The Clinical Research On The Endovascular Treatment Of Intracranial Vertebral Artery Dissecting Aneurysms

Objective:The clinical characteristics of vertebral artery dissecting aneurysms were retrospectively analyzed,and the safety and effectiveness of endovascular treatment were summarized to provide basis for individualized interventional treatment.Materials and methods:Retrospective analysis of 50 patients with neurovascular disease admitted to the First Hospital of Bethune Hospital of Jilin University from January 2014 to December 2018.All patients with IVADA were diagnosed with endovascular intervention.Treatment methods include occlusion of the aneurysm of the dissection aneurysm,stent-assisted intracranial aneurysm embolization,and simple stent placement.Statistical analysis of these data yielded a safer and more effective endovascular treatment regimen.Result:A total of 50 patients in this study were treated with modified Rankin Scale(mRS)at admission and discharged,and the admission and discharge mRS scores were compared.Among them,the admission mRS score was 58.0% of the total number of cases,and the discharged mRS score was good.The 88.0%of the total cases were significantly different from the mRS scores at admission and discharge,and the difference was statistically significant(?~2=1.301,P=0.522).Of the 50 patients,15(30%)had different degrees of headache,nausea,vomiting,and disturbance of consciousness.32(64.0%)patients had dizziness,diplopia,limb numbness and other ischemic symptoms.Another 3(6.0%)patients had neurological symptoms,such as 1 case of epilepsy,drinking water,cough,and difficulty swallowing.Will PICA scores be included in the two groups,which accounted for 30.8% of patients with poor PIA,and did not affect PICA,the proportion of poor prognosis was 5.4%,the two had significant differences,accurate probability method P = 0.024 < 0.05,the difference was statistically significant.Bilateral vertebral arteries often show a blood supply advantage due to congenital development and arterial degeneration,and the lumen is large.On the other hand,the side is slim and the blood supply capacity is poor.Of the 50 patients,the aneurysm was located in28 patients with dominant vertebral artery,5 patients with non-dominant vertebral artery,and 17 patients with bilateral vertebral artery development were basically equal.The patients were reviewed 3-6 months after surgery,and22 of them underwent DSA review.The remaining 28 patients were not followed up for imaging,followed up by telephone,and recovered well without rebleeding.Of the 22 patients who underwent DSA review,4 had recurrence and 18 had no recurrence.Immediately after surgery,the degree of embolization was 1 case of complete embolization and 16 cases of no recurrence.In the second total embolization,3 cases(18.2%)recurred and 2cases(81.8%)did not relapse.There was a significant difference in the probability of recurrence between the two groups.The exact probability method was P=0.024<0.05,and the difference was statistically significant.Conclusion:(1)IVADA patients treated with endovascular intervention have a good overall prognosis.Endovascular intervention is a safe and effective method for the treatment of IVADA patients.(2)The clinical efficacy of endovascular treatment can be improved by considering individual clinical manifestations,the relationship between aneurysms and PICA,and the superiority of vertebral artery.(3)Endovascular treatment involving PICA has greater risk and affects prognosis and is a risk factor for recurrence of aneurysms.