支架辅助弹簧圈栓塞治疗颅内未破裂动脉瘤的疗效

目的 探讨支架辅助弹簧圈栓塞治疗颅内未破裂动脉瘤的疗效。方法 回顾性分析2014年1月至2016年3月收治的96例颅内未破裂动脉瘤的临床资料,根据治疗方法分为对照组（50例）与观察组（46例）。对照组采用单纯弹簧圈栓塞治疗,观察组采用支架辅助弹簧圈栓塞治疗。结果 观察组完全栓塞率、术后6个月GOS评分均明显高于对照组（P<0.05）,而复发率明显低于对照组（P<0.05）。结论 对颅内未破裂动脉瘤采用支架辅助弹簧圈栓塞治疗,可显著提高动脉瘤栓塞程度,降低复发率,改善预后。     

支架辅助弹簧圈栓塞治疗颅内动脉瘤相关并发症分析

目的探讨架辅助弹簧圈栓塞治疗颅内动脉瘤的并发症及处理措施。方法2012年1月至12月我科共收治颅内动脉瘤584例,血管内治疗244例（253枚动脉瘤）,其中应用支架辅助弹簧圈栓塞137例（144枚动脉瘤）,采用BALT的LEO支架27枚、Codman的Enterprise支架103枚、EV3的Sditaire支架19枚、LVIS支架1枚。结果13例出现并发症,发生率为9．5％（13／137）。包括术中动脉瘤破裂5例,其中3例死亡,支架诱发血栓栓塞2例（均为LEO支架）,支架移位4例,血管痉挛2例,经积极处理后,10例患者预后均良好。结论支架辅助弹簧圈栓塞治疗颅内动脉瘤是一项成熟的技术,但也存在一定的并发症,因而需要手术者具有良好的手术技能和丰富的经验,同时也需要加强围手术期管理,以减低并发症发生率和改善患者的预后。     

支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤并发症的观察与护理

目的探讨支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤并发症的观察及护理要点。方法 2013年1月至2013年12月采用支架辅助弹簧圈栓塞治疗复杂颅内动脉瘤146例,针对手术相关并发症,采取准确的评估,密切观察,早期护理干预。结果术中颅内动脉瘤破裂出血5例病人中,4例康复出院,1例死亡。2例血栓栓塞、2例支架移位、5例脑血管痉挛、2例穿刺部位出血症状均得以控制,康复出院。结论支架辅助弹簧圈治疗颅内动脉瘤围手术期的有效管理,可降低术后并发症发生率和改善患者的预后。     

显微手术和血管内栓塞术治疗颅内动脉瘤的 疗效分析

目的 探讨显微手术和血管内栓塞治疗颅内动脉瘤的临床疗效。方法 2008年1月至2014年12月收治颅内动脉瘤150例,其中75例采用夹闭术（夹闭组）,75例采用血管内栓塞术（栓塞组）。结果 夹闭组住院时间[（16.6±4.1） d]比栓塞组[（10.3±2.1） d]明显延长（P<0.05）,夹闭组视觉模拟量表评分[（5.2±1.5）分]明显高于栓塞组[（2.3±1.1）分;>P<0.05]。夹闭组血管痉挛发生率（1.3%）显著低于栓塞组（9.3%;>P<0.05）,感染发生率（10.7%）明显高于栓塞组（1.3%;>P<0.05）。两组患者术后半年gos评分无明显差异（>P>0.05）。结论 治疗颅内动脉瘤,显微手术夹闭和血管栓塞均能取得较为满意的效果,但各有利弊;临床应根据患者动脉瘤具体情况而选择对患者最为合适及有利的治疗方法。     

Enterprise支架与Solitaire支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤疗效分析

目的比较Enterprise支架与Solitaire支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤的安全性和有效性。方法 128例共133枚复杂动脉瘤,Enterprise支架治疗67例（68枚）,Solitaire支架治疗61例（65枚）,比较两组术后支架相关并发症发生率和术后3~12个月血管造影随访结果。结果 Enterprise支架治疗组和Solitaire支架治疗组术后30 d内患者临床并发症有血栓形成、短暂性脑缺血发作、脑卒中和脑出血,但两组的并发症发生率差异无统计学意义（P〉0.05）;术后3~12月血管造影随访结果示两种支架栓塞率及再通率无统计学差异（P〉0.05）。结论 Enterprise支架和Solitaire支架治疗颅内复杂动脉瘤效果均良好。     

球囊辅助弹簧圈联合Onyx胶栓塞治疗颅内大型或宽颈动脉瘤

目的探讨弹簧圈联合Onyx胶栓塞治疗颅内大型或宽颈动脉瘤的可行性及有效性。方法回顾性分析2014年11月2016年10月收治15例颅内大型或宽颈动脉瘤的临床资料,其中采用单纯弹簧圈栓塞治疗5例,采用支架辅助弹簧圈栓塞治疗4例,采用球囊辅助弹簧圈联合Onyx胶栓塞治疗6例。结果术后立即造影示动脉瘤完全栓塞12例,部分栓塞3例。1例因年龄较大拒绝随访,其余14例栓塞术后随访6~12个月;单纯弹簧圈栓塞治疗的4例中,复发3例;支架辅助弹簧圈栓塞治疗的4例中,复发1例;球囊辅助弹簧圈联合Onyx胶栓塞治疗的6例均无复发,但2例大脑后动脉P3~P4段巨大夹层动脉瘤出现载瘤动脉远端动脉闭塞。结论球囊辅助弹簧圈联合Onyx胶治疗颅内大型或宽颈动脉瘤可提高动脉瘤的栓塞率,减少复发率。     

颅内大型、巨大型动脉瘤血管内治疗长期血管造影随访

目的探讨血管内治疗颅内大型或巨大型动脉瘤的疗效和长期血管造影随访结果。方法回顾性分析72例颅内大型或巨大型动脉瘤血管内治疗患者的临床资料,其中单纯弹簧圈栓塞30例,支架辅助弹簧圈栓塞14例,覆膜支架治疗15例,载瘤动脉闭塞术13例。结果单纯弹簧圈完全栓塞10例,支架辅助弹簧圈完全栓塞7例,覆膜支架11例,载瘤动脉闭塞13例,总术后即刻完全栓塞率达到56.9%;单纯弹簧圈近完全栓塞17例,支架辅助弹簧圈近完全栓塞6例,覆膜支架4例,总术后即刻近完全栓塞率37.5%;单纯弹簧圈不完全栓塞3例,支架辅助弹簧圈不完全栓塞1例,总术后即刻不完全栓塞率5.6%。随访6~72个月,平均随访24.2个月,所有患者无再出血。围手术期总的并发症率为9.7%,无死亡病例。不同血管内治疗方法对动脉瘤复发率的比较发现,单纯弹簧圈栓塞治疗比其他治疗方法治疗动脉瘤患者复发率高。总的复发率是23.6%。再次用血管内成功治疗14例复发动脉瘤。结论血管内介入治疗颅内大型或巨大型动脉瘤安全有效,远期复发率较高,应加强随访观察。根据动脉瘤部位及形态特点,合理采用相应的血管内介入治疗可有助于提高临床治疗效果,降低复发率。     

介入栓塞治疗不同直径颅内动脉瘤的临床效果观察

目的 观察介入栓塞治疗对不同直径颅内动脉瘤的临床效果及安全性。方法 回顾性分析本院在2015年8月-2017年1月收治的87例颅内未破裂动脉瘤患者的临床资料,根据动脉瘤直径不同分为小型动脉瘤组(瘤体直径≤3 mm)41例,中大型动脉瘤组46例,均行介入栓塞治疗; 比较2组患者栓塞效果、并发症、复发率及预后。结果 术后6个月小型动脉瘤组完全栓塞率为100%,中大型动脉瘤组完全栓塞率为91.30%(42/46),动脉瘤瘤颈残留3例(6.52%),动脉瘤腔残留1例(2.17%),2组比较无明显差异(P>0.05); 小型动脉瘤组单纯弹簧圈栓塞16例,支架辅助弹簧圈栓塞25例,中大型动脉瘤组单纯弹簧圈栓塞23例,支架辅助弹簧圈栓塞18例,球囊辅助弹簧圈栓塞5例,2组比较也无明显差异(P>0.05); 小型动脉瘤组并发症发生率较中大型动脉瘤组低(7.32% vs 15.22%),但无明显差异(P>0.05); 术后6个月小型动脉瘤组无复发病例,中大型动脉瘤组复发率为8.69%(4/46),2组比较也无明显差异(P>0.05); 术后30 d,小型动脉瘤组GCS预后评分中恢复良好例数明显多于中大型动脉瘤组(87.80% vs 58.69%),2组比较有明显差异(P<0.05)。结论 介入栓塞治疗对不同直径的颅内动脉瘤均具有较好的疗效,但小型动脉瘤预后较好。     

LVIS密网支架辅助弹簧圈栓塞介入治疗单发颅内破裂小动脉瘤的近期疗效及其并发症发生情况的研究

目的探究LVIS密网支架辅助弹簧圈栓塞介入治疗单发颅内破裂小动脉瘤的近期疗效及对其并发症发生情况的影响。方法选取2015年3月～2019年4月在我院就诊的70例单发颅内破裂小动脉瘤患者,随机分为常规组(35例)和支架辅助组(35例),常规组予以单纯弹簧圈栓塞介入治疗,支架辅助组予以LVIS密网支架辅助弹簧圈栓塞介入治疗。观察并比较两组的围术期指标、动脉瘤闭塞程度、动脉瘤影像特征、格拉斯哥昏迷评分(GCS)及并发症发生情况。结果支架辅助组相对于常规组的住院费用无统计学差异(P0.05),但在手术时间和住院时间上,支架辅助组明显小于常规组(P0.05)。支架辅助组的动脉瘤致密栓塞率显著高于常规组(P0.05)。术后,支架辅助组动脉瘤的长度、高度、动脉瘤瘤体高度与瘤颈长度之比值(AR)、动脉瘤瘤体最大瘤深与近端载瘤动脉直径之比值(SR)水平显著小于常规组(P0.05)。支架辅助组的术后GOS评分优于常规组,且其并发症发生率为8.57%,显著低于常规组的31.43%(P0.05)。结论 LVIS密网支架辅助弹簧圈栓塞介入治疗单发颅内破裂小动脉瘤的近期疗效显著,可有效促进患者术后恢复,改善其术后动脉瘤影像特征及GOS评分,降低并发症发生率,值得推广。     

Enterprise支架及Solitaire支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤疗效对比

目的比较Enterprise支架与Solitaire支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的安全性和疗效。方法使用支架辅助弹簧圈栓塞治疗98例共103枚颅内宽颈动脉瘤,其中Enterprise组52枚,Solitaire组51枚,比较2组并发症发生率和术后3~6个月血管造影随访结果。结果 Enterprise组和Solitaire组并发症及治疗效果差异无统计学意义(P0.05)。结论 Enterprise支架和Solitaire支架治疗颅内宽颈动脉瘤效果均良好。     

Single-centre comparison of procedural complications,clinical outcome,and angiographic follow-up between coiling and stent-assisted coiling for posterior communicating artery aneurysms

Aneurysm recurrence is a principle limitation of endovascular coiling procedures, especially in posterior communicating artery aneurysms, with reported recurrence rates of >30%. The adjunctive use of self-expandable stents has revolutionised the treatment of intracranial aneurysms, especially for complex morphologies, wide necks, or unfavourable dome-to-neck ratios. However, there are limited data concerning a direct comparison between simple coiling and stent-assisted coiling in posterior communicating artery aneurysms. This study aimed to compare the durability and outcomes of coiling versus stent-assisted coiling procedures. Imaging data of patients with posterior communicating artery aneurysms treated with coiling or stent-assisted coiling between January 2008 and October 2012 were retrospectively analysed. The initial angiographic results, procedural complications, and clinical outcomes were assessed at discharge. Imaging follow-up was performed with cerebral angiography. Complete aneurysm occlusion was achieved on initial angiography in 23/56 (41.1%) stent and 83/235 (35.3%) non-stent patients. At the latest follow-up (mean follow-up 14.3 ± 10.4 months for stent and 13.2 ± 9.5 months for non-stent patients), aneurysms had recurred in 5/47 (10.6%) stent and 57/203 (28.1%) non-stent patients (p = 0.014). Procedural complications occurred in 6/56 (10.7%) stent and 27/235 (11.5%) non-stent aneurysms. No rebleeding occurred during clinical follow-up (mean duration, 46.7 months). Recurrence rates at the latest follow-up were significantly lower in patients undergoing stent-assisted coiling than those undergoing simple coiling. Thus, use of the stent-assisted neck remodelling technique in the treatment of wide-necked posterior communicating artery intracranial aneurysms appears to improve the long-term clinical outcome.     

支架半释放技术辅助弹簧圈栓塞治疗破裂的颅内微小动脉瘤

目的探讨支架半释放技术辅助弹簧圈栓塞破裂颅内微小宽颈动脉瘤的可行性、有效性和安全性。方法2007年1月至2011年8月采用支架半释放技术辅助弹簧圈栓塞治疗破裂颅内微小宽颈动脉瘤37例。结果所有患者均成功通过支架半释放技术辅助弹簧圈栓塞治疗。术后即刻造影结果显示,Raymond分级I级26例,II级8例,III级3例。28例患者影像学随访3～24个月,平均10．4个月,未发现支架内再狭窄或复发。36例患者临床随访9—48个月,平均21．3个月,无再出血或死亡病例。结论支架半释放技术辅助弹簧圈栓塞治疗破裂颅内微小宽颈动脉瘤是安全、可行的。该技术通过增加瘤颈周围的填塞密度和改善血液动力学进一步提高长期疗效。     

Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study

PurposeTo assess efficacy, safety and to discuss optimal medical therapy of stent-assisted coiling of ruptured intracranial aneurysms.MethodsRuptured intracranial aneurysms treated with stent-assisted coiling in eight different institutions were retrospectively reviewed. Medical treatment regimens varied among the centers, mainly regarding heparin administration and post-procedural single or double antiplatelet therapy. Clinical and angiographic results, including complications and outcomes were analyzed and related to the different therapies.ResultsSixty-one consecutive patients (male/female 23/38), aged 59.1 years (36–86) underwent stent-assisted coiling for ruptured intracranial aneurysm without antiplatelet pre-medication. Intravenous acetylsalicylic acid (ASA) 500 mg was administered to all patients immediately after stent deployment. At the same time heparin was given as bolus in 15 patients (24.6%) as part of local protocol. Intravenous glycoprotein 2b/3a inhibitors (antiGP2b3a) were used as bail-out therapy for stent thrombosis. Stent thrombosis occurred in 22 patients (36.1%), of which 4 (6.5%) lead to incomplete and 18 (29.6) to complete occlusion of the stent. Heparin administration had no effect on thrombosis rate. Thrombosis resolution occurred in all cases with intravenous antiGP2b3a (7 tirofiban, 15 abciximab), without increasing overall complication rate. Single antiplatelet therapy with ASA (28 patients, 45.9%) or double antiplatelet therapy including ASA and clopidogrel (33 patients, 54.1%) were administered after procedure, depending on local protocols and on neurointerventionists’ experience. Overall complication rate, including ischemia and hemorrhage was higher in patients in which only ASA was administered (21.4% vs. 12.1%). No late stent thrombosis was seen, regardless of whether a single or double antiplatelet regimen was used. Nevertheless, the small sample size suggests caution in interpreting these results. Moreover, a possible bias may arise from the decision whether to modify the maintenance therapy or not depending on the severity of the intracranial hemorrhage in a case-by-case assessment. At three months, 34 out of 38 patients with HH grade 1-2 (89.4%), and 11 out of 23 with Hunt-Hess grade of 3-4 (47.8%) were independent (Modified Ranking Scale 0-2).ConclusionStent assisted coiling of ruptured intracranial aneurysms is a feasible option when simple coiling is not possible. Optimal medical treatment is still controversial because balance between hemorrhagic and ischemic risks is difficult to evaluate. In our series, heparin bolus had no effect on subsequent stent thrombosis. In all cases peri-operative stent thrombosis was successfully managed using bail-out intravenous antiGP2b3a, which did not increase post-procedural hemorrhage rates. A non-significant trend towards increased complications rate was noticed in patients treated with single antiplatelet therapy versus double antiplatelet therapy.     

比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤安全性和有效性的Meta分析

目的比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤的安全性和有效性。方法计算机检索1990至2018年颅内未破裂动脉瘤的所有临床对照研究。两名研究员分别纳入研究、提取数据、质量评价并应用Rev Man5. 0软件进行数据处理。结果最终纳入21篇文献,病例数109114例。Meta分析结果提示:手术夹闭组动脉瘤闭塞率为88. 2%,平均住院时间7. 7天,均高于介入栓塞组的65. 3%和4. 1天,P 0. 05。介入组患者的短期死亡率和致残率分别为0. 61%和2. 1%,均低于手术组的1. 27%和4. 7%,P 0. 05。介入组患者的1年期死亡率和致残率(2. 5%、2. 5%)均与手术组(2. 2%、1. 8%)无明显差异,P 0. 05。漏斗图未发现发表偏倚。敏感性分析结果一致。结论介入栓塞相比于手术夹闭可缩短患者的住院时间,降低患者的短期不良预后发生率。但是动脉瘤的闭塞率较低,1年期预后与手术夹闭无明显差异。据此推测手术夹闭患者的长期预后可能要好于介入栓塞,手术夹闭更适合于年轻患者。     

Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms

Endovascular coil embolization is a widely accepted and useful treatment modality for intracranial aneurysms. However, the principal limitation of this technique is the high aneurysm recurrence. The adjunct use of stents for coil embolization procedures has revolutionized the field of endovascular aneurysm management, however its safety and efficacy remains unclear. Two independent reviewers searched six databases from inception to July 2015 for trials that reported outcomes according to those who received stent-assisted coiling versus coiling-only (no stent-assistance). There were 14 observational studies involving 2698 stent-assisted coiling and 29,388 coiling-only patients. The pooled immediate occlusion rate for stent-assisted coiling was 57.7% (range: 20.2%–89.2%) and 48.7% (range: 31.7%–89.2%) for coiling-only, with no significant difference between the two (odds ratio [OR} = 1.01; 95% confidence intervals [CI}: 0.68–1.49). However, progressive thrombosis was significantly more likely in stent-assisted coiling (29.9%) compared to coiling-only (17.5%) (OR = 2.71; 95% CI: 1.95–3.75). Aneurysm recurrence was significantly lower in stent-assisted coiling (12.7%) compared to coiling-only (27.9%) (OR = 0.43; 95% CI: 0.28–0.66). In terms of complications, there was no significant difference between the two techniques for all-complications, permanent complications or thrombotic complications. Mortality was significantly higher in the stent-assisted group 1.4% (range: 0%–27.5%) compared to the coiling-only group 0.2% (range: 0%–19.7%) (OR = 2.16; 95% CI: 1.33–3.52). Based on limited evidence, stent-assisted coiling shows similar immediate occlusion rates, improved progressive thrombosis and decreased aneurysm recurrence compared to coiling-only, but is associated with a higher mortality rate. Future randomized controlled trials are warranted to clarify the safety of stent-associated coiling.     

Treatment of unruptured vertebral dissecting aneurysms: internal trapping or stent-assisted coiling

Purpose: Endovascular treatment is an attractive approach for the treatment of unruptured vertebral dissecting aneurysms, and includes internal trapping and stent-assisted coil embolization. However, the optimal therapy remains debatable. We reviewed our experience with both endovascular treatment modalities and compared the safety, efficacy, and short-term outcomes for each approach. Materials and Methods: We retrospectively reviewed 65 consecutive patients with unruptured vertebral dissecting aneurysms who underwent endovascular treatment between January 2003 and January 2014. 24 patients underwent endovascular internal trapping (group A) while 41 patients underwent stent-assisted coiling (group B). Thirteen patients underwent single stent with coiling while 28 patients underwent double or three stent-assisted coiling. Short-term outcomes were evaluated using the modified Rankin Scale. Results: A favorable clinical outcome was achieved in 58 of 65 patients. Procedure-related complications included ischemic symptoms (n = 6) and recurrence (n = 4). There was no statistical difference in modified Rankin Scale scoring between groups. Group A patients had more ischemia symptoms compared with group B patients (p = 0.043), Group B patients had higher recurrence rates compared with group A patients, but the difference had no statistical significance (p = 1.00). However, recurrence only occurred in patients who underwent stent-assisted coiling alone (p = 0.046). Conclusion: Stent-assisted coiling for unruptured vertebral dissecting aneurysms may maintain artery patency. Multilayer disposition of stents with coils may decrease complications and facilitate aneurysm occlusion. Larger, prospective studies are necessary to determine the long-term outcomes of reconstructive therapy.     

Neuroform Atlas支架辅助弹簧圈治疗颅内宽颈动脉瘤的初步应用

目的初步探讨Neuroform Atlas支架辅助弹簧圈治疗颅内宽颈动脉瘤的疗效及安全性。方法回顾性分析2020年8—12月郑州大学人民医院神经外科应用Neuroform Atlas支架辅助弹簧圈栓塞治疗的64例颅内宽颈动脉瘤患者(67个动脉瘤)的临床资料。其中10例患者(12个动脉瘤)同时采用尾端套叠式"Y"型支架技术治疗。术后3个月进行临床随访,采用改良Rankin量表评分(mRS)评估患者的临床预后。术后5~6个月复查数字减影血管造影(DSA),采用Raymond分级评估动脉瘤的闭塞情况。结果67个动脉瘤置入的74枚Neuroform Atlas支架均成功释放,术中发生操作相关并发症1例。67个动脉瘤的术后即刻DSA显示,56个(83.6%)动脉瘤完全闭塞(RaymondⅠ级),4个(6.0%)动脉瘤瘤颈残留(RaymondⅡ级),7个(10.4%)动脉瘤瘤体残留(RaymondⅢ级)。术后1例患者因脑疝死亡,2例发生脑梗死。术后失访3例,60例患者完成3个月随访,其中mRS 0分53例,1分4例,2分2例,3分1例。术后5~6个月,53例患者(55个动脉瘤)完成影像学随访,其中动脉瘤闭塞达RaymondⅠ级50个(90.9%),Ⅱ级2个(3.6%),Ⅲ级3个(5.5%),且均未发现支架内狭窄或迟发性血栓事件。结论初步发现,Neuroform Atlas支架辅助弹簧圈治疗颅内宽颈动脉瘤具有较高的闭塞率和较低的并发症发生率,有效性及安全性均较好。     

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.     

Safety and long-term efficacy of endovascular treatment of small posterior communicating artery aneurysms by coiling with or without stent: A single center retrospective study

Objectives

Endovascular stents have been widely used in intracranial aneurysm embolization. In this work, we compared the safety and long-term efficacy of stent-assisted coiling with those of conventional coiling for small posterior communicating artery aneurysms, aiming at a better understanding of the related safety and efficacy profiles.

Methods

Between January 2008 and December 2011, 114 small PcomA aneurysms (defined as 3 mm ≤ maximum diameter < 10 mm in this study) in 108 patients were treated by endovascular treatment in our department. Patient demographics, aneurysm characteristics, angiographic results (initial and follow-up), and procedural complications were assessed.

Results

Embolization was successfully performed in all the patients. Complications occurred in 7.4% of patients in both groups. There was no associated mortality. Based on initial post-procedural angiography, the rate of complete aneurysm occlusion, neck remnant and residual sac in the stented group were 37.9%, 24.1%, and 37.9%, while in the conventional group the figures were 42.9%, 48.2%, and 8.9%, respectively. The initial angiographic results were significantly better in the conventional group, compared with the stented group (P = 0.038). The follow-up results showed that the rate of improvement in the stented group was significantly higher (53.3% vs. 14.0%; P < 0.001) and the recurrence rate was significantly lower than that in the conventional group (4.4% vs. 3.02%; P = 0.001).

Conclusion

Compared with conventional coiling, stent-assisted coiling of the small posterior communicating artery aneurysms does not increase the risk. Stents bear an advantage in reducing the recurrence rate, increasing progressive occlusion rate, and improving long-term prognosis in endovascular treatment of intracranial aneurysms.     

血管内治疗颈内动脉床突旁破裂动脉瘤

目的 探讨血管内治疗颈内动脉床突旁破裂动脉瘤的临床效果。方法 2011年1月至2014年12月血管内治疗颈内动脉床突旁破裂动脉瘤26例。结果 单纯弹簧圈栓塞治疗11例,支架辅助弹簧圈栓塞治疗15例。术后即刻造影示:Raymond分级Ⅰ级15例,Ⅱ级8例,Ⅲ级3例。术中发生并发症9例,其中1例术中再次破裂,最后死亡。25例术后平均随访6个月,无动脉瘤再破裂出血;5例复发,其中3例再次支架辅助弹簧圈栓塞治疗;改良Rankin量表评分评估患者预后:预后良好（0~2分）23例,预后差（3~6分）2例。结论 血管内治疗颈内动脉床突旁破裂动脉瘤仍存在挑战,常需使用支架辅助技术,尽管存在一定复发率,但近期仍可达到很好的临床效果。