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目的探讨血管内带膜支架治疗椎动脉夹层动脉瘤和颈内动脉海绵窦瘘(carotid cavernous fi stula,CCF)的临床疗效。方法2006年3月-2007年5月,采用Jostent带膜支架治疗4例椎动脉夹层动脉瘤以及3例CCF。患者均为男性。椎动脉夹层动脉瘤患者年龄37～57岁;左侧3例,右侧1例。主要症状为突发头痛、呕吐;头部CT均示蛛网膜下腔出血;病程2 d～10年。CCF患者年龄35～51岁;左侧2例,右侧1例。主要症状为头痛,一侧眼球突出、胀痛,球结膜充血伴视力下降;1例有反复鼻腔大出血病史;出现症状前2 d～1个月均有头部外伤史;病程1周～2个月。结果椎动脉夹层动脉瘤均完全闭塞,椎动脉保持通畅,附近小脑后下动脉及小脑前下动脉保持通畅;无手术相关并发症发生。4例均获随访,随访时间8个月～2年,无症状复发及颅内再出血。CCF患者瘘口均完全闭塞,颈内动脉保持通畅;术后3 d患者眼球突出及球结膜充血表现均明显改善。3例均获随访,随访时间1～3个月;患侧视力均有不同程度改善。结论血管内带膜支架是治疗椎动脉夹层动脉瘤和CCF的有效方法之一。
Objective To investigate the clinical efficacy of endovascular stent graft in the treatment of vertebral artery dissection and carotid cavernous fi stula (CCF). Methods From March 2006 to May 2007, 4 cases of vertebral artery dissection and 3 cases of CCF were treated with Jostent stent - graft. All patients were male. Vertebral artery dissection aneurysm patients aged 37 to 57 years old; left in 3 cases, right in 1 case. The main symptoms of sudden headache, vomiting; head CT showed subarachnoid hemorrhage; course of 2 d ~ 10 years. CCF patients aged 35 to 51 years old; left in 2 cases, right in 1 case. The main symptoms were headache, prominent eyeball on one side, pain and bulbar conjunctival hyperemia with decreased visual acuity; one case had history of repeated nasal hemorrhage; the history of head trauma occurred 2 days to 1 month before symptom onset; course of disease ranged from 1 week to 2 month. Results Vertebral artery dissection aneurysm were completely occluded, the vertebral artery was maintained unobstructed, the posterior inferior cerebellar artery and the anterior inferior cerebellar artery remain patency; no complications associated with surgery. Four patients were followed up for 8 months to 2 years, with asymptomatic recurrence and intracranial hemorrhage. CCF patients were completely occluded fistula, internal carotid artery patency; 3 d after surgery in patients with prominent bulbar and conjunctival hyperemia were significantly improved. 3 cases were followed up for 1 to 3 months; affected side vision improved to varying degrees. Conclusion Endovascular stent graft is an effective method for the treatment of dissecting aneurysm and CCF in vertebral artery.