基底动脉主干动脉瘤血管内治疗的安全性及有效性：单中心经验

doi:10.3877/cma.j.issn.2095-5782.2026.01.005

目的

评价血管内治疗基底动脉主干动脉瘤（basilar artery trunk aneurysm，BATA）的安全性和有效性。

方法

回顾性分析2018年10月至2024年12月于南京医科大学第一附属医院接受血管内治疗的40例BATA患者（共41个动脉瘤）的临床资料。根据数字减影血管造影（digital subtraction angiography, DSA）结果，将动脉瘤分为囊状、经典型、节段扩张型和延长扩张型动脉瘤。观察围手术期手术相关脑血管并发症（术中动脉瘤破裂、术中急性血栓形成、术后急性脑梗塞等）；采用Raymond分级评估术后即刻及6个月栓塞程度；3个月随访时采用改良Rankin量表（modified Rankin Scale, mRS）评分评估患者临床预后。

结果

41个动脉瘤中，囊状9个（22.0%）、经典型18个（43.9%）、节段扩张型5个（12.2%）、延长扩张型9个（22.0%）。所有动脉瘤均成功实施支架辅助弹簧圈栓塞术（stent-assisted coiling, SAC），其中单支架SAC 11例（27.5%）、重叠支架SAC 26例（65.0%）和血流导向装置（flowdiverter, FD）3例（7.5%）。术后即刻Raymond分级：Ⅰ级13例（31.7%）、Ⅱ级16例（39.0%）、Ⅲ级12例（29.3%）。围手术期并发症：1例（2.5%）经典型动脉瘤患者术中再破裂，1例（2.5%）延长扩张型动脉瘤术中支架内急性血栓形成（经动脉内灌注替罗非班未好转），1例（2.5%）囊状动脉瘤患者术后发生急性脑缺血症状且出院时遗留有左侧偏瘫，2例（5.0%）延长扩张型患者术后发生急性缺血事件但出院时无明显残疾（mRS: 2）。3个月随访时，33例（82.5%）患者预后良好（mRS：0~2）。6个月DSA随访的31例中，24例（77.4%）完全闭塞（Raymond Ⅰ级）。

结论

对于基底动脉囊状及经典型夹层动脉瘤，传统支架辅助弹簧圈栓塞术技术可行且安全，闭塞率高、复发率可接受。对于节段扩张型、延长扩张型动脉瘤的治疗，尽管存在围手术期缺血事件，大型编织支架重叠技术及血流导向装置仍可优化治疗结局。

关键词: 颅内动脉瘤, 基底动脉, 夹层动脉瘤, 基底动脉延长扩张症, 血管内治疗

Objective

The optimal treatment strategy for basilar artery trunk aneurysms (BATA) remains controversial. This study aimed to evaluate the safety and efficacy of endovascular treatment for BATA.

Methods

A retrospective analysis was performed on 40 BATA patients (41 aneurysms in total) who underwent endovascular treatment in our institute between October 2018 and December 2024. Based on digital subtraction angiography (DSA) findings, aneurysms were categorized into saccular, classic, segmental dilatation, and dolichoestasia types. Perioperative cerebrovascular complications were recorded. Immediate and 6-month embolization degrees were assessed with the Raymond scale, while clinical outcomes were evaluated with modified Rankin Scale (mRS) scores at 3-month follow-up.

Results

Among the 41 aneurysms, 9 were saccular (22.0%), 18 classic (43.9%), 5 segmental dilatation (12.2%), and 9 dolichoestasia (22.0%). All aneurysms were successfully treated with stent-assisted coiling (SAC), including single-stent SAC in 11 cases (27.5%), overlapping-stent SAC in 26 cases (65.0%), and flow diverters in 3 cases (7.5%). Immediate postprocedural Raymond grades were Ⅰ in 13 (31.7%), Ⅱ in 16 (39.0%), and Ⅲ in 12 (29.3%) cases. Perioperative complications included: 1 (2.5%) intraoperative re-rupture of classic dissecting aneurysm, 1 (2.5%) acute stent thrombosis in dolichoestasia aneurysm (no improvement after tirofiban infusion). Postprocedurally acute ischemic events occurred in 1 saccular aneurysm case (2.5%), and the patient was left with left-sided hemiplegia at discharge. Two dolichoestasia cases (5.0%) developed acute ischemic events after the procedure but showed no significant disability at discharge (mRS: 2). At 3-month follow-up, 33 patients (82.5%) achieved favorable outcomes (mRS 0-2). Among 31 cases with 6-month DSA follow-up, 24 (77.4%) achieved complete occlusion (Raymond I).

Conclusion

For saccular and classic dissecting BATAs, conventional stent-assisted coiling is technically feasible and safe, with a high occlusion rate and an acceptable recurrence rate. Despite the occurrence of periprocedural ischemic events, overlapping large woven stents techniques and flow diverters can further improve treatment outcomes for segmental dilatation and dolichoestasia aneurysms.

Key words: intracranial aneurysm, basilar artery, dissecting, dolichoestasia, endovascular treatment

图1 单支架辅助弹簧圈栓塞术治疗囊状基底动脉夹层动脉瘤 1A：基底动脉主干下段一枚囊状动脉瘤；1B：使用Enterprise支架辅助栓塞，术后造影示动脉瘤栓塞完全；1C：复查时动脉瘤闭塞程度较术后即刻造影相仿。

图2 双支架辅助弹簧圈栓塞术治疗经典型基底动脉夹层动脉瘤 2A：基底动脉主干一枚经典型夹层动脉瘤，伴近端狭窄；2B：Neuroform重叠LVIS支架辅助弹簧圈栓塞，术后造影示动脉瘤栓塞完全；2C：复查示动脉瘤完全愈合，基底动脉主干重建良好。

图3 重叠Leo支架治疗基底动脉中段节段扩张型基底动脉夹层动脉瘤 3A：基底动脉主干中段一枚节段扩张型夹层动脉瘤；3B：使用双Leo-plus支架重叠技术，术后造影示仍有血流进入瘤腔；3C：复查时瘤腔内无血流进入。3D：术后18个月高分辨血管壁磁共振示瘤腔内未见血液充盈。

图4 重叠Leo支架治疗基底动脉延长扩张型基底动脉夹层动脉瘤 4A、B：高分辨血管壁磁共振及DSA示基底动脉延长扩张；4C：使用双Leo支架重叠置入基底动脉主干。4D：辅以数枚弹簧圈填充基底动脉主干下段扩张瘤腔及右侧椎动脉开口处，填充后见右椎动脉进入瘤腔内血流明显减缓。4E：复查时基底动脉管腔无明显扩张，右椎进入基底动脉内血流术后即刻相仿。

表1 所有患者临床及动脉瘤基线数据

项目	患者（n=40）
年龄[岁, $x ¯$ ±s]	67.9±10.3
性别[例(%)]
女性	12 (30.0)
男性	28 (70.0)
高血压[例(%)]	35 (87.5)
糖尿病[例(%)]	7 (17.5)
吸烟[例(%)]	7 (17.5)
破裂动脉瘤[例(%)]	4 (10.0)
动脉瘤类型[例(%)]
囊状	9 (22.0)
经典型	18 (43.9)
节段扩张型	5 (12.2)
延长扩张型	9 (22.0)
动脉瘤最大径(mm, $x ¯$ ±s)	13.3±11.7
治疗方式[例(%)]
单支架	11 (27.5)
重叠支架	26 (65.0)
血流导向装置	3 (7.5)
围手术期脑血管并发症[例(%)]
出血事件	1 (2.5)
缺血事件	4 (10.0)

表1 所有患者临床及动脉瘤基线数据

项目	患者（n=40）
年龄[岁, $x ¯$ ±s]	67.9±10.3
性别[例(%)]
女性	12 (30.0)
男性	28 (70.0)
高血压[例(%)]	35 (87.5)
糖尿病[例(%)]	7 (17.5)
吸烟[例(%)]	7 (17.5)
破裂动脉瘤[例(%)]	4 (10.0)
动脉瘤类型[例(%)]
囊状	9 (22.0)
经典型	18 (43.9)
节段扩张型	5 (12.2)
延长扩张型	9 (22.0)
动脉瘤最大径(mm, $x ¯$ ±s)	13.3±11.7
治疗方式[例(%)]
单支架	11 (27.5)
重叠支架	26 (65.0)
血流导向装置	3 (7.5)
围手术期脑血管并发症[例(%)]
出血事件	1 (2.5)
缺血事件	4 (10.0)

表2 术后即刻及随访造影结果

结果指标	术后即刻造影结果[n=41，n (%)]			随访6个月造影结果[n=31，n (%)]
结果指标	Raymond Ⅰ级	Raymond Ⅱ级	Raymond Ⅲ级	Raymond Ⅰ级	Raymond Ⅱ级	Raymond Ⅲ级
囊状	6 (14.6)	3 (7.3)	/	4 (12.9)	1 (3.2)	1 (3.2)
经典型	7 (17.1)	8 (19.5)	3 (7.3)	13 (41.9)	1 (3.2)	1 (3.2)
节段扩张型	/	3 (7.3)	2 (4.9)	2 (6.5)	1 (3.2)	/
延长扩张型	/	2 (4.9)	7 (17.1)	5 (16.1)	1 (3.2)	1 (3.2)
合计	13 (31.7)	16 (39.0)	12 (29.3)	24 (77.4)	4 (12.9)	3 (9.7)

表2 术后即刻及随访造影结果

结果指标	术后即刻造影结果[n=41，n (%)]			随访6个月造影结果[n=31，n (%)]
结果指标	Raymond Ⅰ级	Raymond Ⅱ级	Raymond Ⅲ级	Raymond Ⅰ级	Raymond Ⅱ级	Raymond Ⅲ级
囊状	6 (14.6)	3 (7.3)	/	4 (12.9)	1 (3.2)	1 (3.2)
经典型	7 (17.1)	8 (19.5)	3 (7.3)	13 (41.9)	1 (3.2)	1 (3.2)
节段扩张型	/	3 (7.3)	2 (4.9)	2 (6.5)	1 (3.2)	/
延长扩张型	/	2 (4.9)	7 (17.1)	5 (16.1)	1 (3.2)	1 (3.2)
合计	13 (31.7)	16 (39.0)	12 (29.3)	24 (77.4)	4 (12.9)	3 (9.7)

表3 3个月随访临床结局（例）

mRS评分	囊状	经典型	节段扩张型	延长扩张型	共计
0~2	9	15	4	5	33
3~5	/	1	1	3	5
6	/	1	/	1	2

表3 3个月随访临床结局（例）

mRS评分	囊状	经典型	节段扩张型	延长扩张型	共计
0~2	9	15	4	5	33
3~5	/	1	1	3	5
6	/	1	/	1	2

[1]	中国医师协会神经外科医师分会神经介入专家委员会, 中国卒中学会神经介入分会, 中国医师协会神经外科医师分会青年医师委员会. 颅内动脉夹层的影像学诊断中国专家共识[J]. 中华神经外科杂志, 2016, 32(11): 1085-1094.
[2]	中华医学会神经外科学分会神经介入学组, 中国医师协会神经外科医师分会神经介入专家委员会. 颅内夹层动脉瘤的血管内治疗中国专家共识[J]. 中华神经外科杂志, 2018, 34(8): 757-763.
[3]	Yoon W K, Kim Y W, Kim S R, et al. Angiographic and clinical outcomes of stent-alone treatment for spontaneous vertebrobasilar dissecting aneurysm[J]. Acta Neurochir (Wien), 2010, 152(9): 1477-1486; discussion 86.
[4]	Chung J, Park H, Lim Y C, et al. Endovascular treatment of basilar artery trunk aneurysms[J]. Acta Neurochir (Wien), 2011, 153(11): 2137-2145.
[5]	van Oel L I, van Rooij W J, Sluzewski M, et al. Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils[J]. AJNR Am J Neuroradiol, 2013, 34(3): 589-595.
[6]	Cui Q K, Liu W D, Liu P, et al. Arterial occlusion to treat basilar artery dissecting aneurysm[J]. Neurol Neurochir Pol, 2015, 49(2): 99-106.
[7]	Kim B M, Suh S H, Park S I, et al. Management and clinical outcome of acute basilar artery dissection[J]. AJNR Am J Neuroradiol, 2008, 29(10): 1937-1941.
[8]	Phan K, Huo Y R, Jia F, et al. Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms[J]. J Clin Neurosci, 2016, 31: 15-22.
[9]	Wu Q, Shao Q, Li L, et al. Prophylactic administration of tirofiban for preventing thromboembolic events in flow diversion treatment of intracranial aneurysms[J]. J Neurointerv Surg, 2021, 13(9): 835-840.
[10]	Wu Q, Xu S, Wang C, et al. Endovascular Management of Vertebrobasilar Trunk Artery Large Aneurysms: Complications and Long-Term Results[J]. Front Neurol, 2022, 13: 839219.
[11]	Wu Q, Wang C, Xu S, et al. Low-profile visualized intraluminal support-within-Enterprise overlapping-stent technique versus flow diversion in the treatment of intracranial vertebrobasilar trunk dissecting aneurysms[J]. Quant Imaging Med Surg, 2023, 13(6): 3536-3546.
[12]	Park S I, Kim B M, Kim D I, et al. Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms[J]. AJNR Am J Neuroradiol, 2009, 30(7): 1351-1356.
[13]	Giang D W, Perlin S J, Monajati A, et al. Vertebrobasilar dolichoectasia: assessment using MR[J]. Neuroradiology, 1988, 30(6): 518-523.
[14]	Smoker W R, Corbett J J, Gentry L R, et al. High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review[J]. AJNR Am J Neuroradiol, 1986, 7(1): 61-72.
[15]	Grunwald I Q, Balami J S, Weber D, et al. Different factors influence recanalisation rate after coiling in ruptured and unruptured intracranial aneurysms[J]. CNS Neurol Disord Drug Targets, 2013, 12(2): 228-232.
[16]	Schievink W I. Intracranial aneurysms[J]. N Engl J Med, 1997, 336(1): 28-40.
[17]	Higa T, Ujiie H, Kato K, et al. Endovascular treatment of basilar trunk saccular aneurysms[J]. Neuroradiol J, 2011, 24(5): 687-692.
[18]	Kayembe K N, Sasahara M, Hazama F. Cerebral aneurysms and variations in the circle of Willis[J]. Stroke, 1984, 15(5): 846-850.
[19]	Cho K C, Jeon P, Kim B M, et al. Saccular or dissecting aneurysms involving the basilar trunk: Endovascular treatment and clinical outcome[J]. Neurol Res, 2019, 41(7): 671-677.
[20]	Oya S, Yoshida S, Saito A, et al. The optimal management of ruptured basilar artery dissecting aneurysms: a case series and scoping review[J]. Neurosurg Rev, 2022, 45(5): 3427-3436.
[21]	Bi Y, Song X, Chen X, et al. Endovascular treatment of ruptured basilar artery trunk aneurysms: complications and long-term outcomes[J]. J Stroke Cerebrovasc Dis, 2024, 33(11): 107957.
[22]	Fischer S, Vajda Z, Aguilar Perez M, et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections[J]. Neuroradiology, 2012, 54(4): 369-382.
[23]	Sim S Y, Choi J H, Kim M J, et al. Endovascular treatment of ruptured basilar artery trunk aneurysm in the acute period: risk factors for periprocedural complications[J]. Neurol Res, 2023, 45(2): 152-159.
[24]	Li C, Li Y, Jiang C, et al. Stent alone treatment for dissections and dissecting aneurysms involving the basilar artery[J]. J Neurointerv Surg, 2015, 7(1): 50-55.
[25]	Drake C G, Peerless S J. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992[J]. J Neurosurg, 1997, 87(2): 141-162.
[26]	Bender M T, Colby G P, Jiang B, et al. Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases[J]. Neurosurgery, 2019, 84(1): 206-216.
[27]	Adeeb N, Griessenauer C J, Dmytriw A A, et al. Risk of Branch Occlusion and Ischemic Complications with the Pipeline Embolization Device in the Treatment of Posterior Circulation Aneurysms[J]. AJNR Am J Neuroradiol, 2018, 39(7): 1303-1309.
[28]	Kiyofuji S, Graffeo C S, Perry A, et al. Meta-analysis of treatment outcomes of posterior circulation non-saccular aneurysms by flow diverters[J]. J Neurointerv Surg, 2018, 10(5): 493-499.
[29]	Wang C, Zhu D, Xu X, et al. Use of flow diverter device in basilar artery for aneurysm treatment: Case series and literature review[J]. Front Neurol, 2022, 13: 990308.
[30]	Passero S G, Rossi S. Natural history of vertebrobasilar dolichoectasia[J]. Neurology, 2008, 70(1): 66-72.
[31]	Huang Q H, Wu Y F, Xu Y, et al. Vascular geometry change because of endovascular stent placement for anterior communicating artery aneurysms[J]. AJNR Am J Neuroradiol, 2011, 32(9): 1721-1725.
[32]	Ji Z, He C, Li J, et al. Safety and Efficacy of Low-Profile Braided Stents versus Flow Diverters in the Reconstructive Technique in the Treatment of Patients with Vertebrobasilar Dolichoectasia Aneurysms: A Cohort of 47 Patients with Long-Term Follow-Up[J]. AJNR Am J Neuroradiol, 2024, 45(2): 176-182.
[33]	He X, Duan C, Zhang J, et al. The safety and efficacy of using large woven stents to treat vertebrobasilar dolichoectasia[J]. J Neurointerv Surg, 2019, 11(11): 1162-1166.
[34]	Wu X, Xu Y, Hong B, et al. Endovascular reconstruction for treatment of vertebrobasilar dolichoectasia: long-term outcomes[J]. AJNR Am J Neuroradiol, 2013, 34(3): 583-588.

[1]	许梓锋, 黄展森, 狄金明. 胡桃夹综合征诊治进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 784-791.
[2]	马泽坤, 姜世豪, 吴鹏飞, 阿力玛斯·阿布力孜, 杨文博, 尹胜楠, 王增亮. Pipeline血流导向装置治疗颅内大型与巨大型动脉瘤效果分析[J/OL]. 中华神经创伤外科电子杂志, 2025, 11(06): 358-364.
[3]	黄志宏, 郭俊清, 鄢宇芳, 张帆, 曾国勇. 经前交通动脉入路支架取栓及球囊扩张治疗大脑前动脉急性闭塞一例报道[J/OL]. 中华神经创伤外科电子杂志, 2025, 11(05): 333-335.
[4]	陈振华, 戴勇, 陈佳磊, 蔡正华, 朱向阳, 蔡刚. 经桡动脉穿刺置管治疗颅内动脉瘤后桡动脉穿刺点出血的影响因素分析[J/OL]. 中华神经创伤外科电子杂志, 2025, 11(04): 238-242.
[5]	童嘉胤, 朱健伟. 基底动脉旁穿支破裂动脉瘤的介入治疗[J/OL]. 中华神经创伤外科电子杂志, 2025, 11(03): 201-203.
[6]	刘亚, 潘晓虎, 杨明刚, 施学松, 董启武, 张宁, 唐燕, 谢春明, 赵国锋. 初级卒中中心与高级卒中中心血管内治疗急性大血管闭塞性脑卒中的对比研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(06): 364-369.
[7]	牟兰, 崔砚, 王琪, 徐如祥, 王振宇, 刘洁. 重度椎-基底动脉狭窄患者经皮支架植入术后定量脑电图特征研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(06): 333-341.
[8]	严丹丹, 马蓓蓓, 包建英, 卢光东, 刘圣, 施海彬. 未破裂颅内动脉瘤介入治疗患者术前焦虑与信息需求状况及影响因素分析[J/OL]. 中华介入放射学电子杂志, 2025, 13(04): 355-360.
[9]	曹婷婷, 刘嘉博, 都一鸣, 吴桥伟, 马丽娜. 血流导向装置治疗未破裂基底动脉大型动脉瘤的安全性及疗效分析[J/OL]. 中华介入放射学电子杂志, 2025, 13(03): 206-211.
[10]	张国赛, 赵林波, 曹月洲, 贾振宇, 施海彬, 刘圣. 低剖面支架治疗未破裂大脑前动脉远端动脉瘤的单中心经验[J/OL]. 中华介入放射学电子杂志, 2025, 13(03): 212-216.
[11]	杨墨, 曹月洲, 吕朋华, 丁鸭锁, 刘振生, 贾振宇, 赵林波, 徐川, 施海彬, 刘圣. 溶栓时间窗内动脉粥样硬化性基底动脉闭塞桥接治疗与直接取栓的多中心对照研究[J/OL]. 中华介入放射学电子杂志, 2025, 13(02): 104-109.
[12]	张莉, 王汉祥. 急性缺血性脑卒中血压管理研究进展[J/OL]. 中华临床实验室管理电子杂志, 2025, 13(03): 178-182.
[13]	柴昌, 李定安, 姜进, 薛延华, 王衡. 前循环大血管闭塞性轻型卒中患者早期进展的危险因素及其补救性血管内治疗的临床疗效[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(06): 503-510.
[14]	于棋, 李兰君, 韩红星, 王贤军, 王蒙恩. 晚窗血管内治疗不同病因类型急性大血管闭塞性缺血性卒中的临床疗效[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(04): 296-303.
[15]	张笑闻, 钟海龙, 佟鑫, 范梦妍, 万佳鑫, 林日金, 李菁, 管生. 瘤内扰流装置相关临床应用的研究现状[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(03): 250-254.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Safety and Efficacy of Endovascular Therapy for Basilar Artery Trunk Aneurysms: Single-Center Experience

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Safety and Efficacy of Endovascular Therapy for Basilar Artery Trunk Aneurysms: Single-Center Experience