瘤均安全有效,但也存在一定的并发症风险.

Objective To evaluate the safety of branch arteries covered by Tubridge flow diverters (TFDs) in the treatment of intracranial aneurysms.Methods The clinical and angiographic data of 79 patients harboring 79 aneurysms treated with TFD from the Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using Tubridge (PARAT) trials were retrospectively collected and analyzed,in which 12 nationwide centers participated from December 2012 to May 2014.Digital subtraction angiography (DSA) was performed to evaluate immediate treatment results and coverage of branch vessels.For aneurysms treated by TFDs and coils,immediate results were classified according to Raymond Grade System,and for aneurysms treated by TFDs only,immediate results were evaluated according to stagnation of contrast.Angiographic follow-up was preformed conventionally after treatment with TFDs at 3 months using magnetic resonance angiography (MRA) and 6 months using DSA.Results A total of 91 TFD were delivered and implanted successfully in the 79 lesions.Fifty-eight aneurysms were treated by TFDs and coils,and Raymond Ⅰ was achieved in 2 lesions (3.4％),Raymond Ⅱ in 5 lesions (8.6％) and Raymond Ⅲ in 51 lesions (87.9％).For 21 aneurysms treated by TFDs alone,stagnation of contrast was observed in 15 lesions (71.4％).One hundred and ten branch arteries were covered by TFDs.MRA was available in 52 patients at 3 months,and 31 lesions (59.6％) were completed cured,16 lesions (30.8％) were improved and 5 lesions (9.6％) remained stable.DSA data were available in 73 patients at 6 months.Among them,55 (75.3％) were completed cured,14 (19.2％) were improved,2 (2.7％) remained stable and 2 (2.7％) developed recurrence.The total rate of effective treatment (completely cured and improved) was 94.5％ (69/73).Branch artery occlusion was observed in 3 cases,including 1 anterior choroidal artery,1 anterior cerebral artery and 1 ophthalmic artery,without permanent neurologic deficits.The occlusion rate of branch arteries was 2.9％ (3/104).Conclusion Branch arteries covered by Tubridge flow diverter in treatment of intracranial aneurysms seem relatively safe and further clinical follow-up is needed.

Objective To evaluate the safety and efficacy of Tubridge flow diverter (TFD) in the treatment of intracranial aneurysms at a single center.Methods The clinical and angiographic data of 139 patients harboring 143 aneurysms treated with TFD between August 2010 and December 2018 at Department of Neurosurgery,Changhai Hospital,Naval Medical University were retrospectively collected and analyzed.Among them,127 lesions were located in anterior circulation and 16 in posterior circulation.The size of the aneurysms ranged from 2.8-50.0 mm,with the mean size of 16.4 ± 9.2 mm.Clinical and angiographic follow-up were preformed conventionally after treatment with TFD.The clinical outcomes of the patients were evaluated using modified Rankin Scale (mRS).Results Among the 139 patients with 143 intracranial aneurysms,a total of 163 TFD were delivered and implanted successfully.Three patients had acute ischemic stroke after TFD deploymnet.And there were no bleeding complications and no death.The median clinical follow-up time of 109 patients was 29.6 months (range:5 to 82 months).The mRS of 0 was obtained in 97 patients,mRS of 1 in 10 and mRS of 2 in 2.Procedure-related complications occurred in 3 patients.Angiographic follow-up data were available in 103 patients.The median follow-up time was 13.0 months (range:6 to 80 months).The complete occlusion rates at 6 months,12 months,24 months and last followup were 75.7％ (78/103),83.5％ (66/79),92.3％ (48/52) and 82.5％ (85/103),respectively.Conclusion Tubridge flow diverter seems safe and effective in the treatment of intracranial aneurysms with relatively high success rate and few complications.

Objective To clarify the indications,technical essentials and complication preventing strategies concerning the telescoping flow diverter devices technique by summarizing our premilitary experience in treatment of cervical and intracranial aneurysms using this technique.Methods Fifteen cases with 15 cervical and intracranial aneurysms treated with telescoping flow diverter devices at Department of Neurosurgery,Changhai Hospital,Navy Military Medical University from August 2010 to April 2019 were retrospectively reviewed.Five aneurysms were treated with Pipeline embolization devices (PED) and 10 with Tubridge flow diverters using telescoping technique.Among all aneurysms,7 were treated in intended manner,while 8 aneurysms were treated in salvaging purpose.In 9 patients,the first flow diverter was deployed distally,followed by a second flow diverter deployed proximally in the parent artery (D-P manner),while in the remaining 6 patients,the first flow diverter was deployed proximally,followed by deployment of a second flow diverter (P-D manner).Coiling was also performed in 11 patients.Modified Rankin scale (mRS) was used to comprehensively evaluate the patients after surgery,and O'kelly-Marotta (OKM) grading scale was to evaluate aneurysm embolization.Results The techniques were succeeded performed in all patients.Contrast stasis was observed in 14 aneurysms immediately post procedure.According to OKM grading scale,7 were categorized as OKM grade A,7 as grade B and 1 as grade C.No procedure-related complications were encountered.In 10 patients who had DSA follow-up lasting for 6-30 (median:12) months,7 aneurysms were totally occluded (OKM grade D),while further thrombosis was observed in the other 3 aneurysms (OKM grade B in 1 and grade C in 2).The parent arteries were patent in all except for 1 patient who developed occlusion at 9 months postoperatively.All patients were clinically followed up for 2-30 (median:12) months.During that period,no new neurological deficits were revealed (mRS:0-2),except for that 1 patient developing contralateral hemiplegia (mRS:3).Conclusion Telescoping flow diverter devices could be used to treat complicated cervical and intracranial aneurysms safely with good short-term effect.It should be considered with priority in treatment of large,giant or fusiform aneurysms with extremely wide neck.

目的 评价前循环远端血管闭塞行支架取栓器机械取栓治疗的疗效.方法 连续回顾性纳入2013年9月至2018年5月于海军军医大学(第二军医大学)长海医院脑血管病中心行支架取栓器机械取栓治疗的急性前循环远端血管闭塞患者.根据是否给予静脉溶栓治疗,将患者分为桥接组与直接取栓组.主要评价指标为支架取栓器机械取栓术后90 d改良Rankin量表(mRS)评分(mRS评分≤2分为预后良好),次要评价指标为血管成功再通率[改良脑梗死溶栓(mTICI)再通等级达2b、3级]、术后24 h美国国立卫生研究院卒中量表(NIHSS)评分、并发症及死亡率等.结果 共纳入36例(男22例)患者,年龄为26～88(68.3±13.6)岁.大脑中动脉M2段闭塞27例、大脑前动脉A1/A2段闭塞5例、大脑中动脉M2段+大脑前动脉A2段闭塞4例.远端血管闭塞行支架机械取栓术后血管成功再通率达91.7％(33/36),术后90 d预后良好率为52.8％ (19/36).血管痉挛是最常见的并发症(33.3％,12/36),其次为出血转化(16.7％,6/36).症状性颅内出血发生率为5.6％(2/36),死亡率为8.3％(3/36).桥接组患者14例,直接取栓组22例.桥接组术前NIHSS评分高于直接取栓组,差异有统计学意义(Z=3.025,P=0.002);而两组术后24 h NIHSS评分、取栓次数、血管成功再通率、术后90 d预后良好率、出血转化率及死亡率差异均无统计学意义(P均＞0.05).结论 前循环远端血管闭塞行支架取栓器机械取栓治疗可能是安全有效的,有利于血管再通及90 d良好预后.

目的 探讨阿托伐他汀钙配合单孔双管冲洗引流治疗慢性硬膜下血肿的临床疗效.方法 回顾分析2016年5月至2017年4月我院神经外科采用阿托伐他汀钙配合单孔双管冲洗引流治疗的42例慢性硬膜下血肿的临床预后及随访结果.男33例、女9例,年龄为38～82岁,平均年龄为(70.0±5.8)岁.42例患者均有头痛、头晕症状,36例有不同程度肢体肌力障碍.结果 42例患者中36例为单侧慢性硬膜下血肿,6例为双侧慢性硬膜下血肿.所有患者的头痛、头晕症状和肌力障碍术后24 h内均改善,1个月后症状完全消失.41例完全治愈,其中22例患者术后3个月时复查头颅计算机断层扫描(CT)提示血肿完全消失,19例患者术后6个月时复查头颅CT示血肿完全消失;1例(2.38％)双侧慢性硬膜下血肿患者因心房颤动口服华法林,术后1个月时复查头颅CT提示慢性硬膜下血肿复发,在随访过程中突发呼吸心跳骤停死亡.结论 阿托伐他汀钙配合单孔双管冲洗引流治疗慢性硬膜下血肿确实有效,值得推广应用.

Objective To evaluate the prognosis and its predictors after treatment of the unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs) with stent-related reconstructive techniques.Methods Clinical data of 182 consecutive patients harboring 182 uis-VADAs,which were treated with the stent-related reconstructive techniques at Department of Neurosurgery,Changhai Hospital,Naval Military Medical University (92 cases) and Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University (90 cases) from January 2009 to December 2015,were retrospectively reviewed and analyzed.The prognosis [favorable prognosis,modified Rankin Scale (mRS):0-2;unfavorable prognosis,mRS:3-6] and its predictors were evaluated and analyzed.Results The postoperative control angiography confirmed complete obliteration or near-complete obliteration in 135 (74.2％) cases and partial obliteration in 47 (25.8％) cases.Four (2.2％) patients suffered from periprocedural complications,which included stent thrombosis in 2 cases and occlusion of the distal posterior inferior cerebellar artery in 1 case with favorable prognosis,and the cerebellar hemisphere and brainstem multiple infarctions in 1 with unfavorable prognosis.Of 182 patients with uis-VADAs,12 (6.6％) had unfavorable prognosis and included 4 (2.2％) deaths.In contrast,of 178 survivals with the median follow-up of 45 months (range:12-72 months),170 (93.4％) patients had favorable prognosis.Follow-up angiography was available for 131 (73.6％) cases and reported recurrence in 23 (17.6％).The multivariate logistic regression analysis indicated that preoperative cerebral infarction(OR =9.212,95％ CI:2.154-39.395,P =0.003) and the largest diameter of VADAs (OR =1.112,95％ CI:1.036-1.194,P =0.003) were predictors of unfavorable prognosis in the reconstructed uis-VADAs.Conclusions Patients with stent-related reconstructive treatment for uis-VADAs seem to have favorable prognosis with a low complication rate.The largest diameter of VADAs and preoperative cerebral infarction may be 2 independent predictors of unfavorable prognosis in the reconstructed uis-VADAs.

Objective To compare the safety and efficacy of stent-assisted coil and non-stent-assisted coil for the treatment of ruptured posterior communicating artery aneurysms.Methods A total of 121 consecutive patients with ruptured posterior communicating artery aneurysm treated at the Department of Neurosurgery,Heze Municipal Hospital between June 2014 and June 2017 were enrolled retrospectively.They divided into either a stent group (n =63) or non-stent group (n =58) according to whether they used stent treatment or not.The two groups were compared,and their clinical data,surgical related complications,the degree of embolism immediately after aneurysm surgery,and the follow-up results of clinical and imaging were analyzed.Results Interventional embolization therapy was successfully performed in all the patients.(1) The proportion of wide-necked aneurysms of the stent group was higher than that of the non-stent group.There was significant difference (92.1％ [58/63] vs.8.6％ [5/58],x2 =84.249,P ＜ 0.01).There were no significant differences in age,aneurysm size,sex,and HuntHess grade (all P ＞ 0.05).(2) The incidences of intraoperative aneurysm rupture of the stent group and non-stent group were 4.8％ (3/63) and 3.4％ (2/58) respectively.There was no significant difference (x2 =0.132,P =0.717).The incidence of thromboembolie complication was 12.7％ (8/63) and 5.2％ (3/58)respectively.There was no significant difference (x2 =2.070,P =0.150).In the stent group,1 patient disabled and 1 died,and in the non-stent group,there were no cases with surgical related disability,and 1 died.(3) The comparison of immediate results after procedure between the stent group and non-stent group:there were no significant differences in the complete embolic rate (39.7％ [25/63] vs.37.9％[22/58],x2 =0.039),aneurysm neck residual rate (25.4％ [16/63] vs.39.7％ [23/58],x2 =2.811],and residual rate of aneurysm (34.9％ [22/63] vs.22.4％ [13/58],x2 =2.298,all P ＞ 0.05).(4) The recurrence rate of aneurysms (4.3％ [2/46]) of the stent group was lower than that of the non-stent group (31.8％ [14/44]).There was significant difference between the two groups (x2 =112.610,P =0.01).No rebleeding occurred in all aneurysms after procedure.Conclusion Compared with the non-stent-assisted coil embolization,the stent assisted embolization of ruptured posterior communicating artery aneurysms in acute phase may reduce the recurrence rate of aneurysms and without significantly increasing the incidence of surgery-related complications.