Neuroform支架在颅内宽颈动脉瘤血管内治疗中的应用及随访

目的 探讨应用Neuroform支架辅助栓塞治疗颅内宽颈动脉瘤的效果.方法 回顾性分析Neuroform支架辅助栓塞治疗的187例颅内动脉瘤患者的临床资料及随访结果 .结果 术中支架均顺利到位,放置满意.即刻造影完全栓塞88.9%,次全栓塞6.9%,不全栓塞4.2%.操作相关致残率和死亡率分别为5.9%和1.1%.临床随访87.7%患者预后满意(mRS 0～2分),术后无再出血发生.造影随访总体再通率8.7%.无支架或弹簧圈移位发生.迟发性并发症包括1例支架内狭窄和1例眼动脉闭塞.结论 Neuroform支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤中期疗效肯定.     

颅内宽颈动脉瘤的血管内治疗

目的总结使用neuroform支架或球囊辅助瘤颈重塑技术与电解可脱弹簧圈结合治疗颅内宽颈动脉瘤的体会，探讨两种方法的适应症、存在问题、技术要点及临床应用前景。方法25例颅内宽颈动脉瘤中，19例采用neuroform支架置入结合电解可脱弹簧圈栓塞，6例采用球囊辅助瘤颈重塑技术结合电解可脱弹簧圈栓塞。结果以neuroform支架与电解可脱弹簧圈栓塞的动脉瘤中，10例完全闭塞，8例闭塞90％以上，1例闭塞90％以下。球囊辅助瘤颈重塑技术结合电解可脱弹簧圈栓塞的动脉瘤中，3例完全闭塞，3例闭塞90％以上。结论Neuroform支架或球囊辅助瘤颈重塑与电解可脱弹簧圈结合是治疗颅内宽颈动脉瘤的有效方法；两种方法各有优缺点，应根据宽颈动脉瘤的具体情况选择neuroform支架或球囊辅助进行栓塞。     

血管内治疗46例宽颈颅内动脉瘤

目的 报告并评价46例宽颈动脉瘤的治疗方法及效果。方法 自1997年以来对于46例宽颈动脉瘤采取多种技术联合治疗。其中用3D电解微弹圈“筐篮”技术栓塞治疗27例,用球囊载瘤动脉再塑形联合GDC栓塞17例,用支架联合GDC栓塞2例。结果 使用筐蓝技术治疗的27例中完全闭塞者为22例,有5例不完全闭塞;17例球囊再塑型技术治疗的动脉瘤,11例完全栓塞;2例支架加微弹簧圈栓塞,1例完全栓塞,1例近全栓塞,其中1例术后出现了一过性的神经功能障碍。全部46例无永久性神经症状并发症,44例保持载瘤动脉通畅。结论 对于宽颈动脉瘤,采用多种技术联合栓塞,可取得良好效果。     

血管内支架介入治疗颅内宽颈动脉瘤临床分析

目的应用血管内支架介入治疗颅内宽颈动脉瘤的疗效探讨。方法抽取86例患有颅内宽颈动脉瘤的患者,将其分为对照组和治疗组,每组43例。对照组采用微弹簧圈栓塞疗法治疗;在对照组治疗的基础上,治疗组加用血管内支架介入方式治疗。结果治疗组患者治疗效果明显优于对照组;手术操作时间和术后住院时间明显短于对照组;出现围手术期并发症的人数明显少于对照组。结论应用血管内支架介入方式对颅内宽颈动脉瘤患者实施治疗的临床效果非常明显。     

Neuroform支架辅助弹簧圈栓塞颅内宽颈动脉瘤长期疗效分析

目的评价使用Neuroform支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤术后的长期疗效。方法 8例Neuroform支架辅助弹簧圈栓塞颅内宽颈动脉瘤患者均在术后3年以上接受DSA下全颈脑血管造影检查。结果 8例患者均未发现支架内狭窄迹象,动脉瘤体完全无显影,1例未致密填塞患者有动脉瘤颈轻度复发迹象。结论 Neuroform支架辅助弹簧圈栓塞颅内宽颈动脉瘤术式有效、可行,长期效果良好,长期术后并发症发生率低。     

努力提高颅内宽颈动脉瘤的血管内治疗水平

颅内动脉瘤是严重危害人类健康的疾病之一,文献报告成人动脉瘤的尸检阳性率达2.0％-7.6％。颅内动脉瘤破裂导致蛛网膜下腔出血,其死亡率和致残率都很高。近十年来,血管内介入治疗飞速发展,出现了以机械解脱弹簧圈（mechanical detachable     

联合颅内支架和生物活性弹簧圈血管内治疗颅内宽颈动脉瘤初步经验

目的　探讨颅内宽颈动脉瘤新的血管内治疗技术,初步评价该技术和新栓塞材料的安全性和有效性。方法　回顾我们治疗中心近9个月内收治的11例宽颈动脉瘤病人的临床资料。对颅内Neuroform支架辅助生物活性Matrix弹簧圈栓塞宽颈动脉瘤技术特点进行探讨,并通过对部分获得血管造影随访病人的疗效观察,评价该技术的临床应用价值。结果　联合颅内Neuroform支架和生物活性Matrix弹簧圈血管内治疗的11例宽颈动脉瘤病人中,除1例死于并发症外其余病人均得到满意疗效,其中6例病人术后半年行数字减影血管造影(DSA)随访,未见动脉瘤复发,但仍需长期观察。结论　联合颅内支架和生物活性弹簧圈是一有效的血管内治疗颅内宽颈动脉瘤技术,颅内支架理想的大小选择和恰当的植入位置是成功治疗的重要一环,生物活性Matrix弹簧圈栓入瘤腔后可有效促进血栓和结缔组织形成。     

Neuroform支架辅助栓塞颅内宽颈动脉瘤的应用

近十余年来,血管内支架已被成功地应用于颅内血管病的治疗中,并取得了可靠的效果。血管内支架在颅内动脉瘤特别是宽颈动脉瘤的治疗中,起着“栅栏”作用,可以防止弹簧圈突入载瘤动脉,使弹簧圈在瘤内达到致密填塞,从而改变瘤内血流动力学,促进血栓的形成,防止动脉瘤再出血。血管内支架的出现,为这类动脉瘤的治疗提供了新的思路,特别是Neuroform颅内专用支架的问世及其结合电解可脱卸弹簧圈(Guglielmi detechable coil,GDC)在临床的应用,给复杂动脉瘤特别是颅内宽颈动脉瘤的治疗带来了新的曙光。     

血管内栓塞治疗颅内宽颈动脉瘤

目的：探讨血管内不同栓塞方法治疗颅内宽颈动脉瘤的临床疗效。方法选择颅内宽颈动脉瘤患者50例,根据颅内宽颈动脉瘤的不同类型采用不同的栓塞方法,观察各种方法的临床疗效。结果不同栓塞技术的致密栓塞率情况：3D-GDC为75.0％,双微导管技术为85.7％,球囊辅助技术87.5％,血管内支架辅助技术85.7％。所有患者随访1 a ,其中20例CTA 复查,30例DSA 复查,均未发生动脉瘤复发及再出血。结论根据动脉瘤的形态、位置、大小及血流动力学特点,采用双微管技术、球囊或支架辅助技术可提高颅内宽颈动脉瘤治疗效果。     

Solitaire支架辅助栓塞颅内宽颈动脉瘤的临床分析

目的总结Solitaire支架辅助栓塞颅内宽动脉瘤的经验。方法回顾性分析2011年l月至2012年12月应用Solitaire支架辅助弹簧圈栓塞治疗的16例颅内宽颈动脉瘤患者的临床资料,应用弹簧圈微导管穿越支架网孔技术栓塞10例,支架平行释放技术栓塞6例。结果 16例患者支架均成功放置,无手术相关并发症;动脉瘤完全填塞8例,大部分填塞6例,部分填塞2例。16例病人术后随访3-15个月,复查DSA未见动脉瘤显影,动脉瘤颈部与弹簧圈之间没有造影剂充盈;未发生支架相关的并发症。结论 Solitaire支架辅助栓塞颅内宽颈动脉瘤安全、可靠,短期临床疗效较好。     

血管内支架在颅内宽颈及梭形动脉瘤栓塞治疗中的应用

目的　探讨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疗效及并发症。方法　将冠脉支架横跨于 6例颅内梭形动脉瘤 2 4例宽颈动脉瘤瘤颈后释放 ,通过支架的网孔在动脉瘤腔填塞GDC。结果　 2 6例动脉瘤致密填塞 ,4例大部分填塞 ,载瘤动脉通畅。除 5例发生支架移位 ,2例颈内动脉一过性痉挛外 ,无其他手术并发症 ,患者均恢复良好。结论　血管内支架作为腔内隔绝物 ,结合GDC是治疗颅内梭形及宽颈动脉瘤的有效方法     

支架后释放技术在颅内宽颈动脉瘤栓塞治疗中的应用

目的探讨支架后释放技术在颅内宽颈动脉瘤栓塞治疗中的安全性、疗效及技术优势。方法回顾分析2007年1月至2009年5月间支架后释放技术（支架输送至载瘤动脉动脉瘤段,先填塞部分弹簧圈后再释放支架）治疗的153例178＂个动脉瘤患者的动脉瘤及载瘤动脉解剖形态,支架植入技术操作程序,临床和造影结果。结果所有动脉瘤均成功植入支架,其中Neuroform支架76枚、Enterprise支架72枚、LEO支架33枚。术后即刻完全栓塞136个动脉瘤（76．4％）,瘤颈残留29个（16．3％）,部分栓塞13个（7．3％）。术中弹簧圈拉丝1例,血栓栓塞并发症1例。平均术后9．3个月后DSA随访74例,MRA随访44例,显示3例动脉瘤再通。结论支架后释放技术是颅内动脉瘤栓塞治疗中的一种重要手段,能显著提高动脉瘤颈覆盖率而达到血管重建目的,使支架治疗技术成功率、安全性和疗效进一步提高。     

Endovascular stenting for treatment of mycotic intracranial aneurysms

Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology for which obliteration must be undertaken when they present with rupture or fail to respond to antibiotic therapy. Intracranial stents provide the unique ability to simultaneously preserve parent vessel integrity while obliterating the aneurysmal sac, but their use for the treatment of MIA has only been reported in a few instances for proximally located lesions. We report a patient with a MIA treated with endovascular stenting and review the literature for similar cases. Three case reports of four MIA treated with either stent monotherapy or stent-assisted coil embolization were identified. The clinical and radiographic features of each case were detailed. A 35-year-old with bacterial endocarditis from Streptococcus mitis was diagnosed with a ruptured 3 mm MIA of the pericallosal anterior cerebral artery after episodic diplopia. The MIA was successfully treated with stent-assisted coil embolization utilizing a Neuroform EZ stent (Stryker Neuroendovascular, Kalamazoo, MI, USA). Follow-up magnetic resonance angiography at 3 months demonstrated complete aneurysm obliteration, and the patient was neurologically intact. In the literature, a M1 segment middle cerebral artery MIA, bilateral cavernous carotid MIA, and a unilateral cavernous carotid MIA were also successfully treated with Neuroform, Helistent (Hexacath, Rueil-Malmaison, France), and SILK (BALT Extrusion, Montmorency, France) stents, respectively. We present the first patient with a pericallosal MIA treated with stent-assisted coil embolization. Proper treatment of the causative organism with antibiotics minimizes the risk of infectious seeding of the stent. Intracranial stenting may be safely and effectively utilized to treat select cases of MIA.     

颅内大型动脉瘤血管内治疗的长期随访

目的总结颅内大型动脉瘤血管内治疗的治疗策略、操作技巧和预后。方法回顾性分析血管内治疗的189例颅内大型和巨大动脉瘤病人的临床资料,其中闭塞载瘤动脉15例,单纯应用弹簧圈栓塞治疗27例,应用球囊辅助栓塞治疗48例,应用颅内自膨式辅助栓塞治疗99例。结果 189例病人共行手术247次,动脉瘤首次治疗致密栓塞133例,次全栓塞35例,部分栓塞21例。其中47例病人行分期栓塞治疗。术后7例出现血栓栓塞症状,死亡1例,偏瘫4例,其余病人恢复良好。随访16个月~5年,所有病人无再出血。结论血管内治疗颅内大型和巨大动脉瘤是一种安全有效的方法,合理运用辅助手段可有助于减少并发症、降低复发率。     

血管内支架结合电解可脱弹簧圈治疗颅内宽颈动脉瘤

目的：总结使用血管内支架结合电解可脱弹簧圈（GDC）治疗颅内宽颈动脉瘤的体会，探讨其适应证、方法、疗效及并发症。方法：18例颅内宽颈动脉瘤，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，应用GDC栓塞动脉瘤。结果：15例动脉瘤达到致密堵塞，3例大部堵塞，载瘤动脉通畅。无手术 并发症，患均恢复良好。结论：联合使用支架及微弹簧圈是治疗颅内宽颈动脉瘤的有效方法，远期疗效尚需进一步随访。     

Balloon-in-stent assisted coiling for treatment of intracranial overwide and undertall aneurysms

This study reports our experience of balloon-in-stent assisted coiling for the treatment of morphologically unfavorable aneurysms located in the internal carotid artery (ICA). From July 2007 to April 2014, twelve patients with twelve aneurysms located in the ICA were coil embolized by simultaneously using balloon and stent assistance. Five aneurysms were ruptured and seven were unruptured. All the aneurysms were overwide (dome-to-neck ratio ⩽1.2) and undertall (aspect ratio ⩽1.2) anatomically. The procedure-related adverse events, clinical and angiographic results were retrospectively analyzed. Intraprocedural aneurysmal bleeding occurred for one unruptured aneurysm but was stopped immediately after the balloon was inflated. Periprocedural thromboembolism occurred for two ruptured aneurysms, leading to death in one patient and severe neurological deficit for the other one. Procedure-related permanent morbidity and mortality rates were 8.3% (1/12) and 8.3% (1/12). Satisfactory (total and subtotal) occlusion was obtained immediately in 11 (91.7%) cases. Nine aneurysms received digital subtraction angiography follow-up (mean 25.1 months, range 6–55), and all of them except one were totally obliterated. No aneurysmal bleeding occurred during a mean period of 59.1 months, clinical follow-up for eleven patients. Balloon-in-stent assisted coiling might be a therapeutic alternative to prevent growth or rupture of overwide and undertall aneurysms. Nevertheless, it should be used prudently for ruptured ICA aneurysms, for its disadvantage of technical complexity and relatively high rate of adverse events.     

辅助栓塞技术治疗颅内复杂动脉瘤的临床应用(附36例报告)

目的 探讨多种辅助栓塞技术治疗颅内复杂动脉瘤的临床应用.方法 共36例患者的41个颅内复杂动脉瘤行辅助栓塞治疗,方法包括球囊、支架辅助栓塞和双微导管栓塞技术.结果 宽颈动脉瘤33个,其中球囊辅助栓塞11例,完全栓塞7例,次全栓塞3例,另外1例因球囊放置困难改用双微导管栓塞技术;支架辅助栓塞15例,完全栓塞10例,次全及部分栓塞各2例,单纯支架植入1例;双微导管技术栓塞8例,完全栓塞6例,次全及部分栓塞各1例.梭形动脉瘤8个,全部行支架辅助栓塞,完全栓塞1例,次全栓塞6例,单纯支架植入1例.3例出现并发症,其中术中血栓形成2例,术后视野缺损1例.结论 球囊、支架辅助和双微导管栓塞技术是治疗颅内复杂动脉瘤安全有效的方法,具体应根据动脉瘤部位、形态和患者临床情况进行选择.

Abstract：

Objective To investigate the application of assisted coiling techniques in the treatment of complex intracranial aneurysms.Methods From Jun.2007 to Aug.2010, 36 patients with 41 complex intracranial aneurysms were treated by varient endovascular methods, including balloon, stent-assisted coiling and double microcatheter coiling techniques.Results Among the 33 wide-neck aneurysms, 11cases underwent balloon-assisted coiling, in which 7 were totally occluded, 3 subtotally occluded, 1 diverted to double microcatheter treatment after failure balloon placement 15 cases underwent stent-assisted coiling, in which 10 were totally occluded, 2 subtotally or partially occluded respectively, 1 by single stent placement without coiling.8 cases accepted double microcatheter treatment, 6 were totally occluded, 1 subtotally occluded and 1 partially occluded.All 8 fusiform aneurysms were treated by stent-assisted coiling, one case was totally occluded, 6 subtotally occluded, and another one was treated by single stent placement.The complications were found in 3 patients, including intra-operative thrombosis in 2 cases and dysopia in one case.Conclusion Balloon, stent-assisted coiling and double microcatheter techniques are safe and effective in treating complex intracranial aneurysms, but it should be determined by the position and morphologic characteristics of aneurysms as well as the patients' clinical condition.     

Blister-like aneurysms of the supraclinoid internal carotid artery: Challenging endovascular treatment with stent-assisted coiling

'Blister-like' aneurysms of the supraclinoid segment of the internal carotid artery are usually small and have fragile walls, necessitating special care to prevent rebleeding. These lesions are considered high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. In this report, we describe the use of stent-assisted, repeated coil embolization in the treatment of a ruptured blister-like aneurysm that experienced rapid growth. Stent-assisted coil embolization is an alternative, but sometimes hazardous, treatment for select blister-like aneurysms. Careful serial follow-up angiography will provide documentation as to the long-term stability of the endovascularly treated blister-like aneurysm described here, but early results are encouraging. Alternatively, placement of telescoped stents or graft-stent devices offers promise for future endovascular therapy.     

Endovascular treatment of ruptured tiny intracranial aneurysms

Endovascular treatment of ruptured tiny intracranial aneurysms (RTIA) is technically challenging. We retrospectively collected and analyzed the clinical data of 51 patients with RTIA who underwent attempted endovascular treatment at our institution between November 2000 and April 2009. Forty-nine patients were successfully treated by coiling alone (29 patients), stent-assisted coiling (11 patients) or stent placement alone (nine patients). Procedural complications occurred in five patients. One patient died from a severe initial hemorrhage and poor clinical condition. At the time of discharge, 44 patients (89.8%) had recovered in good condition (Glasgow Outcome Scale [GOS] score 5), two were moderately disabled (GOS score 4) and two were severely disabled (GOS score 3). Angiographic follow-up (mean follow-up time = 14 months) was available for 33 patients, and two were re-treated. None of the 46 patients who were clinically followed up (mean = 54.2 months) experienced re-bleeding. Our results suggest that RTIA is not uncommon and can be safely treated endovascularly.     

相对宽颈的颅内破裂微小动脉瘤的血管内治疗

目的 探讨相对宽颈的颅内破裂微小动脉瘤(动脉瘤最长径≤3 mm且动脉瘤颈/瘤体宽径I>3/4)血管内治疗的町行性和安全性.方法 回顾分析24例27个相对宽颈的颅内破裂微小动脉瘤的临床、影像、血管内治疗和随访资料.结果 27个动脉瘤中24个用弹簧圈栓塞,3个仅在载瘤动脉内放置支架.前者有4个动脉瘤100%栓塞,13个90%,6个80%,1个80%以下.2例术后出现一过性轻偏瘫.所有患者临床随访平均51个月(1-94个月)无再出血,6例7个动脉瘤在术后6-38个月复查血管造影,未见再生长.结论 相对宽颈的颅内破裂微小动脉瘤的血管内治疗,技术上可行,操作相对安全,初步结果有效.