椎动脉夹层动脉瘤血管内治疗的研究进展

Research advances in endovascular treatment of vertebral artery dissecting aneurysm

摘要:

椎动脉夹层动脉瘤（VADA）为颅内最常见的动脉夹层病变，其破裂可引发致命性蛛网膜下腔出血，对患者生命构成严重威胁，是临床处置中极具复杂性与挑战性的疾病亚型之一。治疗策略的制定常受多重因素制约，涵盖椎动脉解剖变异、动脉瘤破裂状态及其与小脑后下动脉的解剖关系等核心要素。现阶段，临床主要干预手段包括开颅手术与血管内治疗两大类别。随着血管内技术的迭代更新，特别是血流导向装置的持续革新，血管内治疗已逐步确立为VADA的重要治疗路径。其策略体系可归纳为解构性与重建性两类，前者通过阻断载瘤动脉或瘤腔以实现治疗目标；后者则借助支架辅助弹簧圈栓塞或血流导向装置植入，在维持血管通畅性的同时促进瘤体闭塞。近年来，血管内器械的升级与临床经验的累积持续推动VADA治疗策略的优化。该文系统综述VADA血管内治疗的最新研究进展及策略选择要点，旨在为临床治疗决策提供理论依据与实践参考。

Abstract:

Vertebral artery dissecting aneurysm （VADA） is the most common intracranial arterial dissection， and VADA rupture can cause fatal subarachnoid hemorrhage， thereby posing a serious threat to the life of patients. It has become one of the disease subtypes with extreme complexity and challenges. Development of treatment regimens is often limited by various factors including anatomical variation of vertebral artery， the status of aneurysm rupture， and the anatomical relationship between the aneurysm and the posterior inferior cerebellar artery. At present， the main clinical interventions include craniotomy and endovascular treatment. With the updates in endovascular techniques， especially the continuous innovation of flow diversion devices， endovascular treatment has gradually been established as an important treatment modality for VADA. The treatment strategies can be classified into deconstructive and reconstructive techniques； deconstructive strategies achieve treatment goals by blocking parent artery or aneurysm sac， whereas reconstructive strategies preserve luminal patency while facilitating aneurysm occlusion through stent-assisted coil embolization or placement of flow diversion devices. In recent years， the refinements of endovascular devices and the accumulation of clinical experience continue to promote the optimization of VADA treatment strategies. This article reviews the latest research advances in endovascular treatment of VADA and the key points in the selection of treatment strategies， in order to provide a theoretical basis and practice reference for clinical decision-making.