The Clinical Research Of Endovascular Treatment On Dissecting Aneurysm In Intracranial Vertebral Artery And The Anatomic Study Of Intracranial Vertebral Artery

Objective:1. To study the morphology, course and important branches of intracranial vertebral artery, therefore provide anatomical basis for endovascular treatment on dissecting aneurysm in intracranial vertebral artery.2. To compare therapeutic effects of vascular occlusion and stent assisted coil embolization in the treatment of intracranial segment of vertebral artery dissecting aneurysm. Methods:1. The morphology, course and important branches of intracranial vertebral arterys were studied on 16 adult head specimens. At the same time we measured the diameter and the length of the left and right sides of the vertebral artery.2. The diameter and the length of the left and right sides of the vertebral artery on DSA was measured on 50 patients in the second affiliated hospital of nanchang university between 2010.05 and 2015.05.3. Clinical data of 33 dissecting aneurysm in intracranial vertebral artery treated with endovascular treatment in the second affiliated hospital of nanchang university between 2010.05 and 2015.05 were analyzed retrospectively. Results:1. Posterior inferior cerebellar artery, anterior spinal artery and perforating branches of brainstem from vertebral artery intracranial segment participate in the blood supply of brain-stem, spinal and cerebellum. D1 a 5.20±0.33 mm, D2 a 5.05±0.37 mm, D1 b 4.80±0.59 mm, D2 b 4.62±0.77 mm, L1 a 32.7±1.1mm, L1 b 31.8±1.4mm, L2 a 17.6±1.2mm, L2 b 16.4±1.1mm, L3 a 25.4±1.5mm, L3 b 23.8±1.3mm. The diameter and the length of the left and right sides of the vertebral artery were not statistically significant difference, P > 0.05.2. 50 cases of normal patients vertebral artery intracranial segment by DSA shows D1 a 3.20±0.30 mm, D2 a 2.20±0.30 mm, D1 b 3.10±0.40 mm, D2 b 2.00±0.20 mm, L1 a 33.50±3.40 mm, L1 b 32.3±4.10 mm, L2 a 16.80±2.20 mm, L2 b 15.9±3.40 mm, L3 a 23.40±2.50 mm, L3 b 22.8±2.70 mm. The diameter and the length of the left and right sides of the vertebral artery were not statistically significant difference, P > 0.05.3. 5 cases of dissecting aneurysm in intracranial vertebral artery were treated by occlusion skill in our study,4 cases were cured,1 case had recurrence of aneurysm after half a year.28 cases of dissecting aneurysm in intracranial vertebral artery were treated by stent skill,27 cases were cured,1 case had recurrence of aneurysm after half a year.Using mRS scoring system to evaluate the prognosis of the two treatments,efficacy was no significant difference. Conclusions:1. Normal and variable vertebral artery anatomy have important significance on endovascular therapy.2. The occlusion skill and stent skill have good effect for curing dissecting aneurysm in intracranial vertebral artery. But they all have possibility of recurrence after the treatment. So we should do DSA regularly after endovascular treatment.3. Vascular occlusion in the treatment of intracranial vertebral artery dissecting aneurysm have strict surgical indications.Stent assisted coil embolization in the treatment of vertebral artery dissection aneurysm can also reduce the risk of hemorrhage and aneurysm recurrence rate is low too.there is no difference of prognosis between Vascular occlusion and stent assisted coil embolization.