Endovascular Treatment of Bilateral Intracranial Vertebral Artery Aneurysms: An Algorithm Based On a 10-Year Neurointerventional ExperienceYisen Zhang, Zhongbin Tian, Wei Zhu, Jian Liu, Yang Wang, Kun Wang, Ying Zhang, Xinjian Yang, Wenqiang Lidoi:10.1136/svn--000376
Stroke & Vascular Neurology（SVN）最新上线文章“Endovascular Treatment of Bilateral Intracranial Vertebral Artery Aneurysms: An Algorithm Based On a 10-Year Neurointerventional Experience”，来自首都医科大学附属北京天坛医院神经介入中心、北京市神经外科研究所杨新健、张义森、李文强等。
双侧颅内椎动脉夹层动脉瘤（IVADAs）的治疗在临床上尚存有争议，尽管血管内治疗被视为颅内动脉瘤治疗的主要方式之一，然而对于双侧IVADAs的治疗方法与原则仍需进一步探讨。作者团队基于该研究探讨了血管内治疗双侧IVADAs的策略及其结果。
作者团队回顾性分析了自1月至12月为期的高容量神经介入中心数据，筛查了所有诊断为双侧IVADAs的患者，记录其临床及影像学相关数据，并推导总结出相关治疗原则。
Figure 1. Algorithm showing endovascular treatment protocol for bilateral IVADAs. CTA, CT angiography; DSA, digital subtraction angiography; HR-MRI, high-resolution MRI; IVADAs, intracranial vertebral artery dissecting aneurysms; PICA, posterior inferior cerebellar artery; SAH, subarachnoid haemorrhage; VA, vertebral artery
研究共纳入经血管内治疗的双侧IVADAs患者27例，IVADA共计54枚，其中，未破裂51枚、破裂3枚。4例（14.8％）进行同期血管内治疗，12例（44.4％）进行分期血管内治疗，仅单侧血管内治疗的为11例（40.8％）。在患者治疗后的脑血管造影随访中，36枚IVADA出现完全闭塞（85.7％）。在支架辅助弹簧圈的病例中，所有3枚破裂的IVADA中有2枚出现再通并进一步进行了栓塞治疗。3例患者（11.1％）出现术中或术后并发症（其中单期治疗2例，分期治疗1例）。25例患者（92.6％）临床结局良好，2例患者（7.4％，均为单期治疗）随访时出现了不良临床结局。在所有仅进行单侧血管内重建治疗的IVADAs患者中，未接受治疗的对侧IVADA均稳定，随访期间无生长或破裂。所有IVADAs在临床随访期间均未出现再出血。
Figure 2. (A) A patient showing subarachnoid haemorrhage on CT imaging. (B and E) Digital subtraction angiography showed bilateral IVADAs. The ruptured side could not be determined based on the CT scan. (C and F) Thus, for this ruptured patient, both aneurysms were treated with stentassisted coil embolisation at one stage, and a near-complete obliteration was achieved. (G) At the 3-month follow-up, the left IVADA recanalised, and the right IVADA was stable. The recanalised IVADA was further retreated with recoiling. (D and H) Both IVADAs were stable at the last follow-up angiography. IVADAs, intracranial vertebral artery dissecting aneurysms.
Figure 3. (A and D) An unruptured patient with bilateral IVADAs. This patient received a two-stage treatment. (E) At the first stage, the right aneurysm was treated with PED alone, and partial obliteration was achieved immediately. (F) Three months later, the right aneurysm was completely obliterated, while no compensatory blood flow was supplied to the left vertebral artery. (B) At the same time, the left aneurysm was also treated with PED alone, and partial obliteration was achieved immediately. (G) At the last follow-up DSA, the right aneurysm remained stable. The left posterior inferior cerebellar artery received compensatory blood flow from the right vertebral artery, while the left parent artery disappeared (C). No clinical symptoms were found. DSA, digital subtraction angiography; IVADAs, intracranial vertebral artery dissecting aneurysms; PED, Pipeline Embolization Device.
Figure 4. (A and D) A patient with bilateral IVADAs, who was treated only one side. (B) The left aneurysm was treated with PED alone, and partial obliteration was achieved immediately. (E) Three months later, the right aneurysm remained stable. (C and F) At the last follow-up angiography, the left aneurysm was completely obliterated, and the right aneurysm remained stable. IVADAs, intracranial vertebral artery dissecting aneurysms; PED, Pipeline Embolization Device.
研究结论：双侧IVADAs进行血管内治疗具有较高的技术成功率，较高的动脉瘤完全闭塞率及可接受的并发症率或死亡率。以分期或定期观察的方式治疗IVADAs，对侧IVADA出现生长和破裂的概率较低。
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