颅内动脉瘤铂金弹簧圈栓塞术后MRA随访价值

弹簧圈栓塞术已逐步成为治疗颅内动脉瘤破裂性蛛网膜下腔出血(SAH)的有效手段。术后长期规律的随访是评价治疗效果的重要方法。数字减影血管造影(DSA),特别是辅以3D重组(VR)技术的旋转DSA被认为是目前颅内动脉瘤弹簧圈栓塞术后随访的金标准,但它为有创性检查,重复施行不是理想的方法。而MR血管成像(MRA)在显示动脉瘤弹簧圈栓塞后残腔存在与否方面具有高度的敏感性和特异性,有望成为随访中首选的无创性检查手段。因此研究者建议将MRA纳入颅内动脉瘤弹簧圈栓塞术后随访策略。     

颅内动脉瘤铂金弹簧圈栓塞术后MRA随访价值

弹簧圈栓塞术已逐步成为治疗颅内动脉瘤破裂性蛛网膜下腔出血（SAH）的有效手段。术后长期规律的随访是评价治疗效果的重要方法。数字减影血管造影（DSA）,特别是辅以3D重组（VR）技术的旋转DSA被认为是目前颅内动脉瘤弹簧圈栓塞术后随访的金标准,但它为有创性检查,重复施行不是理想的方法。而MR血管成像（MRA）在显示动脉瘤弹簧圈栓塞后残腔存在与否方面具有高度的敏感性和特异性,有望成为随访中首选的无创性检查手段。因此研究者建议将MRA纳入颅内动脉瘤弹簧圈栓塞术后随访策略。     

3D-TOF MRA对颅内动脉瘤GDC治疗随访的预期评估

目的:评价磁共振血管成像(MRA)在随访43例病人的45个颅内动脉瘤GDC栓塞后的价值.材料和方法:以数字减影血管造影(DSA)作为诊断的金标准,回顾研究43例病人的45个颅内动脉瘤(前循环34个,后循环11个)MRA检查.所有的病人在GDC栓塞治疗后9个月之内的同一周行DSA和MRA检查,这期间不作处理.分析弹簧圈内残余血流、载瘤动脉和邻近动脉血流,MRA以最大强度投影(MIP)重建和源图像为基础.结果:所有病例中,MRA能提供良好的信息.对于动脉瘤的分析,MRA的敏感性、特征性、阳性预测价值、阴性预测价值,诊断弹簧圈内残余血流分别为87.5%、100%、100%、97%,诊断瘤颈的残余血流分别为90%、100%、100%、97%.对于动脉通畅性分析,MRA的敏感性和阴性预测价值,载瘤动脉分别是90.5%和100%,邻近动脉分别是85.7%和100%.结论:在随访GDC栓塞的动脉瘤中,MRA可以作为一个筛选手段,提高检查效率,减少病人的随访风险.     

3D-T0F MRA对颅内动脉瘤GDC治疗随访的预期评估

目的：评价磁共振血管成像(MRA)在随访43例病人的45个颅内动脉瘤GDC栓塞后的价值。材料和方法：以数字减影血管造影(DSA)作为诊断的金标准，回顾研究43例病人的45个颅内动脉瘤(前循环34个，后循环11个)MRA检查。所有的病人在GDC栓塞治疗后9个月之内的同一周行DSA和MRA检查，这期间不作处理。分析弹簧圈内残余血流、载瘤动脉和邻近动脉血流，MRA以最大强度投影(MIP)重建和源图像为基础。结果：所有病例中，MRA能提供良好的信息。对于动脉瘤的分析，MRA的敏感性、特征性、阳性预测价值、阴性预测价值，诊断弹簧圈内残余血流分别为87．5％、100％、100％、97％，诊断瘤颈的残余血流分别为90％、100％、100％、97％。对于动脉通畅性分析，MRA的敏感性和阴性预测价值，载瘤动脉分别是90．5％和100％，邻近动脉分别是85．7％和100％。结论：在随访GDC栓塞的动脉瘤中，MRA可以作为一个筛选手段，提高检查效率，减少病人的随访风险。     

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。     

兔颈总动脉创伤性假性动脉瘤微弹簧圈栓塞治疗研究

在24只兔的右侧颈总动脉制作创伤性假性动脉瘤TPA）。术后3－4周存留的16个TPA随机分为对照组、微弹簧圈（MC）瘤腔栓塞组和MC载瘤动脉栓塞组，给予相应的治疗。栓塞治疗后3个月复查，数字减影血管造影（DSA）见MC瘤腔栓塞组TPA完全闭塞，载瘤动脉通畅，局部解剖发现TPA消失。MC载瘤动脉栓塞组TPA亦消失。对照组均于观察过程中死于TPA破裂出血。统计分析显示两组实验均有显著性意义（P＝0．029）。     

自发性孤立性肠系膜上动脉夹层的CT诊断和介入治疗(附6例报道)

目的探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的CT表现及评价介入治疗的安全性和疗效。方法回顾性分析6例(男5例,女1例;症状性5例,无症状性1例,平均年龄52.3岁)SISMAD患者CT及DSA造影表现特征,以及介入治疗方法和术后临床及影像学随访结果。结果 6例患者CT及DSA均清楚显示病灶,横轴面CT、多平面重组(MPR)及曲面重组(CPR)图像均可显示夹层真假双腔、内膜破裂口、假腔内血栓、真腔狭窄程度等,按照Sakamoto血管影像学分型:TypeⅠ型1例、TypeⅡ型1例、TypeⅢ型4例,全部患者均接受介入治疗,其中弹簧圈栓塞1例,支架联合弹簧圈栓塞2例,双支架重叠技术3例,技术成功率100%,无并发症。术后随访3～12个月(平均7个月),5例症状性患者术后3周内症状消失。5例患者术后3～6个月时肠系膜上动脉CTA及血管造影动脉瘤腔均不显影,支架腔内血流通畅、夹层愈合。结论 CT增强扫描及CTA检查能清楚显示SISMAD,可作为本病的首选检查方法;介入治疗SISMAD是一种微创、安全、有效的方法。     

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。     

动脉瘤破裂后经血管止血的实验研究

目的 评价实验性动脉瘤破裂后经血管治疗的可行性。方法 在９只犬颈动脉瘤破裂模型建立后,采用微导管技术放行游离钨弹簧圈动脉瘤腔栓塞。９处动脉瘤共用１６间簧圈。栓塞术后即刻行血管造影检查。栓塞后１周、１个月、６个月分别处死各３只犬并作动脉瘤组织学检查,并在处死前作血管造影。结果 栓塞即刻血管造影示５处动脉瘤完全闭塞,４年动脉瘤部份（〉７０％）闭塞。所有９处动脉瘤栓塞后出血即刻停止。随访血管造影栓塞之动     

犬嫁接性梭形动脉瘤包裹治疗的高频超声评价

目的 分析包裹后动脉瘤的声像图特点和血流动力学情况,探讨高频超声(HFUS)对实验性动脉瘤包裹治疗术的检测价值.方法 将10只犬双侧颈总动脉经HFUS和数字减影血管造影(DSA)检查确定制作成功的20枚梭形动脉瘤模型随机分4组,采用不同的材料进行包裹治疗,其中人造生物膜片5枚、膨体聚四氟乙烯膜片(e-PTFE)5枚、涤纶片5枚、自体颈外静脉(EJV)5枚,于术后1、4、8、12周再次行HFUS和DSA检测,并与包裹前动脉瘤模型结果对照分析.结果 自体EJV包裹动脉瘤形态同动脉瘤模型,瘤腔内径大于载瘤动脉和吻合口内径.涤纶片包裹动脉瘤腔全部闭塞.e-PTFE和人造生物膜片包裹动脉瘤形态相同,二者瘤腔内径与吻合口、载瘤动脉内径接近,与对照组相比二者包裹动脉瘤腔内径均缩小.人造生物膜和e-PTFE包裹动脉瘤腔、吻合口和载瘤动脉血流形态为单一的、延续良好的层流,自体EJV包裹动脉瘤血流形态为涡流;不同材料包裹动脉瘤段的血流速度在不同部位有着不同的变化.结论 人造生物膜片、e-PTFE包裹治疗梭形动脉瘤效果优于自体EJV和涤纶片.HFUS可清晰地显示包裹动脉瘤大小、前后壁、夹层演变过程,以及吻合口、瘤腔、载瘤动脉之血流动力学变化,可作为评价犬颈部梭形动脉瘤包裹治疗效果的有效手段.     

犬颈动脉囊状动脉瘤模型的建立实验研究

目的探讨建立犬颈总动脉囊状动脉瘤模拟人体颅内动脉瘤的可行性。方法采用外科手术方法建立犬颈动脉囊状侧壁动脉瘤模型。结果建立20条健康实验犬颈动脉囊状侧壁动脉瘤模型40枚,血管造影证实动脉瘤与载瘤动脉均通畅者有36枚,4枚动脉瘤腔自发性完全性闭塞,但颈总动脉均保持通畅,模型建立成功率为90.0%。结论犬颈总动脉囊状侧壁动脉瘤是模拟人体颅内动脉瘤的最佳模型之一。     

介入法制作犬颅内动脉瘤模型

目的运用介入方法建立犬颅内动脉分叉部囊状动脉瘤模型。方法6条犬全麻后，采用血管内介入方法，用冠状动脉球囊导管扩张右颈总动脉近段，再用可脱球囊于扩张段远端将其栓塞，制作成6个分叉部动脉瘤。分别于术后1、2、3d行DSA检查并切除动脉瘤做病理组织学检查。结果6条犬成功获得6个动脉瘤模型。动脉瘤的平均宽度和平均长度在3d内逐渐减少。结论犬动脉瘤模型较好地模拟了人颅内动脉瘤大小、形态及DSA表现，可用于介入治疗新材料、新技术的实验研究。本动脉瘤模型的建立快速、可靠、可重复性强。     

囊状动脉瘤血流动力学的DSA、彩色多普勒与病理的实验研究

目的探讨囊状动脉瘤的血流动力学与动脉瘤生长、血栓形成或破裂之间可能的相互关系。方法用“静脉囊镶嵌法”将18只犬制成三种类型（单侧型、分叉型和末梢型）颈总动脉囊状动脉瘤模型。术后2、4周分别进行DSA、彩色多普勒检查，然后将犬处死进行病理观察。结果DSA、彩色多普勒能显示动脉瘤的位置、形态、类型，瘤体内血液循环状态。DSA、彩色多普勒显示动脉瘤的远侧缘、顶部、近侧缘为层流，瘤腔为湍流。三种类型动脉瘤模型既有相同的血流动力学特征，又有各自的特点。第4周时动脉瘤颈部、顶部、瘤内有血栓形成。结论动脉瘤的血流动力学直接影响动脉瘤的生长、血栓形成、破裂。     

MR angiography of aneurysm models of various shapes and neck sizes.

PURPOSETo investigate the signal intensity of lateral and terminal saccular aneurysm models with differing neck sizes using three-dimensional time-of-flight (TOF) MR angiography with various imaging parameters.METHODSThe study included four lateral and four terminal saccular aneurysm models with pulsatile flow. The height and fundus diameter were 10 mm; the neck diameters were 2.5 mm, 5 mm, 7.5 mm, and 10 mm, respectively. Each aneurysm model was examined with fast imaging with steady-state precession MR sequences with parameters of 20-140/7 (repetition time/echo time) and flip angles of 10 degrees to 30 degrees. Signal intensity was measured and compared among the models.RESULTSThree-dimensional TOF MR angiography with the shorter repetition time and/or larger flip angle showed weaker signal intensity in the aneurysm models. Stronger signal intensity was obtained in the terminal saccular aneurysm models and/or the models with a wider neck than in the lateral saccular aneurysm models and/or the models with a narrower neck. In some aneurysm models, longer repetition times produced greater signal intensity than that of background brain models, but not in aneurysms with narrow necks.CONCLUSIONNoncontrast 3-D TOF MR angiography delineated terminal saccular aneurysms and/or aneurysms with wider necks and did not delineate lateral saccular aneurysms and/or aneurysms with narrower necks. Longer repetition times are recommended to allow the spins flowing into the aneurysms to recover.     

Elastase-induced saccular aneurysms in rabbits: comparison of geometric features with those of human aneurysms.

BACKGROUND AND PURPOSE: The development of more effective intracranial aneurysm therapy depends on the ability to test various intravascular occlusion devices and techniques in preclinical animal models. This requires the creation of experimental aneurysms, which, ideally, should mimic the size and geometric features of human intracranial aneurysms. The purpose of this study was to characterize the morphologic features of elastase-induced saccular aneurysms in rabbits to determine whether the morphology of such aneurysms mimics that of human intracranial aneurysms. METHODS: Elastase-induced saccular aneurysms were created in 40 New Zealand white rabbits. Intravenous digital subtraction angiography was performed 14 days after surgery. Relative to an external sizing device, the following dimensions were determined: aneurysm dome (height and width), aneurysm neck diameter, and parent artery diameter. Based on maximal diameter, aneurysms were categorized as small (2.0-4.9 mm), medium-sized (5.0-9.9 mm), or large (10-16 mm), and as narrow-necked (<4.0 mm neck width) or wide-necked (>4.0 mm neck width). Mean dome-neck ratio was calculated and compared with that of human aneurysms. RESULTS: All aneurysm cavities were angiographically patent. Widths of the cavities ranged from 2.5 to 7.1 mm (mean, 4.1 +/- 1.2 mm); heights ranged from 3.0 to 15.6 mm (mean, 8.8 +/- 2.6 mm). Three (7.5%) of 40 aneurysms were small, 20 (50%) were medium-sized, and 17 (42.5%) were large. Twenty-two (55%) of 40 aneurysms were small-necked, and 18 (45%) were wide-necked. Mean dome-neck ratio was 1.13 +/- 0.54. Mean parent artery diameter was 4.3 +/- 1.4 mm. CONCLUSION: Saccular aneurysms of sizes similar to that of human intracranial aneurysms were reliably created using a simple method of vessel ligation and elastase injury. Neck sizes varied with both large and small-necked aneurysms created.     

异物创伤性动脉瘤犬模型构建的初步探讨

目的：建立异物创伤性动脉瘤的犬模型,为伴血管损伤软组织异物一站式介入治疗研究提供动物模型。 方法：随机选取2年龄的健康雄性比格犬7只,分为颈动脉瘤造模5只和未造模2只,造模于右侧颈动脉共5支血管为研究组,其左侧颈动脉及未造模2只犬两侧颈动脉共9支血管为对照组。研究组将长约15~20 mm的离断颈静脉剪开、缝合于同侧颈总动脉前璧上,以弯型断针穿破静脉片及动脉前壁,静脉片-动脉壁间腔搏动性充盈且无缝缘渗漏后,断针部分留存于该间腔甚或动脉腔内,逐层缝合手术区域组织。然后,经皮经股动脉插管选择性颈总动脉进行数字减影血管造影（DSA）。对照组颈动脉仅于其旁以缝针经皮扎伤软组织且无明显出血及血肿。术前、术后行颈部CT血管成像（CTA）和数字放射摄影（DR）检查与评估。 结果：研究组5支右侧颈动脉断针创伤性动脉瘤均成功造模,技术成功率100%;DSA清晰显示动脉破口、动脉瘤状动脉突起及断针异物,载瘤动脉局部轻度痉挛及狭窄,创伤性动脉瘤模型的瘤颈宽度为（2.1±1.3）mm,瘤体宽（9.7±1.1）mm,瘤体高（4.2±1.7）mm;CTA不如DSA显示效果佳。对照组9支颈动脉均正常。 结论：采用颈静脉片侧-侧吻合于同侧颈动脉前壁上并以断针穿破静、动脉壁且断针部分留置于其间的技术与方法,成功构建了异物创伤性动脉瘤犬模型。     

Are the configuration and neck morphology of experimental aneurysms predictable? A technical approach

Aneurysm configuration and neck morphology are important factors in the decision for cerebral aneurysm therapy, i.e., clipping versus coiling. The aim of our study was to create various aneurysm configurations in a predictable and reproducible way in an animal model. In our recently proposed endovascular approach to produce bifurcation aneurysms in the rabbit, the right common carotid artery (CCA) is surgically exposed and distally ligated, and a sheath is advanced retrogradely into the CCA, the base of which is proximally occluded using a Fogarty balloon. Subsequently, elastase is injected via a microcatheter that is placed directly distal to the balloon and allowed to incubate for 20 min. After removal of the sheath, saccular aneurysms begin to form within 2 weeks. For greater variability in aneurysm size and neck morphology, we modified two parameters of this formerly established elastase-induced aneurysm model—the distance between the balloon and sheath and the level of balloon position—before the elastase was endoluminally incubated in 15 rabbits. Three weeks after aneurysm induction, the size and configuration of the aneurysms were controlled using DSA. Our results confirm that balloon occlusion in the brachiocephalic trunk results in broad-based aneurysms, whereas balloon occlusion in the CCA gives rise to circumscribed aneurysm necks. By increasing the distance between the balloon and sheath, the rabbits developed significantly larger aneurysms. The balloon-sheath distance and the level of balloon occlusion proved to be parameters whose modifications result in predictable and reproducible aneurysm variants that can be used for the testing of endovascular devices.     

64层螺旋CT脑血管造影在颅内动脉瘤诊断中的应用

目的:与DSA相对照,探讨64层螺旋CT脑血管造影在颅内动脉瘤中的诊断价值。方法:对29例临床怀疑颅内动脉瘤的患者行64层螺旋CT脑血管造影(CTA)和DSA检查,使用GE64层Lightspeed VCT获得原始图像,所有病例均采用多层面重建(multiplanar reconstruction,MPR)、容积再现(volume rendering,VR)、薄层块最大密度投影(thin-slab maximumintensity projectjon,TS MIP)。后处理图像及DSA图像由2位放射科医生共同评估。结果:29例患者中,DSA证实25例共27个动脉瘤,其中2例为2个动脉瘤。与DSA结果相对照,CTA共检出25例26个动脉瘤,漏诊了1个颈出动脉瘤。CTA清晰显示了动脉瘤的形态、大小及载瘤动脉,3例动脉瘤瘤颈DSA未显示,CTA显示了全部动脉瘤的瘤颈。结论:64层CTA在颅内动脉瘤的诊断中具有极高价值,特别在显示动脉瘤瘤颈方面具有独特的优势,对临床治疗具有指导意义。     

Experimental side-wall aneurysms: a natural history study

We studied the natural history of canine side-wall experimental aneurysms to determine the incidence of spontaneous aneurysm thrombosis, to serve as control data for future studies focusing on development of aneurysm occlusion devices. Bilateral common carotid artery vein patch aneurysms were surgically created in eight mongrel dogs (20–25 kg). Duplex Doppler sonography was performed at 14 days and angiography between 30 and 210 days following aneurysm creation. Sonography demonstrated patency of 13 (81 %) of 16 aneurysms. Patent aneurysms ranged in size from 8 × 10 mm to 14 × 16 mm. Conventional angiography was performed in four dogs approximately 30 days following aneurysm creation; in these four, all of 7 initially patent on sonography remained fully patent. One dog underwent conventional angiography at approximately 60 days following aneurysm creation; both aneurysms in this case remained widely patent. Three dogs underwent conventional angiography at approximately 200 days following aneurysm creation; all 4 aneurysms initially patent on sonography remained fully patent. None of the three aneurysms found to be occluded on sonographs demonstrated spontaneous recanalization. The canine side-wall aneurysm model is a valid tool for testing some aneurysm-occlusion devices, because control aneurysms remain patent indefinitely. Received: 6 May 1998 Accepted: 14 October 1998     

MR angiography and surgery for unruptured familial intracranial aneurysms in persons with a family history of cerebral aneurysms.

OBJECTIVE: We used MR angiography to determine prevalence of unruptured familial intracranial aneurysms in a prepaid medical care program. We compared surgical outcomes and the cost of treating unruptured versus ruptured aneurysms. We compared the cost of MR angiography with the cost of screening mammography and with the cost of surgically treating a ruptured aneurysm. SUBJECTS AND METHODS: During a 30-month period, we performed MR angiography to show cerebral aneurysms in 63 surgical candidates who had one or more first-degree relatives with an aneurysm. Unruptured aneurysms seen on MR angiography were evaluated by digital subtraction angiography (DSA) and treated surgically. RESULTS: MR angiography showed nine unruptured aneurysms in six patients. Eight aneurysms were seen on MR angiography and nine were seen on DSA. Seven unruptured aneurysms were treated surgically. The mean treatment cost was 50% lower for an unruptured aneurysm than that for a ruptured aneurysm. No patient surgically treated for an unruptured aneurysm required rehabilitation, unlike 25% of patients with ruptured aneurysms. The annual total cost of MR angiography was equivalent to 2.9% of the annual cost of screening mammography. The annual cost of MR angiography equaled half the cost of treating one patient after aneurysm rupture. CONCLUSION: MR angiography showed a 9.5% prevalence of unruptured aneurysms among persons who had one or more first-degree relatives with a cerebral aneurysm. DSA confirmed 88% of aneurysms found on MR angiography. Persons with unruptured aneurysms had better treatment outcomes at lower cost than did patients treated for aneurysm rupture. The annual MR angiography cost was low compared with the cost of screening mammography and with the cost of treating one patient with aneurysm rupture.