摘要：

目的: 探讨颈内动脉血泡样动脉瘤的最佳血管内治疗方式。方法与结果: 回顾分析2018年1月至2022年1月苏州大学附属第一医院诊断与治疗的25例颈内动脉血泡样动脉瘤患者的临床资料，17例采用单支架辅助栓塞，其中14例应用Lvis支架，3例应用Enterprise支架；4例采用双支架辅助栓塞，均为Lvis支架；1例采用重叠支架植入（2个Lvis支架和1个Enterprise支架）；1例采用球囊辅助栓塞；2例采用血流导向装置植入。术中均未发生动脉瘤破裂，1例出现支架内血栓形成，余24例术后即刻DSA均显示血流通畅。Raymond分级显示17例为Ⅰ级栓塞，3例为Ⅱ级栓塞，5例为Ⅲ级栓塞。术后并发症主要包括脑梗死（2例）、蛛网膜下腔出血引起的脑血管痉挛（1例）、脑积水（2例）。术后有6例动脉瘤复发（3例应用单Enterprise支架，1例应用双Lvis支架，1例应用血流导向装置Tubridge，1例应用球囊辅助栓塞），其中5例再次接受支架辅助栓塞，术后仍有1例复发，最终经调整抗血小板治疗方案治愈；余1例经调整抗血小板治疗方案治愈。术后12个月改良Rankin量表评分0分者15例、1分者6例、2分者3例、6分者1例，病残率为12%（3/25），病死率为4%（1/25）。结论: 术后即刻栓塞程度对术后动脉瘤是否复发至关重要；对于复发的颈内动脉血泡样动脉瘤，应优先考虑调整抗血小板治疗方案。

关键词: 动脉瘤, 颈内动脉, 栓塞, 治疗性, 支架, 血小板聚集抑制剂, 脑血管造影术

Abstract:

Objective: To explore endovascular treatment for patients with blood blister-like aneurysms (BBA) of the internal carotid artery (ICA). Methods and Results: A retrospective analysis of the clinical data of 25 patients with BBA of ICA admitted to The First Affiliated Hospital of Soochow University from January 2018 to January 2022 were conducted. All of them accepted endovascular treatment: 17 cases were treated with single-stent-assisted embolization, including 14 cases using Lvis stents and 3 cases using Enterprise stents; 4 cases were treated with double-stent-assisted embolization, all using Lvis stents; one case was treated with overlapping stent implantation, including 2 Lvis stents and one Enterprise stent; one case was treated with balloon-assisted embolization, and 2 cases were treated with Tubridge flow diverter. No aneurysm rupture occurred during the surgery. One patient had intra-stent thrombosis during the procedure, while other 24 patients showed smooth blood flow on postoperative immediate DSA. The Raymond classification showed that among the patients, there were 17 cases of grade Ⅰ occlusion, 3 cases of grade Ⅱ occlusion, and 5 cases of grade Ⅲ occlusion. Postoperative complications included cerebral infarction (2 cases), cerebral vasospasm due to subarachnoid hemorrhage (one case), and hydrocephalus (2 cases). Six patients had aneurysm recurrence postoperatively (3 cases using a single Enterprise stent, one case using 2 Lvis stents, one case using Tubridge flow diverter, and one case using a balloon-assisted embolization), among whom 5 patients underwent repeat stent-assisted embolization treatment. And one patient still had recurrence after treatment but achieved cure by adjusting antiplatelet therapy regimen; one patient recovered by adjusting antiplatelet therapy regimen. At 12 months after surgery, the modified Rankin Scale (mRS) scores were as follows: 0 in 15 cases, 1 in 6 cases, 2 in 3 cases, and 6 in one case. The disability rate was 12% (3/25), and the mortality rate was 4% (1/25). Conclusions: The degree of immediate postoperative occlusion is crucial for preventing aneurysm recurrence postoperatively. For recurrent BBA of ICA, adjustment of antiplatelet therapy should be considered first.

Key words: Aneurysm, Carotid artery, interal, Embolization, therapeutic, Stents, Platelet aggregation inhibitors, Cerebral angiography