Analysis Of Imaging Diagnosis And Endovascular Treatment Of Vertebrobasilar Artery Dissecting Aneurysm

BackgroundVertebrobasilar dissecting aneurysm is the main reason of stroke in youth. Due to vertebrobasilar supply to the brainstem, adjaeent important nerves and blood vessels, and is located in deep space, operation and show very difficult,making the craniotomy operation treatment difficulties, and high mortality and disability rate. With the development of imaging, interventional neuro science and materials engineering, the treatment ofvertebrobasilar dissecting aneurysms have got rapid development, minimally invasive, low morbidity, mortality,and has been more and more recognized by patients and doctors.ObjectiveTo investigate the imaging diagnosis of vertebrobasilar artery dissecting aneurysm and summarize the experience with the endovascular treatments.MethodsMRI and angiography imaging features, endovascular intervention procedures and effects were retrospectively analyzed for 20 patients with posterior circulation (vertebral basilar artery) who were admitted to our hospital (The Armed Police General Hospital Nerves and blood vessels surgery dept)between May 2010 and June 2014.ResultsDSA is a gold standard in diagnosing dissecting aneurysms. Typical performances included pear land string, double cavity syndrome, fusiform dilatation, contrast agent clearance delay and the false lumen. High-resolution MRI clearly showed the intimal flap and intramural hematoma. In 8 cases who had micro coil occlusion of the aneurysm and parent artery, intraoperative angiography showed complete occlusion of the aneurysm and parent artery and normal vascular imaging for each passing branches.9 cases were performed with stenting combined with auxiliary spring coiling, among whom 7 cases achieved dense embolization,2 cases less dense embolization. In 3 cases of only spring coil embolism,2 cases obtained dense embolization, while the rest one got less dense embolization.1 case with occlusive aneurysm and parent artery aneurysm had transient dysphagia and limb numbness, while the rest were stable after operation,1 case who had subarachnoid hemorrhage was in a coma after operation. DSA follow-ups of 3-36 months after surgery showed that 1 case of pure spring coiling with less dense dissecting aneurysm embolization relapsed and needed secondary surgery,1 cases died of a subarachnoid hemorrhage.while the rest found no recurrence or progress. MRS scoring was done at the end of the follow-ups,12 cases 0,5 cases 1 points,2cases 2 points,1 case of death.ConclusionHigh-resolution imaging has a huge advantage over DSA in the diagnosis of dissecting aneurysm. Endovascular treatment such as simple stenting, stenting assisted by coiling, load tumor artery occlusion are safe and effective. Of course, when choosing treatment strategies, we need to take into consideration clinical manifestations of the patients, aneurysm morphology and whether an aneurysm in the vertebral artery, whether rupture hemorrhage, whether involvement after cerebellar artery, and choose individualized treatment to obtain best effects.