儿童颅内外伤性动脉瘤的诊治

目的 评价儿童颅内外伤性动脉瘤的诊断、介入治疗疗效和安全性.方法 分析5例有明确头颅外伤史患儿颅内外伤性动脉瘤病例.经CT、MRI检查,2例为外伤性蛛网膜下腔出血,2例分别表现为右枕部颅内出血及左颞部颅内出血,另1例为后颅凹少量出血伴天幕缘少量硬膜下出血,右侧侧脑室三角区少量出血.5例患儿经DSA全脑血管造影分别诊断为左颈内动脉C1段外伤性动脉瘤,右侧裂动脉分支外伤性动脉瘤,左大脑中动脉分支外伤性动脉瘤,右大脑后动脉远端外伤性动脉瘤,右小脑后下动脉外伤性动脉瘤.其中左颈内动脉C.段外伤性动脉瘤和右侧裂动脉分支外伤性动脉瘤经GDC栓塞术治疗,左大脑中动脉分支外伤性动脉瘤及右小脑后下动脉外伤性动脉瘤于术夹闭.另1例严密随访观察.结果 2例外伤性颅内动脉瘤经GDC栓塞术及2例外伤性动脉瘤手术均获成功,末留任何后遗症;5例均能正常的学习和牛活.结论 儿童颅内外伤性动脉瘤虽属罕见,但GDC及手术治疗儿童颅内动脉瘤安全而有效,长期预后则有待于随访观察.     

Intermittent opacification of an injured artery: a potential aid to superselective transcatheter embolization.

PURPOSE: To evaluate the prevalence of intermittent opacification, a finding previously described as diagnostic of active bleeding that allows identification of an injured vessel at initial aortography or first-order selective angiography. MATERIALS AND METHODS: Retrospective review was performed of 35 consecutive cases that were positive for true or false aneurysm, arteriovenous fistula or malformation, or hemorrhage when a lesion was located beyond a first-order branch of the aorta. An artery that potentially supplied the lesion was considered positive if it filled with contrast material, emptied, and filled again while adjacent vessels demonstrated progressive opacification. RESULTS: Nine (26%) of the 35 cases demonstrated intermittent opacification of an injured artery. All were confirmed as true-positive with superselective catheterization or additional projections, and seven were successfully treated with transcatheter embolization. Intermittent opacification was associated only with false aneurysm and hemorrhage. No congenital arteriovenous malformations or congenital aneurysms demonstrated intermittent opacification. CONCLUSION: If present, the intermittent opacification of an artery is a valuable finding that assists in superselective transcatheter embolization of the arterial branch that supplies a false aneurysm or hemorrhage.     

Endovascular treatment of an “anterior cerebral artery” aneurysm in a patient with “embryonic unfused middle cerebral artery” anomaly: a case report

We report a unique case of an anterior cerebral artery aneurysm in a patient with embryonic unfused middle cerebral artery anomaly. The arterial twigs of the middle cerebral artery supply the entire middle cerebral artery territory including the lenticulostriate branches. There was a vessel incorporated into the aneurysm, which was referred to as an accessory middle cerebral artery and it gave rise to a lenticulostriate branch. The aneurysm was occluded with detachable coils using a remodeling technique. After successful occlusion of the aneurysm the so-called accessory middle cerebral artery including its lenticulostriate branch started to fill from the anomalous middle cerebral artery network and the patient did not experience any ischemic injury.     

Dynamic CT diagnosis of primary dissecting aneurysm of the renal artery

Incremental dynamic CT clearly demonstrated primary dissecting aneurysm of the renal artery in a 36-year-old man presenting with loin pain. A sustained dense bolus in abdominal dynamic CT is vital if branch artery abnormalities are to be diagnosed.     

Dynamic CT diagnosis of primary dissecting aneurysm of the renal artery

Incremental dynamic CT clearly demonstrated primary dissecting aneurysm of the renal artery in a 36-year-old man presenting with loin pain. A sustained dense bolus in abdominal dynamic CT is vital if branch artery abnormalities are to be diagnosed.     

Posterior inferior cerebellar artery aneurysm in the fourth ventricle

We report a patient with a ruptured aneurysm of the choroidal branch of the right posterior inferior cerebellar artery (PICA), lying in and causing an isolated haemorrhage in the fourth ventricle. MRI on the first day after bleeding revealed an abnormal vessel in the fourth ventricle, which was surrounded by a mass of intermediate signal on T1- and T2-weighted images. The aneurysm was clipped via partial splitting of the lower vermis and opening the inferior medullary velum. A postoperative angiogram confirmed complete obliteration of the aneurysm. With PICA aneurysms the rate of intraventricular haemorrhage is high and in most cases due to reflux of blood. It there is an isolated intraventricular haemorrhage, a peripheral PICA aneurysm, lying in or near the fourth ventricle, may be suspected.     

Endovascular treatment of wide-necked aneurysms by using two microcatheters: techniques and outcomes in 25 patients

BACKGROUND AND PURPOSE: The endovascular occlusion of aneurysms with unfavorable configurations such as a broad neck and an important branch from the fundus remains a technical challenge. The purpose of this study was to evaluate the radiologic and clinical results of complicated aneurysm treatment by using two microcatheters. METHODS: Twenty-five aneurysms in 25 patients were treated by using two microcatheters, from August 2001 to February 2004. Fourteen patients presented with a subarachnoid hemorrhage (SAH) and 11 had unruptured aneurysms. The aneurysms were of the basilar top (7), middle cerebral artery bifurcation (4), posterior communicating artery (4), anterior communicating artery (3), superior cerebellar artery (2), ophthalmic artery (2), and one aneurysm of each of cavernous internal carotid artery (ICA), dorsal ICA, and midbasilar artery. In 16 aneurysms (64%), the width of the aneurysm was the same or longer than the height. In 19 (76%), important branches arose from the aneurysm base, and some were even incorporated with the aneurysm fundus. The mean dome (height)-to-neck ratio was 1.23 +/- 0.37 (range, 0.65-2.33), and this was greater than or equal to 1.0 in 19 aneurysms (76%). RESULTS: All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in eight aneurysms (32%), and some residual contrast filling in 16. The aneurysm remnants, however, were intentionally left to preserve important branches in 12 of the 16 aneurysms with incomplete occlusion. Two complications occurred, including one thromboembolic and one coil protrusion, but they were successfully resolved and produced no clinical symptoms. All patients except one showed excellent clinical outcomes. One patient revealed moderate cognitive dysfunction. During the follow-up period, no new bleeding occurred. CONCLUSION: Our experience with 25 cerebral aneurysm patients shows that the technique of using two microcatheters is feasible and safe for coil embolization of aneurysms with unfavorable configurations. Although the lack of angiographic follow-up prevents us from drawing conclusions about its effectiveness as compared with other techniques such as stent placement and balloon-neck protection, we believe that this technique offers a reliable alternative for endovascular therapy of complicated aneurysms.     

Idiopathic pulmonary artery aneurysm: digital subtraction pulmonary angiography grossly underestimates the size of the aneurysm.

Pulmonary artery aneurysm is a rare disease entity. The majority of cases are associated with congenital cardiovascular diseases, infection, and trauma; idiopathic pulmonary artery aneurysm is extremely rare. Although conventional and digital subtraction pulmonary angiography remains as the imaging modality of choice for the pulmonary vessels, it is invasive and sometimes may be inaccurate. With the advent of spiral computed tomographic angiography (CTA), pulmonary artery aneurysm can be diagnosed noninvasively and accurately. We report a case of a 68-year-old man with idiopathic pulmonary artery aneurysm of the descending branch of right pulmonary artery where the true caliber of the aneurysm was significantly underestimated in the digital subtraction pulmonary angiography. The literatures of this rare condition are reviewed with the emphasis on the application of CTA in this disease.     

Horizontal stent placement plus coiling in a broad-based basilar-tip aneurysm: an alternative to the Y-stent technique

Introduction Basilar tip aneurysms are the most frequent type of aneurysm in the posterior circulation. Specifically, if wide-necked, they remain a significant therapeutic challenge. On the endovascular side, stents may help to overcome many of these technical challenges. However, if both P1 segments encroach into the aneurysm neck, sometimes stent placement from the middle of the basilar artery to one P1 segment is not enough. Therefore, some groups recommend the use of the so-called Y-stent technique, with one stent passing through the interstices of another stent in a Y-configuration thus remodelling the basilar tip.Methods We describe a patient with a broad-based basilar tip aneurysm and a single, very tortuous vertebral artery which did not allow the use of the vertebrobasilar system as the straight route to the aneurysm. Because of the well-known high surgical risk we decided to navigate the stent through the internal carotid artery and via the posterior communicating artery into the contralateral P1 segment and placed the stent at right angles to the aneurysm from one P1 segment to the contralateral one.Results The outcome in the patients was excellent without any ischemic lesions.Conclusion Horizontal stent placement in wide-necked basilar tip aneurysms may be a therapeutic alternative if the regular route via the vertebral arteries is not feasible.     

Endovascular treatment of splenic artery aneurysm with splenic preservation

Splenic artery aneurysm (SAA) is the commonest visceral artery aneurysm. Surgical or endovascular treatment of SAA may result in loss of most or all of spleen. We present a case of an aneurysm of superior segmental branch of splenic artery, which was successfully treated by sub-selective embolisation of the feeding arterial branch. The splenic function was preserved and hence precluding pneumococcal vaccines and long-term antibiotics.     

A retained neurointerventional microcatheter fragment in the anterior communicating artery aneurysm in multi-slice computed tomography angiography

We present a case of multi-slice computed tomography angiography of a 60-year-old patient with a retained fragment of microcatheter within an anterior communicating artery (AcomA) aneurysm. This is a rare complication of Guglielmi detachable coil embolization. After an unsuccessful embolization procedure, the patient underwent surgery. During clipping of an AcomA aneurysm, the microcatheter traveled up the pericallosal branch of the right anterior cerebral artery. Subsequently, the microcatheter fragment did not prevent normal blood flow through the artery, and the patient has been doing well without neurological sequelae.     

Behcet病的胸部CT表现

目的 分析Behcet病的胸部CT表现,评价其在诊断中的作用.方法 回顾性分析13例有胸部病变的Behcet病的临床病历记录及CT影像资料,所有患者的诊断根据Behcet病国际研究小组诊断标准.结果 13例中3例表现为胸膜下斑片状实变影,3例为双肺弥漫磨玻璃密度影,1例左下叶塌陷伴有右下叶结节影,1例胸膜下孤立结节影,2例双侧少量胸水,2例伴有纵隔淋巴结增大,1例在治疗过程中CT表现为双肺弥漫性粟粒状结节.13例中8例有胸部血管病变,2例为上腔静脉栓塞;1例左锁骨下动脉瘤;1例左下肺动脉瘤伴附壁血栓;1例双下肺动脉瘤及左侧基底动脉瘤;3例右下肺动脉栓塞,其中2例伴有左肺动脉闭塞,1例伴有左侧基底动脉分支动脉瘤.结论 Behcet病的胸部CT表现多种多样,增强CT可显示胸部血管病变如上腔静脉或肺动脉栓塞、肺动脉瘤等,有助于对病变的评价.     

Rupture of a jejunal artery aneurysm

Aneurysm of the superior mesenteric artery or its branches is rare. We herein present a case of a ruptured aneurysm of the jejunal artery, a branch of the superior mesenteric artery, and we also review 19 cases of jejunal artery aneurysm reported in the English literature. A 66-year-old male who had received a fist blow to the face presented in the emergency ward of his local hospital. His physical examination was unremarkable and he went back home after treatment of his facial wound. Two hours later he again visited the hospital, this time for severe abdominal pain, and he was hospitalized for suspicion of an intraperitoneal hemorrhage. Selective arteriography of the superior mesenteric artery revealed a ruptured aneurysm in the first branch of the jejunal artery. An emergency laparotomy was performed, but the patient died 29h after the injury. Because there was no evidence of any trauma to the abdomen, we concluded that the cause of death was exsanguination due to a ruptured aneurysm, and was not directly related to the earlier trauma. This case is considered to be of medico-legal interest regarding whether the rupture resulted from a natural disease or was due to an assault.     

颅内动脉瘤破裂早期介入治疗的临床价值

目的探讨颅内动脉瘤破裂后早期行数字减影血管造影(DSA)诊断价值并介入栓塞治疗的临床价值。方法对在我院治疗的38例自发性蛛网膜下腔出血患者行头颅CT扫描及早期DSA检查,并行血管内微弹簧圈栓塞治疗及或手术夹闭,包括GDC34例,手术夹闭4例。38例患者按Hunt-Hess分级:Ⅰ级30例、Ⅱ级6例、Ⅲ级1例、Ⅳ级1例,所有病例均行DSA造影及CT扫描。结果 CT扫描均提示不同程度的自发性蛛网膜下腔出血;脑血管DSA造影诊断:前交通动脉瘤13例,后交通动脉瘤16例,大脑中动脉瘤7例,颈内动脉分叉部2例。介入栓塞及手术夹闭成功36例,占94.7%。36例随访3～35个月无再次出血,全部病例CT复查显示弹簧圈形态、位置无改变,30例6个月后复查DSA未见动脉瘤复发。2例后交通复杂动脉瘤介入栓塞失败,家属不愿手术治疗,他们分别于术后1周及1月后死亡。结论对颅内动脉瘤破裂患者需尽早行数字减影血管造影(DSA)作出早期诊断,早期进行弹簧圈血管内栓塞治疗;DSA在诊断,治疗及患者随访中均发挥非常重要的作用。     

Detection of arterial bleeding points in basilar subarachnoid hemorrhage by postmortem angiography

The most common cause of basal cerebral subarachnoid hemorrhage (SAH) is rupture of a cerebral artery aneurysm, but most reported series of SAH include cases where no aneurysm could be found. This would have no forensic relevance if all basal SAH would result from spontaneous ruptures of pathological blood vessels, but the situation is more complex because traumatic ruptures of otherwise normal cerebral arteries may be the only intracranial result of an injury. From the gross appearance, these two types of basal SAH cannot be distinguished. In victims with external injuries and in cases with doubtful circumstances, the detection and (histological) classification of the bleeding point(s) is necessary to distinguish between a spontaneous and traumatic origin of the rupture. We recommend post-mortem radiological examination of the cerebral arteries after instillation of a contrast medium. This method probably allows detection of even small bleeding points in the most inaccessible locations (not present in our actual series), and the radiological appearance of the bleeding points can also be helpful in the identification of the type of arterial alteration.     

Placement of a Neuroform2 stent into the parent vessel by navigating it along the inner wall of the aneurysm sac

Introduction The Neuroform2 stent has proven to be a very helpful device in the stent-assisted coiling of wide-necked cerebral aneurysms particularly because of its high navigability. We describe the case of a 33-year-old man with a ruptured anterior cerebral artery aneurysm that was successfully embolized and a wide-necked unruptured middle cerebral artery (MCA) aneurysm that required stent-assisted coiling. Methods All attempts to catheterize the parietal branch of the MCA in order to deploy the stent were unsuccessful since various guidewires followed a circular path inside the aneurysm sac. Based on our experience on the flexibility of the Neuroform2 stent, and since the aneurysm was unruptured, we decided to follow the circular path of the wire inside the aneurysm with the stent microcatheter. Results The stent navigated easily into the parietal branch where it was correctly deployed and the aneurysm was uneventfully embolized. Conclusion This maneuver might pose the risk of aneurysm puncture in ruptured aneurysms but might prove helpful in unruptured wide-necked calcified or partially thrombosed aneurysms.     

Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization

Renal artery branch injury resulting from stab wounds of iatrogenic origin or street violence is an important cause of renal hemorrhage. Over a period of 10 years we accurately diagnosed the injury and successfully managed the associated hemorrhage in 15 patients by using angiography and percutaneous embolization techniques. Nine branch injuries in eight patients were due to street knifings and seven injuries were complications of invasive medical procedures (four from renal biopsy, two from nephrostolithotomy, and one from nephrostomy). All patients had gross hematuria at the time of angiographic evaluation. False aneurysms were present in six patients (one with associated frank extravasation), false aneurysm/arteriovenous fistula in three, false aneurysm/arteriocaliceal fistula in one, and isolated arteriovenous fistula in two. Frank extravasation without associated false aneurysm/arteriovenous fistula was present in two. One patient had two injuries, an upper-pole false aneurysm and a lower-pole false aneurysm/arteriovenous fistula. In the eight patients injured in street knifings, hematuria recurred after surgical exploration and treatment. None of the 16 injuries involved the main renal artery. Gelfoam was used for embolization of nine lesions and steel coils for four. Three others were treated with Gelfoam plus coils. Hemostasis was achieved in all and none required subsequent surgery. Renal tissue loss was small to moderate (less than 30%) in 12 patients and large (30-50%) in three patients. Transient postembolization hypertension occurred in one of the latter. We consider selective angiography/embolization to be an effective and safe means for diagnosing and treating wounds of the renal artery branches.     

Endovascular treatment of bacterial intracranial aneurysms

We report three patients with bacterial intracranial aneurysms treated by the endovascular approach: two presented with sudden severe neurological deficits after a diagnosis of endocarditis; the other had suspected vasculitis. CT showed an intracerebral haematoma in all cases: angiography revealed bacterial aneurysms of distal branches of the middle cerebral artery in two cases and posterior cerebral artery in one. Because of the patients' condition and the location of the aneurysms, endovascular treatment was considered the fastest and safest treatment. Hyperselective catheterisation of the parent branch, close to the aneurysm, was performed with a microcatheter. A small amount of glue was injected to occlude both the aneurysm and a short segment of the diseased vessel. Follow-up angiography revealed occlusion of the aneurysm in all cases. One patient recovered completely; one recovered over some months, with neurological deficit due to the haematoma. The third patient suddenly worsened and died 9 days after treatment for a contralateral haematoma, due to rupture of a new bacterial aneurysm of the middle cerebral artery. Endovascular occlusion of the aneurysm and parent vessel may be an alternative to surgery in selected, severe cases of deep or distal bacterial intracranial aneurysms.     

经导管动脉栓塞术治疗支气管动脉瘤

目的:探讨经导管动脉栓塞术(TAE)治疗支气管动脉瘤(BAA)的价值。方法:搜集经支气管动脉造影证实的BAA 2例,根据形态及部位不同,行不同方式TAE治疗,并临床随访。结果:囊状动脉瘤1例(微导管能顺利到达并通过),其远端实施球形PVA微颗粒栓塞止血,输出端及输入端分别用弹簧圈阻断血流,复查造影示支气管动脉远端血流阻断,BAA未见显示;梭形动脉瘤1例(距离支气管动脉起始部较远),其远端行球形PVA微颗粒栓塞,近端加注明胶海绵颗粒栓塞,复查造影BAA未见显示。结论:TAE是一种治疗BAA的微创、高效、可靠方法,不同形态及部位的BAA应选择不同方式的TAE。     

Endovascular treatment of pseudoaneurysms with electrolytically detachable coils.

PURPOSEWe describe the clinical presentation, angiographic findings, and clinical outcome in a group of patients with pseudoaneurysms treated by a new endovascular technique using Guglielmi electrolytically detachable platinum coils (GDCs).METHODSWe retrospectively reviewed the angiographic and clinical findings in a series of 11 patients with pseudoaneurysms occurring in a variety of locations: seven in the cavernous carotid artery, one in the petrous carotid artery, two in the anterior cerebral artery, and one in the cervical vertebral artery.RESULTSAll aneurysms were cured with GDC embolization. The only complication was a branch occlusion, which resolved with heparinization and produced no clinical sequelae.CONCLUSIONPseudoaneurysms can be safely and effectively treated by embolization with GDCs. Consideration needs to be given to the anatomic location of the pseudoaneurysm and the acuity of onset. Treatment efficacy may by improved if there are bony confines around the aneurysm or if therapy takes place in the subacute period, when the wall of the pseudoaneurysm has matured and stabilized.