Фузиформні аневризми основної артерії — клінічні прояви та лікування

Abstract

Objective — to study the prevalence and clinical manifestations of fusiform aneurysms (FA) of the basic artery (MA), methods of their treatment.Materials and methods. The analysis of 2049 histories of diseases of patients with arterial aneurysms of the vessels of the brain for the period from January 2007 to December 2018. It was revealed that in 87 (4.25 %) patients there were FA, of which 30 (34.5 %) — FA MA. Aneurysms were initially detected according to neuroimaging techniques (spiral computer and magnetic resonance imaging). All patients were given a selective cerebral angiography. Depending on clinical manifestations of patients, it was divided into four groups: the 1st group — patients with hemorrhagic manifestations; the 2nd group — patients with ischemic manifestations; the 3rd group — patients with compressive and ischemic manifestations (pseudo-fumarous action or «mass effect»); the 4th group — patients with asymptomatic course. Groups were compared by age and sex composition, severity of clinical condition of patients, data of neuroimaging methods and angiographic characteristics of aneurysms.Results. 12 (40 %) patients with FA MA had an asymptomatic course, 10 (33 %) — ischemic manifestations, 6 (20 %) compressive-ischemic manifestations, 2 (7 %) — hemorrhagic manifestations. Operated 18 (60 %) patients. 20 operations were performed, including 16 single-session endovascular operations on FA and 2 repeated (in patients with MA, after coiling). According to the study, among operated patients in 4 (22.2 %) cases — the reduction of clinical manifestations of the disease within 5–7 days after the operation (2 — in the 2nd group, 2 — in the 3rd group). In 5(27.8 %) cases — the emergence or increase of a neurological deficit associated with the implantation of an intracranial stent in the form of an increase/appearance of stem-symmetry (1 — in the 2nd group, 1 — in the 3rd group, 3 — in the 4th group). Surgical mortality among operated patients was 16.7 % (3 cases (all in the 2nd group)) and is related to the presence of concomitant cardiovascular disease. Clinical outcomes of endovascular treatment of patients with fuziform aneurysms of the main artery on the Glasgow Outcomes Scale at the time of discharge from the hospital are good (≥ 5 points) in 12 (80 %) patients and satisfactory (4 points) — in 3 (20 %) patients.Conclusions. FA MA often occur asymptomatic — in 40 % of patients. The most frequent and clinically significant manifestation of the disease is ischemic (in 33 % of patients), compression-ischemic (in 20 %), while hemorrhagic was observed in 7 % of patients. Clinical manifestations of the disease are closely related to the sex and age of the patients. Results of treatment depend on the period of the disease, the structure of the aneurysm, the gender of the patient and the presence of concomitant pathology.