探讨脉络膜前动脉(AChA)区圈闭部位与脑梗死的关系及颈内动脉血泡样动脉瘤(BLA)高流量分流术和病灶圈闭治疗的相关风险。
我们纳入了26例诊断为BLAs并接受高流量旁路和诱捕的患者。我们检查了临床特征,包括年龄,动脉瘤陷阱位置,最终预后,脑梗塞术后磁共振成像,出院时改良Rankin量表评分。我们还搜索了类似研究的文献。
20例患者出院时改良Rankin量表评分为0-2分,2名患者中有3-5名,2例患者中有6例。在19/26患者(73.1%)中,被困段位于后交通(PcomA)和眼动脉之间。在2例患者(7.7%)中,被困节段包括PcomA和AChA;4例患者(15.4%),被困段在PcomA内。在这些患者中,PcomA被阻塞,高流量旁路的血液单独流向AChA。无患者出现脑梗死。我们的系统评价确定了70例患者。在所有96名患者中,12人患有AChA脑梗塞;然而,梗死仅影响2例患者的预后。
当用高流量旁路和病灶捕获治疗BLAs时,即使PcomA闭塞,AChA脑梗死的频率也很低,在高流量旁路期间,将AChA作为唯一的流出血管。然而,治疗C1-2附近晚期动脉硬化患者时,PcomA闭塞可能与风险相关。
To examine the relationship between trap location and cerebral infarction in the anterior choroidal artery (AChA) region and associated risks in ruptured internal carotid artery blood blister-like aneurysm (BLA) treatment with high-flow bypass and lesion trapping.
We included 26 patients diagnosed with BLAs and treated with high-flow bypass and trapping. We examined clinical characteristics including age, aneurysm trap location, final prognosis, cerebral infarction on postoperative magnetic resonance imaging, and modified Rankin Scale score at discharge. We also searched the literature for similar studies.
The modified Rankin Scale score at discharge was 0-2 in 20 patients, 3-5 in 2 patients, and 6 in 2 patients. In 19/26 patients (73.1%), the trapped segment was between the posterior communicating (PcomA) and the ophthalmic arteries. In 2 patients (7.7%), the trapped segment included the PcomA and the AChA; in 4 patients (15.4%), the trapped segment was within the PcomA. In these patients, the PcomA was occluded, and blood from the high-flow bypass flowed out to the AChA alone. No patient showed cerebral infarction. Our systematic review identified 70 patients. Of all 96 patients, 12 had AChA cerebral infarction; however, the infarction affected the prognosis of only 2 patients.
When treating BLAs with high-flow bypass and lesion trapping, the frequency of AChA cerebral infarction is low even when the PcomA is occluded, leaving the AChA as the only outflow vessel during high-flow bypass. However, PcomA occlusion may be associated with risks when treating patients with advanced arteriosclerosis near C1-2.