Neuroform支架辅助栓塞基底动脉宽颈动脉瘤

目的 探讨应用自膨胀颅内专用支架(Neuroform支架)与弹簧圈栓塞相结合治疗基底动脉宽颈动脉瘤技术的临床应用价值.方法 采用Neuroform支架与弹簧圈结合栓塞治疗30例基底动脉宽颈动脉瘤.其中基底动脉末端动脉瘤16例,基底动脉中段9例,基底动脉起始部5例.结果 30例中,25例致密栓塞,5例部分栓塞.仅2例术中发生支架内血栓,其余患者均恢复良好出院.临床随访20例,随访期3～6个月,无血栓栓塞症状发生.22例术后3个月血管造影随访:19例致密栓塞的动脉瘤均末显影,载瘤动脉通畅;3例动脉瘤颈有残留.结论 Neuroform颅内支架使用方便、安全,适用于颅内基底动脉宽颈动脉瘤的支架辅助弹簧圈栓塞,特别适用于迂曲的脑血管.     

自膨胀式支架联合可解脱弹簧圈栓塞治疗宽颈颅内动脉瘤的效果

目的探讨应用自膨胀式颅内专用支架（Neuroform支架）与可解脱微弹簧圈（GDC）栓塞相结合治疗宽颈颅内动脉瘤技术的临床应用价值。方法采用Neuroform支架与GDC结合栓塞治疗30例基底动脉宽颈动脉瘤（基底动脉末端动脉瘤16例、基底动脉千9例、基底动脉起始部5例），30例后交通宽颈动脉瘤，5例椎动脉宽颈动脉瘤。通过微导管释放Neuroform支架覆盖动脉瘤瘤颈，将另一微导管通过支架网孔进入动脉瘤腔以GDC栓塞动脉瘤。结果全部病例采用Neuroform支架结合GDC栓塞，支架均顺利通过载瘤动脉，覆盖瘤颈，其中60例致密栓塞，5例部分栓塞。2例术中发生支架内血栓。全部患者均恢复良好出院。42例术后3～6个月血管造影随访，其中39例致街栓塞的动脉瘤均未显影，载瘤动脉通畅；3例动脉瘤颈有残留。结论Neuroform颅内支架使用方便、安全，适用于颅内宽颈动脉瘤的支架辅助GDC栓塞。     

Neuroform支架联合生物活性弹簧圈栓塞治疗颅内宽颈动脉瘤二例

随着新技术及新材料的进步,血管内治疗已成为颅内动脉瘤的主要治疗方法之一。然而宽颈动脉瘤的栓塞治疗仍然十分困难,单纯的弹簧圈栓塞难以闭塞动脉瘤,还有导致载瘤动脉闭塞的风险。近年来,应用血管内支架植入结合微弹簧圈栓塞使宽颈动脉瘤的栓塞治疗成为可能。我科采用新型的NeuroformⅡ型专用颅内支架结合生物活性Matrix弹簧圈栓塞2例宽颈动脉瘤,报告如下。     

Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤

目的 探讨 Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤的技术,并评价临床疗效和并发症.方法 采用Neuroform支架辅助技术对31例颅内宽颈动脉瘤进行了弹簧圈填塞治疗.31例患者共有颅内动脉瘤43枚,均为破裂动脉瘤,其中39枚为宽颈动脉瘤,21枚颈:体≥1,18枚颈:体<1;4枚为宽颈动脉瘤患者合并的非宽颈动脉瘤.结果 31例患者共置入支架35枚,其中3例患者两侧颈内动脉各置入1枚支架,1例两侧大脑中动脉各置入1枚.43枚动脉瘤中41枚进行了不同程度的填塞,2枚末行填塞.2例宽颈动脉瘤患者置入支架后出现非动脉瘤破裂性出血,均可能由于输送导丝损伤大脑中动脉分支引起;1例后交通动脉瘤患者,弹簧圈飘至大脑中动脉M2段,引起相应脑缺血症状.获随访的29例中无死亡病例和再次出血病例,28例生存良好,1例留有明显神经功能障碍.结论 支架辅助技术进行弹簧圈填塞治疗颅内宽颈动脉瘤是安全、有效的临床技术,可以拓宽颅内动脉瘤治疗的适应证.     

颅内宽颈动脉瘤的血管内治疗33例分析

目的总结应用颅内支架或球囊辅助技术治疗颅内宽颈动脉瘤的体会。方法应用颅内支架或球囊辅助瘤颈成形术结合Microplex弹簧圈栓塞治疗颅内破裂宽颈动脉瘤33例。动脉瘤位于前交通动脉8例,后交通动脉19例,大脑中动脉3例,基底动脉顶端3例。结果以支架辅助治疗的19例动脉瘤中13例完全致密填塞,4例填塞90％以上,2例大部填塞（70％～90％）。以球囊辅助治疗的14例动脉瘤中9例完全致密填塞,3例填塞90％以上,2例大部填塞。结论支架或球囊辅助治疗颅内宽颈动脉瘤是安全、有效的方法,两种方法各有优缺点,应根据动脉瘤的具体情况来选择采用支架或球囊治疗。     

支架辅助弹簧圈介入栓塞颅内宽颈动脉瘤

目的探讨支架辅助弹簧圈介入栓塞治疗颅内宽颈动脉瘤的方法和疗效。方法回顾性分析16例患者的临床资料,应用支架包括Neuroform 6枚和Fnterprise 10枚。结果所有支架均成功释放并行弹簧圈栓塞,即刻造影动脉瘤获得完全及大部分栓塞13例,瘤颈残留1例,部分栓塞2例.14例患者术后3～12个月复查,13例完全及大部分栓塞中11例复查未见复发,瘤颈残留1例6个月后复查复发,再次行支架植入完全栓塞.部分栓塞2例复查时瘤腔消失。结论通过支架辅助对宽颈动脉瘤瘤颈重塑及弹簧圈的介入栓塞作用,使动脉瘤栓塞疗效满意。     

Neuroform颅内支架辅助栓塞宽颈颅内动脉瘤的初步经验

目的　报道我科使用Neuroform支架辅助可脱式弹簧圈栓塞宽颈脑动脉瘤的初步经验。方法　 2 2例 2 4枚宽颈颅内动脉瘤采用Neuroform支架和弹簧圈进行栓塞 ,其中急性破裂动脉瘤 19枚、未破裂动脉瘤 5枚。结果　支架均成功地释放 ,支架置入后的造影未发现有瘤内造影剂滞留的血流动力学改变。 10 0 %闭塞动脉瘤 18枚 ,90 %以上闭塞 5枚 ,1枚伴发的未破裂小型宽颈动脉瘤在支架置入后微导管无法超选 ,载瘤动脉均通畅。有 2枚动脉瘤虽有支架阻挡 ,但仍有部分弹簧圈畔进入载瘤动脉。所有患者没有出现与支架置入有关的症状性缺血性并发症。 17例造影随访中 ,有 1例在 3个月复查时发现再通 ,进行 2次栓塞完全闭塞动脉瘤 ,其余未见复发 ,结论　Neuroform颅内支架使用安全有效 ,适合于宽颈颅内动脉瘤的支架辅助弹簧圈栓塞 ,特别适合于迂曲的脑血管 ;其径向支撑力较差 ,在输送微导管时应防止其移位 ;其支架网眼较大 ,对血流动力学改变不明显 ,致密填塞是重要的 ,在输送弹簧圈时仍应防止弹簧圈畔进入载瘤动脉 ;术前、术后抗血小板药物的应用以及术后严格的系列造影随访是必要的。     

以Neuroform支架辅助弹簧圈栓塞颅内复杂动脉瘤

目的　 探讨复杂颅内动脉瘤的介入治疗方法 ,探讨支架辅助弹簧圈栓塞动脉瘤的适应证 ,急诊期使用支架术中、术后的安全性。方法　采用Neuroform支架 ,弹簧圈主要采用Matrix。以 1枚支架覆盖 2枚动脉瘤并同时栓塞 2例 ;以支架辅助栓塞巨大宽颈动脉瘤 1例 ,急诊常规栓塞时瘤颈残留 ,择期再以支架植入辅助弹簧圈栓塞瘤颈 1例 ;动脉瘤常规弹簧圈栓塞后 3年复发 ,再以支架辅助栓塞 1例 ;急诊期支架辅助栓塞宽颈动脉瘤 4例。择期栓塞患者术前 3d予强抗血小板聚集药物 ,所有患者术后予强抗血小板聚集药物及 5d抗凝治疗。术后 3～ 6个月复查 4例。结果　所有病例栓塞操作均顺利完成 ,无手术并发症 ;除 1例巨大动脉瘤为次全栓塞外 ,其他均致密栓塞 ;复查 4例中 ,除次全栓塞的巨大动脉瘤出现动脉瘤腔部分显影外 ,其余 3例均未见动脉瘤显影。结论　以支架辅助弹簧圈栓塞提高了颅内宽颈动脉瘤、复杂性动脉瘤的治疗效果 ;既使用Matrix也要求致密栓塞 ;使用支架对抗血小板聚集药物的要求与蛛网膜下腔出血后可能需要的外科手术处理存在矛盾 ;未行抗血小板聚集药物准备情况下 ,急诊栓塞时使用支架的安全性尚有待探讨。     

Neuroform自膨式支架结合弹簧圈栓塞颅内宽颈动脉瘤

目的 探讨Neuroform自膨式支架结合弹簧圈治疗颅内宽颈动脉瘤的安全性、术中并发症、近中期疗效和应用前景.方法 采用Neuroform支架结合弹簧圈栓塞治疗25例27枚颅内宽颈动脉瘤.动脉瘤位于颈内动脉海绵窦段3枚,眼动脉1枚,后交通动脉18枚,前交通动脉2枚,大脑中动脉M1段1枚,大脑中动脉分义部1枚,基底动脉干1枚.其巾2例患者为多发动脉瘤,绝对宽颈(瘤颈>4 mm)动脉瘤21枚,相对宽颈6枚,瘤颈/瘤体均大于0.7.结果 4枚采用NeuroformⅡ代自膨式支架结合弹簧圈栓塞治疗,其余均采用NeuroformⅢ代支架结合弹簧罔栓塞治疗.25例26枚支架均成功到位释放,1例多发动脉瘤患者置入2枚支架.7枚动脉瘤完全栓塞(100%),9枚几乎完全栓寒(95%～99%),11枚不完全栓塞(95%以下).2例术中出血;2例术中支架内血栓形成,其中1例术后遗留肢体偏瘫,另1例死亡;1例术中弹簧圈尾端从支架网孔突入颈内动脉,术后出现一过性脑缺血表现,其余患者均恢复良好出院.临床随访24例,随访期1～32个月,平均10.8个月.3例术后3～6个月血管造影随访,其中1例后交通动脉瘤患者同侧大脑前动脉闭塞,大脑中动脉主干血栓形成;另2例原有瘤颈残留者无变化.结论 在栓塞颅内宽颈动脉瘤时应用Neurolform自膨式支架结合弹簧圈技术,使弹簧圈无法突入载瘤动脉,可提高柃塞致密度,安全、疗效好.     

支架联合弹簧圈技术栓塞颅内微小宽颈动脉瘤

目的　探讨三维 (3D)数字减影 (DSA)辅助下血管内支架联合弹簧圈 (stent coil)技术栓塞颅内微小宽颈动脉瘤的技术要点及疗效。方法　 12例瘤体 颈比值≤ 1的颅内微小宽颈动脉瘤 (瘤体最大径≤ 4 .0mm) ,全部经二维 (2D)造影及 3D重建 ,前交通动脉 2例采用双侧置管 ,微导管头端到位后 ,通过对侧导引导管内释放颅内自膨胀支架Neuroform ,再通过微导管使用弹簧圈塞动脉瘤。后交通动脉 8例 ,小脑后下动脉动脉起始部 2例 ,先释放支架覆盖瘤颈 ,通过支架网眼将微导管送入动脉瘤腔使用弹簧圈栓塞 ,术后 6～ 12个月进行临床和影像学随访。结果　 12例 2DDSA检查中 7例需经 3D确定为宽颈动脉瘤 ;12例全部技术成功 ,动脉瘤致密栓塞 ,载瘤动脉通畅 ;1例前交通动脉瘤栓塞后出现一过性神经功能障碍 ,经治疗后恢复正常 ,其余 11例恢复顺利。 12例临床随访 6～ 12个月 ,无动脉瘤再出血或脑血栓形成 ,7例DSA随访 ,无支架内膜增生狭窄及动脉瘤复发。结论　 3DDSA在颅内微小宽颈动脉瘤的诊断和介入治疗中有重要的辅助作用 ,支架～弹簧圈技术栓塞颅内微小宽颈动脉瘤疗效确实 ,颅内专用支架为特殊部位宽颈动脉瘤的介入治疗提供了方便。     

Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效

目的评价Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效。方法2007年至2011年应用Neuroform3支架辅助弹簧圈栓塞118例脑动脉瘤,其中86例为破裂出血性动脉瘤,32例为未破裂动脉瘤,76例在出血72 h内实施了治疗。术后对患者进行脑血管造影和临床随访。结果支架准确释放115例(97.5%),因为血管扭曲和痉挛失败植入支架1例,支架移位2例。实施单纯支架植入2例,采用微导管经支架网眼技术66例,支架后释放技术49例。术后即刻造影示动脉瘤完全栓塞87例(74.4%),次全栓塞30例(25.6%)。术中无动脉瘤破裂出血事件发生,术后症状性脑梗死3例,无症状性脑梗死5例。术后随访6～60个月,平均26.8个月,共随访到105例,复查1～5次脑血管造影,完全栓塞99例(84.6%),次全栓塞病例中11例(36.7%)存在血栓形成;9例(7.7%)瘤体复发,其中5例进行了再次治疗达到完全栓塞,术后所有患者均无再出血,除3例外,所有患者支架内无明显狭窄。结论 Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤安全、有效,仍需更长期的随访和多中心研究。     

Neuroform3支架在急诊血管内栓塞破裂性颅内宽颈动脉瘤中的应用

目的 评价急诊血管内Neuroform3支架辅助下可解脱弹簧圈栓塞破裂的颅内宽颈动脉瘤的疗效和中期随访.方法 回顾性分析最近18个月急诊介入栓塞治疗的破裂出血性颅内动脉瘤48例,其中26例在72 h内实施Neuroform3支架辅助下弹簧圈栓塞术.其中3例动脉瘤位于大脑前动脉A1段,3例位于大脑中动脉M1和M2段,13例位于后交通,2例位于颈内动脉眼动脉段,2例位于基底动脉顶端,2例位于椎动脉V2和V4段,1例位于小脑后下动脉;3例在第1枚弹簧圈释放后植入支架,1例在第2枚弹簧圈释放后植入支架,2例在第4枚弹簧圈释放后植入支架,10例在第1枚弹簧圈无法在瘤腔内成篮后植入支架,其余10例先植入支架再进行弹簧圈栓塞,所有微导管均通过支架网眼进入动脉瘤.结果 所有病例均成功释放支架(100%),覆盖了瘤颈,同期行弹簧圈填塞动脉瘤.术后即刻造影显示动脉瘤完全栓塞23例(88.5%),次全栓塞3例(11.5%);术中1例支架轻度回撤,无血栓事件和动脉瘤再破裂出血发生,所有患者均恢复良好出院.栓塞术后随访到23例,至少复查1次脑血管造影,最多复查3次;完全致密栓塞14例(60.8%)动脉瘤均末显影,6例瘤颈少许显影病例中3例(11.5%)存在血栓形成,次全栓塞1例(3.3%)瘤体再通,另外2例始终稳定,所有病例载瘤动脉通畅,狭窄2例(7.7%),临床上无任何症状,术后所有患者均无再出血.结论 急症血管内应用Neuroform3支架辅助弹簧圈栓塞破裂出血的颅内宽颈动脉瘤足方便的、安全的和有效的.     

支架辅助机械解脱弹簧圈栓塞治疗Willis环周围宽颈动脉瘤的临床应用

目的 探讨应用Solitaire AB支架辅助AxiumTM机械解脱弹簧圈栓塞治疗Willis环周围宽颈动脉瘤的技术、方法及疗效.方法 采用Seldinger技术,对21例Willis环周围宽颈动脉瘤应用Solitaire AB支架辅助AxiumTM机械解脱弹簧圈栓塞治疗,9例通过支架网孔置入微导管行动脉瘤栓塞,支架解...     

Treatment of a wide-necked aneurysm of the anterior cerebral artery using two Enterprise stents in “Y”-configuration stenting technique and coil embolization: a technical note

The endovascular treatment of wide-necked aneurysms remains challenging. The “Y”-stenting technique has been used for stent-assisted coil embolization of wide-necked bifurcation aneurysms. So far, this technique has been described for aneurysms of the basilar apex or the middle cerebral artery bifurcation and only for open stent systems using the Neuroform stent. We report a 52-year-old woman with recurrence of a wide-necked aneurysm of the anterior cerebral artery that was successfully retreated by stent-assisted coiling using the “Y”-stenting technique with the Enterprise stent system.     

Stent-assisted coil embolization of wide-necked renal artery bifurcation aneurysms

PURPOSE: To report preliminary results of stent-assisted coil embolization in the treatment of wide-necked renal artery bifurcation aneurysms. MATERIALS AND METHODS: Four patients (three women, one man; mean age, 54 years; range, 49-67 y) with wide-necked renal artery aneurysms were treated with dedicated neurointerventional self-expanding nitinol stent-assisted coil embolization during a 2-year period. The stent was delivered over the neck of the aneurysm, after which the aneurysm was filled with detachable coils through a microcatheter placed into the aneurysm through the stent mesh. RESULTS: Stent delivery and coil embolization was successfully completed in all cases. Complete aneurysm occlusion without coil protrusion or arterial flow compromise was obtained in all patients. A small peripheral subsegmental renal infarction necessitating no therapy was registered in one patient on postembolization computed tomography. At follow-up angiography 1 year after embolization, no aneurysm recanalization or arterial obstruction was registered. CONCLUSIONS: Our preliminary experience indicates that stent-assisted coil embolization is technically feasible and effective for the exclusion of challenging renal artery bifurcation aneurysms without the sacrifice of any branch arteries.     

Stent-assisted coil embolization of intracranial wide-necked aneurysms

The endovascular treatment of cerebral aneurysms with coils poses significant technical challenges, particularly with respect to wide-necked aneurysms. We present the results of our initial experiences in using a stent for endovascular treatment of aneurysms, with an emphasis on potential applications, technical aspects, and associated complications. Twenty-three wide-necked aneurysms from 22 patients were treated during the 13-month study period. Seven patients presented with subarachnoid hemorrhage. Aneurysms were located at the internal carotid artery (n=14), the vertebral artery (n=3), the basilar artery (n=5), and the middle cerebral artery (n=1). A Neuroform stent² was used for stent-assisted procedures. Premedication with antithrombotic agents was available for unruptured cases. Postprocedural antithrombotic medication was prescribed for all patients. Nineteen aneurysms were primarily stented, followed by coil placement. For five of these aneurysms, stenting was performed subsequent to failure of an attempt to frame with an initial coil. Stenting for the remaining four aneurysms was performed as a rescue procedure to prevent the migration of previously placed coils. Complete occlusion was obtained in ten aneurysms, nearly complete occlusion (95% or more occluded) in 11 aneurysms, and partial occlusion (less than 95% occluded) in one aneurysm. In one aneurysm, we failed to navigate the microcatheter into the aneurysmal sac through the interstices of the stent. Stent thrombosis was noted during the procedure in one patient. Hemorrhagic complication on the 25th day after the procedure was noted in one patient. No procedure-related complications were observed during the procedure or during follow-up in the remaining 20 patients, including seven patients who did not receive antithrombotic agents prior to endovascular treatment owing to recent subarachnoid hemorrhage. To overcome the technical limitation in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, even though longer periods of follow-up are required.     

支架结合弹簧圈在栓塞颅内复杂动脉瘤中的应用

目的 探讨支架结合弹簧圈在栓塞颅内复杂动脉瘤中的应用价值以及急性期使用支架的安全性.资料与方法 29例患者,32个动脉瘤.采用Neuroform支架,弹簧圈主要采用Matrix、Orbit圈,分析栓塞效果.急性期支架辅助栓塞宽颈动脉瘤20例.择期栓塞患者术前3天予以强抗血小板聚集药物,所有患者术后予强抗血小板聚集药物及5天抗凝治疗.术后复查21例.结果 所有病例栓塞操作均顺利完成,无手术并发症;除1例巨大动脉瘤为次全栓塞外,其他均致密栓塞.其中1枚支架覆盖2个动脉瘤并栓塞3例,支架辅助栓塞巨大宽颈动脉瘤3例,支架置入行二期动脉瘤颈残留弹簧圈再栓塞2例,动脉瘤常规弹簧圈栓塞后3年复发再以支架辅助栓塞1例.急症支架辅助微弹簧圈栓塞动脉瘤未发现支架内血栓形成或狭窄堵塞.复查21例中,除1例次全栓塞的巨大动脉瘤出现动脉瘤腔部分显影外,其余20例均未见动脉瘤显影.结论 支架结合不同型号弹簧圈栓塞有助于提高颅内复杂动脉瘤的治疗成功率;急性期可以使用支架,但在未行抗血小板聚集药物准备的前提下,其安全性有待进一步研究.     

Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience

BACKGROUND AND PURPOSE: Currently available stents for intracranial use usually are balloon-expandable coronary stents that carry the risk of damaging a dysplastic segment of the artery, with potential vessel rupture. We assessed the technical feasibility and efficacy of the combined application of a flexible, self-expanding neurovascular stent and detachable coils in the management of wide-necked intracranial aneurysms in humans. METHODS: Four consecutive patients with a wide-necked intracranial aneurysm were treated with a combined approach that consisted of delivery of a flexible self-expanding neurovascular stent through a microcather to cover the neck of the aneurysm and subsequent filling of the aneurysm with coils through the stent interstices. The aneurysms were located at the internal carotid artery (n=2) and the basilar tip encroaching the P1 segment (n=2). Previous attempts with conventional endosaccular coil packing alone failed in all cases. RESULTS: Stent placement in the desired position with complete or nearly complete occlusion of the aneurysms was feasible in all patients. In one patient, aneurysm perforation with the microcatheter occurred and necessitated ventricular drainage, which led to a large parenchymal and intraventricular hemorrhage because of the strong anticoagulation regimen. Six-month follow-up demonstrated no focal neurologic sequelae in any of the patients, except slight memory dysfunction in the patient with bleeding. CONCLUSION: Preliminary data demonstrate that this extremely flexible stent is technically easy to deploy and can be easily and safely maneuvered through severely tortuous vessels, enabling the treatment of intracranial wide-necked aneurysms. The combination of endovascular reconstruction of the parent vessel with use of a self-expanding stent followed by coil embolization offers a promising therapeutic alternative for wide-necked aneurysms not amenable to coil embolization alone. Although immediate angiographic results are promising, long-term angiographic and clinical follow-up is essential to determine permanent vessel patency and aneurysm occlusion rate.