Clinical Study Of The Treatment Of Posterior Circulation Intracranial Aneurysms In Interventional Therapy

Objective: Retrospectively collecting the clinical data of interventional therapy of intracranial posterior circulation aneurysms cases.To analyze the interventional therapy, clinical outcome,the perioperative complication,short-term prognosis and recurrence rate.Summarizing the clinical experience to provide bases for interventional therapy of such patients.Methods:A retrospective study of 34 patients admitted to Yi Ji Shan Hospital affiliated to Wan Nan Medical College with intracranial posterior circulation aneurysms treated by the interventional therapy from Jan 2010 to Sep 2014.34 patients with a total of 38 aneurysms of posterior circulation.4 cases had multiple aneurysms of posterior circulation.20 cases of female patients and 14 cases of male patients in our data.On admission,Hunt-hess gradeⅠin 5cases,Hunt-hess grade in 14 cases,HuntⅡ-hess grade Ⅲ in 8 cases,Hunt-hess grade Ⅳin 6 case,Hunt-hess grade Ⅴin 1 cases.18 cases of patients with hypertension and 2 patients with a history of cerebral infarction history.5 pieces of basilar artery aneurysm,16 pieces of vertebral artery aneurysm,4 pieces of posterior cerebral artery aneurysm,5 pieces of the superior cerebellar artery aneurysm and 8 pieces of the posterior inferior cerebellar artery aneurysm were in our study.In the total of 38 aneurysms of posterior circulation,16 were small aneurysms,15 were midsize aneurysms,6 were large aneurysms,1 was gaint aneurysms.10 were narrow-necked aneurysms,7 were wide-necked aneurysms,21 were dissecting and fusiform aneurysms.21 were stent-assisted coil embolization,8 were coil embolization,4 werecovered stent and 5 aneurysms of posterior circulation were treated by parent artery occlusion.The amount of bleeding were more,patients could treated with lumbar puncture for cerebrospinal fluid drainage.Hydrocephalus of patients were treated by lateral ventricular catheter for cerebrospinal fluid drainage. Patients had a mean clinical follow-up time of 6.2 months(rang,3-12months).Results:38 aneurysms of posterior circulation were treated by interventional therapy.Acute angiographic results demonstrated dense occlusion in 26 aneurysms(84%),neck residual in 6 aneurysms(8%),partial occlusion in 6 aneurysms(8%). In which 6 aneurysms were neck residual,1 was the posterior inferior cerebellar artery aneurysm and was treated by coil embolization,1 was giant basilar artery aneurysm and was treated by stent-assisted coil embolization,1 was fusiform posterior cerebral artery aneurysm and was treated by stent-assisted coil embolization,3 were dissecting vertebral artery aneurysms were treated by stent-assisted coil embolization.In which 6 aneurysms were partial occlusion,3 were fusiform vertebral artery aneurysms which were covered by stent,3 were dissecting vertebral artery aneurysms which were treated by stent-assisted coil embolization.Thromboemblic complications in 4 cases,procedural ruptures in 2 cases,2 patients were death,acute hydrocephalus in 6 cases,cerebral vasospasm in 5 cases,all complications occurred in perioperation. At discharge favourable prognosis(MRS grade 0-2) in 25 cases,poor prognosis(MRS grade 3-6) in 9 cases and 2 patients were death.Patients were followed up for 3-12 months,Follow-up angiogram were obtained in 27 cases which had 30 aneurysms, 25 aneurysms demonstrated stable and 5 aneurysms were recurrent.32 patients were clinical followed up,26 cases had favourable prognosis and poor prognosis in 6 cases.Conclusion: The emergency treatment of posterior circulation intracranial aneurysms in interventional therapy can obtain ideal curative effect,but need to take appropriateoption according to the different location,the shape and size of the aneurysm.Narrow-necked aneurysms can be safe and efficient treated by coil embolization.Wide-necked aneurysms and fusiform and dissecting aneurysms treated by stent assisted coil embolization therapy can cure the aneurysm and improve local hemodynamics.Fusiform and dissecting aneurysms covered by stent can gain a degree of protection,which may shrink or even disappear,but need to pay attention to close follow up.Fully preoperative assessment after,distal of posterior circulation aneurysms and unilateral vertebral artery aneurysms can obtain ideal treatment effect by the parent artery occlusion.Interventional therapy before and after, all need to pay attention to the prevention of complications of posterior circulation aneurysms, and should take a long-term follow-up.