微导丝辅助技术在颅内动脉瘤栓塞治疗中的应用研究

目的 探讨微导丝辅助的瘤颈成形技术在弹簧圈栓塞治疗颅内动脉瘤中的价值、技术操作要点及临床应用前景。方法 本组包括25例小型宽颈动脉瘤(前交通动脉12例，大脑中动脉分叉部12例，小脑后下动脉瘤1例)。微导管成功超选动脉瘤囊内，将撤出的微导丝再塑形后跨瘤颈部位放置。通过微导管内用电解可脱卸弹簧圈栓塞动脉瘤。结果 25例均获得成功，动脉瘤致密栓塞，载瘤动脉保持通畅，效果满意。短期影像随访16例，动脉瘤无复发。结论 微导丝瘤颈成形术作为小型宽颈动脉瘤治疗技术是安全、经济有效的。     

电解可脱性弹簧圈(GDC)栓塞治疗颅内动脉瘤(附11例报告)

目的探讨颅内动脉瘤应用电解可脱性弹簧圈(GDC)经血管内治疗的新方法.方法11例病人均行DSA全脑血管造影,明确动脉瘤的部位与载瘤动脉的关系,行可脱性弹簧圈治疗栓塞.结果11例中除1例动脉瘤较大用3枚电解弹簧圈闭塞外,其余均用1枚就完全闭塞动脉瘤腔,并保留了载瘤动脉的通畅.结论应用GDC经血管内闭塞颅内动脉瘤,安全、便捷、见效快.     

颅内动脉瘤的介入放射治疗

目的：分析２０例颅内囊状动脉瘤微弹簧圈和可脱球囊栓塞治疗方法、结果、技术特点、弹簧圈理化特性和并发症处理等。材料和方法：１７例囊状动脉瘤采用微弹簧圈栓塞，３例采用球囊栓塞。１５例颈动脉穿刺入路，途径短，成功率高。５例股动脉穿刺入路。结果：栓塞后动脉瘤完全闭塞，载瘤动脉通畅１４例；动脉瘤栓塞９０％，载瘤动脉通畅３例；动脉瘤同时与载瘤动脉完全闭塞３例。２０例颅内囊状动脉瘤栓塞后３个月随诊无一例死亡和发生栓塞并发症；动脉瘤闭塞９０％的３例，ＤＳＡ证实动脉瘤完全消失。结论：介入放射治疗颅内动脉瘤效果良好，能保持载瘤动脉通畅而达到不开颅治愈病人的目的。     

颅内动脉瘤电解脱弹簧圈栓塞治疗术中破裂的可能性及其对策

目的探讨破裂动脉瘤在电解脱弹簧圈(Guglielmi detachable coil，GDC)栓塞术中再次破裂的可能性及其相应措施。方法159例颅内动脉瘤施行GDC栓塞时，发生术中再次破裂7例。女5例，男2例，平均年龄46．9岁：7例中微导丝原性破裂1例，弹簧丝原性破裂3例，微导管原性破裂2例，弹簧圈填塞过度性破裂1例。结果3例弹簧丝原性破裂和2例微导管原性破裂均施行GDC继续填塞或调整微导管位置后继续填塞，直至瘤腔致密填塞。该5例中4例术后完全康复，1例残留一侧下肢不灵便；1例微导丝原性破裂和1例弹簧圈过度填塞性破裂，因术中出血过多致死亡。结论颅内动脉瘤GDC栓塞中发生动脉瘤破裂难以避免，操作者经验与发生率成反比，材料选择合活可降低其发生率．破裂发生后继续GDC填塞可达到完全填寨、愈复。     

颅内动脉瘤栓塞术中出血易忽视的影像表现——血流变慢

目的分析颅内动脉瘤弹簧圈栓塞治疗术中出血的影像学表现。方法回顾性分析358例颅内动脉瘤采用介入栓塞治疗患者病史及造影资料,其中10例术中出血。10例中4例利用支架辅助弹簧圈栓塞术,2例双导管弹簧圈栓塞术,4例单纯弹簧圈栓塞术治疗。结果 8例弹簧圈栓塞过程中出血,出血表现为对比剂外溢,载瘤血管一过性血流变慢,其中5例弹簧圈突出瘤壁,1例微导管突出瘤壁外,2例微导丝突出瘤壁外;另2例为弹簧圈栓塞中造影仅见血流明显变慢,未见对比剂外溢及微导管、微导丝和弹簧圈突出瘤壁,术后CT证实为出血。10例术中破裂者中9例致密栓塞,1例部分栓塞,术后对症治疗7例,开颅引流减压3例。6例恢复好,1例一过性动眼神经麻痹,3例死于颅内压增高。结论术中出血导致的载瘤血管血流变慢易被忽视,而此征象与患者预后密切相关。     

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。     

大脑中动脉分叉部动脉瘤的介入治疗

目的　总结大脑中动脉分叉部动脉瘤影像学特征、血管内栓塞治疗技巧及结果。方法　采用微弹簧圈栓塞治疗大脑中动脉分叉部动脉瘤 194例 ,对宽颈动脉瘤则采用瘤颈成形辅助技术 ,其中球囊辅助成形术 17例 ,微导丝辅助成形技术 19例 ,支架结合弹簧圈栓塞 2 1例。结果　栓塞程度 :致密栓塞 134例 (6 9% ) ,90 %以上 38例 (2 0 % ) ,90 %以下 2 2例 (11% )。术中出血 9例 (4 .6 % ) ,死亡 1例 (0 .5 % )。结论　GDC栓塞大脑中动脉分叉部动脉瘤具有微创、安全、效果可靠的优点。采用微导丝辅助瘤颈成形技术、瘤颈重塑形技术、血管内支架等方法 ,可以明显提高宽颈动脉瘤的致密栓塞率和减少脑梗死并发症。     

颅内动脉瘤栓塞后载瘤动脉缺血治疗的临床分析

目的：探讨颅内动脉瘤电解可脱卸弹簧圈(GDC)血管内栓塞术后载瘤动脉缺血的l临床治疗及相关影响因素。方法：选择颅内动脉瘤经血管内GDC栓塞治疗病例41例，术后7例出现载瘤动脉闭塞。就其相关因素，治疗方法、临床结果进行分析、探讨。结果：颅内动脉瘤Hunt-Hess分级1～3级41例病例中，经血管内GDC栓塞治疗后，7例出现载瘤动脉主干或其分支闭塞缺血所造成相应的临床神经症状，头疼、头昏、偏瘫、失语、偏盲及出血；经过三高(高血压、高血容量和高血稀释度)、抗痉挛、腰穿等综合治疗后，5例恢复良好，2例遗留偏瘫。结论：颅内动脉瘤栓塞后出现载瘤动脉主干狭窄或闭塞是其易发并发症之一，术中动态观察载瘤动脉血供情况，了解栓塞程度是预防其发生的手段之一，出现狭窄或闭塞时，要及时调整GDC和微导管，并给以抗痉挛、抗凝、扩血管以及三高治疗，当出现恶性颅高压症时手术配合治疗，往往会取得较好的临床效果。     

血管内栓塞治疗颅内动脉瘤

目的 总结血管内栓塞治疗颅内动脉瘤经验。方法 股动脉Seldinger穿刺,先后应用MagicBD,Tracker-16,Tracker-10和Cordis 3F/2.5F微导管,送入球囊、不同长度的国产、进口游离微弹簧圈,配用MDS、GDC系统送入不同长度微弹簧圈、治疗颅内动脉海绵窦段动脉瘤5例、后交通动脉瘤1例、颈内动脉C2段动脉瘤3例、椎动脉颅内段动脉瘤3例、大脑后动脉瘤P2段动脉瘤1例,治疗颅内动脉C3－4段假性动脉瘤5例。结果 本组无1例死亡。球囊闭塞颈内动脉海绵窦段动脉瘤5例均痊愈,无并发症;微弹簧圈栓塞治疗动脉瘤栓塞达100％者9例、95％者2例,其中1例因血管痉挛遗留轻瘫,1例因MDS到位后不能顺利解脱导致部分脱垂于颈内动脉和大脑中动脉2cm,遗留轻瘫;5例假性动脉瘤完全治愈;闭塞载瘤动脉及动脉瘤的2例椎动脉完全治愈。结论 颈内动脉海绵窦段动脉瘤只要前、后交通动脉侧支循环代偿良好,可脱球囊闭塞载瘤动脉是安全有效的。微弹簧圈栓塞治疗颅内动脉瘤是一种有发展前途的治疗方法。     

颅内巨大或大型动脉瘤的血管内治疗:三种技术的比较

目的评价可脱卸球囊、可脱卸弹簧圈和颅内覆膜支架治疗颅内巨大动脉瘤的疗效。方法收集资料完整的经血管内治疗的颅内巨大动脉瘤20例,其中球囊/弹簧圈闭塞载瘤动脉9例,可脱卸弹簧圈动脉瘤腔填塞8例,覆膜支架治疗3例,另有2例为经弹簧圈瘤腔栓塞治疗后复发,行覆膜支架治疗。随访9～83个月,平均(41.1±25.3)个月。术后即刻血管造影结果评价标准为：动脉瘤完全闭塞(100%),大部闭塞(95%～99%)和部分闭塞(＜95%)。随访血管造影结果评价标准为：不变、血栓形成和再开放。结果所有动脉瘤血管内治疗均获得成功,无并发症。术后即刻血管造影显示动脉瘤完全闭塞11例,大部闭塞7例,部分闭塞2例,其中1例部分闭塞患者术后7 d再出血死亡。19例健在患者最终血管造影显示：动脉瘤完全闭塞15例,大部闭塞3例,部分闭塞1例。19例中,10例载瘤动脉保持通畅。长期临床随访结果显示11例患者的临床症状消失,8例改善。结论动脉瘤腔可脱卸弹簧圈栓塞治疗颅内动脉巨大动脉瘤的完全闭塞率低且再通率高;可脱卸球囊或弹簧圈闭塞载瘤动脉治疗动脉瘤完全闭塞率高但牺牲载瘤动脉,有潜在或短暂的脑缺血事件发生;覆膜支架治疗操作简单、安全,且可保持载瘤动脉通畅。     

血管内支架结合弹簧圈治疗颅内宽颈动脉瘤的临床研究

目的 探讨血管内支架结合电解可脱卸弹簧圈(GDC)治疗颅内宽颈动脉瘤的适应证、技术要点、并发症防治及疗效，评估该技术的安全性及疗效。方法 105例颅内宽颈动脉瘤(前循环78例，后循环27例)，首先将冠脉支架跨动脉瘤颈放置，通过支架上的网孔将微导管送入动脉瘤腔，填塞GDC，术后3、6、12个月随访临床症状，6～12个月脑血管造影随访。结果 104例手术成功，1例失败；80例动脉瘤达到致密填塞，24例大部填塞，载瘤动脉通畅；1例术中发生脑梗死，1例发生颈动脉夹层动脉瘤，1例术中动脉瘤破裂，1例在GDC填塞过程中支架完全塌陷。98例临床随访3～32个月，均无再出血或血栓栓塞的症状。血管造影随访62例(随访期6～12个月)，60例动脉瘤不再显影，2例明显缩小，1例出现支架近端轻度狭窄。结论 联合使用支架和微弹簧圈是治疗颅内宽颈动脉瘤安全有效的方法，支架使宽颈动脉瘤的介入治疗成为可能，支架不但可防止弹簧圈突入载瘤动脉，还可防止弹簧圈压缩，促进瘤内血栓形成，防止动脉瘤复发，长期疗效有待于进一步观察。     

Transcranial color-coded Doppler sonography of intracranial aneurysms before and after endovascular occlusion with Guglielmi detachable coils.

BACKGROUND AND PURPOSEOur purpose was to evaluate the ability of transcranial color-coded Doppler sonography (TCCD) to 1) identify Guglielmi detachable coils (GDCs) within intracranial aneurysms, 2) show endovascular aneurysmal occlusion and patency of parent and branch arteries, 3) determine the flow velocities within parent arteries and major branches before and after treatment, and 4) assess persistence of aneurysmal occlusion.METHODSThe sonographic appearance of GDCs was established experimentally by TCCD (2 to 2.5 MHz), which was then performed in 40 patients with 43 aneurysms occluded by GDCs. The patency of parent arteries and major branches was assessed qualitatively and compared with the immediate posttherapeutic angiographic appearance in every patient. Flow velocities were selectively measured and compared before and after treatment in 21 parent arteries and 24 major branches. Follow-up TCCD studies performed in 26 patients were compared with angiographic (16 cases) and MR angiographic (10 cases) findings for signs of recanalization of the treated aneurysms.RESULTSThe GDCs were identified experimentally and in the patients as hyperechoic structures of the size and shape, and in the location of, the treated aneurysm in 41 of 43 cases. TCCD in accordance with angiography showed a lack of flow in 42 aneurysms and the presence of flow signal in one large aneurysm. Patency of the parent artery was shown in 40 aneurysms and in all branches. Follow-up TCCD showed the coils unchanged in 23 of 26 cases. In three large aneurysms, TCCD indicated recanalization and reappearance of a flow signal separate from the parent artery.CONCLUSIONTCCD is a reliable, noninvasive means to assess parent artery and major branch patency and to reveal a lack of hemodynamic compromise in the vicinity of aneurysms after endovascular therapy. On follow-up examinations, TCCD was able to detect signs of aneurysmal recanalization.     

Endovascular occlusion of the posterior cerebral artery for the treatment of p2 segment aneurysms: retrospective review of a 10-year series

BACKGROUND AND PURPOSE: P2 segment aneurysms develop between the junction of the posterior communicating artery with the posterior cerebral artery (PCA) and the posterior part of the midbrain in the ambient cistern. We reviewed our experience with parent artery occlusion in such aneurysms, looking for predictors of safety and effectiveness. METHODS: Clinical and preprocedural data from 10 patients, referred for endovascular treatment of P2 segment aneurysms, were retrospectively studied for prognostic factors influencing postoperative neurologic deficits caused by ischemia of the PCA distal territory. Patient tolerance was assessed by using clinical or anatomic criteria. Embryologic and anatomic features of the PCA were reviewed. RESULTS: Endovascular parent artery occlusion at the level of the aneurysmal neck was possible in nine cases. Control angiography after embolization showed that the aneurysm did not fill, and the distal PCA refilled via leptomeningeal anastomoses. One asymptomatic aneurysm could not be catheterized because of vascular tortuosity. No neurologic deficit occurred after treatment. Clinical presentations and grades were typical. No embryologic or anatomic configuration (eg, basilar tip arrangement, P2 position relative to the choroidal fissure, aneurysmal size or type [berry, fusiform, or serpentine]) was predictive of bad outcomes. CONCLUSION: Acute parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our series, potential collateral supply and hemodynamic balance between the anterior and posterior choroidal arteries, pericallosal vessels, and anterior and middle cerebral vessels to the distal PCA made P2 occlusion safe, because the aneurysm occurred after the thalamoperforating vessels arose from the P1 segment.     

破裂性前交通动脉瘤的电解可脱卸弹簧圈栓塞治疗

目的：总结45例破裂性前交通动脉瘤急症血管内栓塞的经验和体会,方法：采用电解可脱卸弹簧圈（Guglielmi detachable coil,GDC)作动脉瘤内填塞治疗。结果：动脉瘤完全闭塞25,90%以上闭塞14例, 90％闭塞6例;2次填塞2例,复发经手术治愈1例。术后并发脑梗死7例,术后死于肺部并发症1例,植物入状态生存1例,随访1－20个月,治疗结果稳定,颅内多动脉瘤5例,4例1次填塞成功,结论：GDC栓塞破裂性前交通动脉瘤效果好,虽然有较高的脑梗死发生率,但临床预后良好。     

血管内支架结合电解可脱弹簧圈治疗颅内动脉瘤

目的 初步总结使用血管内支架结合电解可脱卸弹簧圈（GDC）治疗颅内梭形及宽颈动脉瘤的体会,探讨其适应证、方法、疗效及并发症。方法 5例颅内梭形动脉瘤及12例宽颈动脉瘤,首先将冠脉支架跨动脉瘤颈放置,通过支架的网孔将微导管送入动脉瘤腔,继续填塞GDC。结果 13例动脉瘤致密填塞,3例大部分填塞,1例支架未能送入颅内而单用弹簧圈部分栓塞,载瘤动脉通畅,临床效果优良。结论 联合使用支架及微弹簧圈是治疗颅内梭形及宽颈动脉瘤的有效方法,远期疗效需进一步随访。     

Endovascular parent artery occlusion in large-giant or fusiform distal posterior cerebral artery aneurysms

Posterior cerebral artery aneurysms are amenable to deconstructive surgical treatment because of the rich collateral supply of the distal posterior cerebral artery. This report retrospectively analyses the outcome of endovascular parent artery occlusion for large or fusiform distal posterior cerebral artery aneurysms. Medical records and cerebral angiograms from two endovascular centres were analysed retrospectively. Eight patients with large or fusiform distal posterior cerebral artery (PCA) aneurysms were treated by endovascular occlusion of the segment of the PCA at the site of the aneurysm. Three of those were treated urgently after acute subarachnoid haemorrhage, the remainder had elective treatment. The clinical and angiographic outcomes in seven patients were assessed at 6 to 12 months. A single case of occipital infarction resulting in permanent homonymous hemianopia was the only permanent complication. Of the remaining patients, six made excellent recoveries and one was lost to follow-up. No recurrence or re-bleeding was noted. Endovascular parent artery occlusion may be an alternative to surgical parent artery occlusion in distal PCA aneurysms which are not convenient for selective endovascular treatment or surgical clipping.     

球囊辅助瘤颈成形术治疗颅内宽颈动脉瘤

目的　总结球囊辅助瘤颈成形术在颅内宽颈动脉瘤治疗中应用的临床体会。方法　采用球囊辅助瘤颈成形术对 18例患者 2 0个颅内宽颈动脉瘤进行栓塞治疗 ,先将微导管超选入动脉瘤内 ,再将不可脱卸球囊于动脉瘤颈处充盈覆盖瘤颈 ,电解可脱卸弹簧圈 (GDC)填塞动脉瘤。结果　 17个动脉瘤治疗成功 ,完全填塞的动脉瘤 12个 ,次全填塞 (>90 % ) 4个 ,不完全填塞 (<90 % ) 1个 ,载瘤动脉均保持通畅 ,平均随访 9.4个月 ,临床效果优良。结论　采用球囊辅助瘤颈成形术治疗颅内宽颈动脉瘤是安全、有效的方法     

Endovascular treatment of ruptured, peripheral cerebral aneurysms: parent artery occlusion with short Guglielmi detachable coils

We report two cases of distal cerebral aneurysms that were treated by parent artery occlusion with short Guglielmi detachable coils (GDCs). One patient had a presumed mycotic aneurysm of the distal left posterior cerebral artery, and the other had a partially clipped aneurysm of the distal right anterior inferior cerebellar artery that had hemorrhaged. Short GDCs allow controlled, accurate occlusion of the parent artery at the aneurysmal neck.     

Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils

BACKGROUND AND PURPOSE: Intravascular treatment of intracranial aneurysms is a relatively new therapeutic technique and long-term controlled angiographic trials are needed to assess persistence of aneurysm occlusion. Our purpose was to evaluate the effectiveness of 3D time-of-flight (3D-TOF) MR angiography as a noninvasive screening tool in the follow-up of cerebral aneurysms treated with Guglielmi detachable coils (GDCs). METHODS: Forty-nine patients with 50 intracranial aneurysms previously treated with GDCs were studied with both DSA and 3D-TOF MR angiography. In 14 cases, a second follow-up examination was performed, for a total of 64 aneurysms evaluated. In 25 aneurysms, both pre- and postcontrast MR angiographic studies were obtained. RESULTS: In seven of 64 aneurysms, the MR angiographic studies were considered to be unreliable owing to the presence of artifacts that obscured part of the parent artery and did not allow an accurate evaluation of the aneurysm neck. These seven aneurysms, however, all were shown to be completely occluded at digital subtraction angiography (DSA). In the remaining 57 aneurysms, DSA revealed complete occlusion in 39 and the presence of residual patency in 18, whereas MR angiography showed complete occlusion in 38 and residual patency in 19. Enhanced MR angiography proved to be useful in evaluating residual patency in large and giant aneurysms and in better depicting the distal branch arteries. CONCLUSION: Although artifacts related to the presence of coils are evident on a considerable number of imaging studies, our findings indicate that MR angiography is useful in the evaluation of residual patency of cerebral aneurysms treated with GDCs and may eventually prove valuable in the follow-up of those cases in which a good initial correlation with DSA was demonstrated.