Using Onyx in endovascular embolization of internal carotid artery large or giant aneurysms

Background and purpose

Internal carotid artery (ICA) large or giant saccular aneurysms is challenging for endovascular coil embolization and surgical clipping with a high recanalization and rebleeding rate. We report our results using Onyx in the endovascular treatment of ICA large or giant saccular aneurysms.

Methods

During 2008–2010, 5 patients with 5 large or giant saccular aneurysms in ICA were treated with a liquid embolic agent (Onyx; Micro Therapeutics, Irvine, CA). One aneurysm was small (<10 mm), 2 were large (≥10 mm, <25 mm) and 2 were giant saccular aneurysms (≥25 mm). Of 3 female and 2 male patients, 3 were incidental and 2 had bleeding. Selective embolization was performed with Onyx alone or a combination with coils. Clinical and anatomic outcomes were assessed with the Modified Glasgow Outcome Scale and follow-up angiography was performed at 4–21 months (mean 12.2 months).

Results

Complete aneurysm occlusion was obtained in all of the aneurysms on immediate control angiogram. There was not any procedure-related complication. No recanalization was observed at the follow- up periods. There were 2 ICA occlusions in giant ICA aneurysms. The 5 patients were all clinically asymptomatic at follow-up.

Conclusion

Endovascular embolization with Onyx is a useful treatment for ICA large or giant aneurysms, which is unsuitable for coiling or surgical treatment.     

Three-dimensional packing with complex orbit coils for the endovascular treatment of intracranial aneurysms

BACKGROUND AND PURPOSE: Endovascular treatment of intracranial aneurysms is too often associated with aneurysm recurrence due to coil compaction. High packing of coils prevents compaction. To increase the packing attenuation, we sought to evaluate the results of selective embolization of aneurysms with complex-shaped coils alone. METHODS: Twenty consecutive patients with an intracranial aneurysm were treated by selective embolization. There were 12 women and eight men, with a mean age of 48 years. Fourteen patients presented with subarachnoid hemorrhage, whereas six were asymptomatic. Mean size of aneurysms was 5 mm (range, 3-11 mm). In all cases, we tried to pack the aneurysm with complex coils only (Orbit, Cordis, Miami Lakes, FL), delivered in a concentric fashion. Remodeling technique was used in two cases of wide-neck aneurysms. Clinical and anatomic outcome were assessed by using the modified Glasgow outcome scale and 6-month MR angiography (MRA). RESULTS: From two to five complex coils were delivered within the aneurysms. Occlusion by using complex coils alone was successful in 16 patients, and resulted in 14 complete occlusions and two neck remnants. In four patients, additional helical Orbit coils or Guglielmi detachable coils were required to complete aneurysm obliteration. No technical complication occurred, and clinical outcome was excellent in 14 cases and good in two. Follow-up MRAs were obtained in all patients and showed only one slight recanalization. CONCLUSIONS: Intracranial aneurysms may be treated by selective embolization with complex coils only. Imaging follow-up at 6 months shows a low rate of coil compaction.     

Short-term outcome of intracranial aneurysms treated with polyglycolic acid/lactide copolymer-coated coils compared to historical controls treated with bare platinum coils: a single-center experience

BACKGROUND AND PURPOSE: Aneurysm recanalization is an innate problem in endovascular treatment of aneurysms with coils. A coated coil system, covered with a bioabsorbable polymeric material (polyglycolic acid/lactide copolymer, PGLA), was developed to accelerate intra-aneurysmal clot organization and fibrosis. The purpose of this study was to evaluate the efficacy and safety of the PGLA-coated coils in patients with intracranial aneurysms and to compare the outcome with that of bare platinum coils. PATIENTS AND TECHNIQUES: Fifty-one patients harboring 56 intracranial aneurysms underwent endovascular embolization with the PGLA-coated coils. In the control group were 78 consecutive patients, harboring 87 aneurysms, who underwent coil embolization with bare platinum coils. The authors compared coil volume, packing attenuation, degree of occlusion of aneurysms, procedure-related complications, and follow-up results between the 2 groups. RESULTS: The PGLA-coil group showed comparable data regarding rate of total or near-total occlusion of the aneurysm, incidence procedure-related thromboembolism, and management outcome. Mean coil volume deployed and packing attenuation of the PGLA-coil group were significantly higher than those of the bare-coil group (P = .0026 and P < .0001, respectively). Radiologic follow-up evaluation revealed recanalization in 14 of 39 aneurysms (major recanalization in 5 [13%] and minor recanalization in 9 [23%]) among the PGLA-coil group and in 29 of 64 aneurysms (major recanalization in 9 [14%] and minor recanalization in 20 [31%]) among the bare-coil group. CONCLUSION: In this study, the incidence of recanalization was not different in aneurysms treated with PGLA-coated coils compared with historical controls treated with bare platinum coils.     

Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience

We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.     

Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability

INTRODUCTION: The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up. MATERIALS AND METHODS: Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with (<10 mm) small neck (<4 mm) (SASN); 55 were small with wide neck (>/=4 mm) (SAWN); six were large (10-25 mm) (L); and one was giant (G) (>25 mm). The embolization technique was the same with that in standard bare coiling. RESULTS: Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively. CONCLUSIONS: Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial.     

Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents

INTRODUCTION: We report our experience with endovascular treatment (EVT) of circumferential and fusiform intracranial aneurysms by a reconstructive approach with self-expandable stents. METHODS: A retrospective review of our prospectively maintained database identified all circumferential and fusiform aneurysms treated by a reconstructive endovascular approach over a 3-year period. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS: From April 2004 to May 2007, 13 patients were identified, of whom 12 were asymptomatic and 1 presented with a subarachnoid hemorrhage. Two patients with an aneurysm 相似文献   

Single-center experience with TruFill platinum coils for the embolization of cerebral aneurysms

Endovascular coiling has become a powerful alternative to neurosurgical clipping of cerebral aneurysms. Apart from the Guglielmi Detachable Coil (GDC) (Boston Scientific, Galway, Ireland), there is limited published data about the newer generation of detachable platinum coils, e.g., TruFill (Cordis, Johnson and Johnson, Miami, Fl.). We report our initial clinical experience with the embolization of aneurysms by TruFill coils. Included in this retrospective study were 26 patients (age 55.4±14.5 years; 9 male, 17 female) with 28 aneurysms, 21 ruptured and 7 unruptured. All patients were treated exclusively by embolization with TruFill platinum coils. Immediate angiographic and 6-month angiographic follow-up results were documented. Acute clinical outcome was recorded. Of the 28 aneurysms, 16 (57%) were completely occluded by TruFill embolization, 11 (39%) were incompletely occluded with residual necks, and 1 (4%) was partially occluded as residual aneurysm. There were no aneurysmal ruptures during the procedures. Follow-up at 6 months after the procedure was available in 18 patients and 19 aneurysms. Of the 19 aneurysms, 2 of 12 initially completely occluded aneurysms (17%) and 1 of 7 aneurysms with initial residual necks (14%) showed recanalization at the 6-month follow-up. One recanalized aneurysm was subsequently recoiled with consequent residual neck and remained unchanged at the 1-year follow-up. Embolization by TruFill platinum coils has a comparable total aneurysmal occlusion rate to that with GDC. The mid-term reintervention rate is low, and will require verification by future long-term studies.     

Treatment and follow-up of 22 unruptured wide-necked intracranial aneurysms of the internal carotid artery with Onyx HD 500

BACKGROUND AND PURPOSE: The purpose of this study was to demonstrate endovascular treatment of wide-necked aneurysms of the internal carotid artery with the liquid embolic agent Onyx HD 500. METHODS: Twenty-two wide-necked, large or giant aneurysms of the internal carotid artery (ICA) were treated in 22 patients with Onyx HD 500 (15 ophthalmic, 1 clinoid, and 6 cavernous aneurysms). Sixteen patients were asymptomatic, and mass effect of the aneuryms caused cranial nerve palsy in 6. Seven aneurysms showed regrowth after prior endovascular coiling. RESULTS: Postinterventional angiography demonstrated total occlusion in 18 aneurysms, and a small remnant was left in 4. Clinical and angiographic follow-up data are available in 19 patients (average follow-up, 13 months; range, 5-36 months). Total occlusion was demonstrated in 17 aneurysms (91%), and a partial recanalization was seen in 2. There were 2 ICA occlusions and 1 ICA stenosis. Clinical follow-up demonstrated a transient ischemic attack in 1 patient; 2 with cranial nerve palsy were unchanged, and 2 showed improved symptoms compared with the findings before treatment. The remaining 14 patients were clinically asymptomatic. There was no permanent severe morbidity and no mortality at follow-up. CONCLUSION: The endovascular treatment of wide-necked, large or giant ICA aneurysms with Onyx HD 500 is a treatment option in these selected cases. The benefit is a primary high and stable occlusion rate and good clinical outcome. ICA occlusion caused by Onyx migration in the parent artery is a typical problem, with a benign clinical course in this series.     

保留载瘤动脉的大型眼动脉动脉瘤的栓塞治疗

目的：探讨颈内动脉眼动脉段大型动脉瘤的栓塞治疗。方法：采用电解可脱式弹簧圈（GDC）栓塞治疗3例，支架植入联合GDC栓塞5例。结果：GDC栓塞治疗3例获得致密栓塞1例、大部栓塞2例；支架植入联合GDC栓塞治疗5例获得致密栓塞4例、大部栓塞1例。结论：采用支架植入联合GDC栓塞治疗为提高大型眼动脉动脉瘤的致密栓塞率及保留载瘤动脉提供了新的手段。     

Guglielmi detachable coil embolization for unruptured aneurysms in nonsurgical candidates: a cost-effectiveness exploration.

PURPOSEWe calculated the incremental cost-utility ratio for Guglielmi detachable coil (GDC) embolization versus no therapy for unruptured intracranial aneurysms considered inappropriate for surgical clipping procedures.METHODSDecision tree and Markov analyses that employ cohort simulation were applied to determine the incremental cost-utility ratio of GDC embolization versus no therapy for unruptured cerebral aneurysms. Clinical values required as input data were estimated from the literature for the following variables: relative frequencies of complete aneurysmal occlusion, partial aneurysmal occlusion, and attempted coiling (no coils detached); morbidity and mortality of GDC embolization; frequency, morbidity, and mortality of spontaneous aneurysmal rupture in untreated and GDC-embolized aneurysms; annual rate of recanalization of GDC-embolized aneurysms; quality of life when knowingly living with untreated or GDG-embolized aneurysms and of living with fixed neurologic deficit; costs of GDC embolization, spontaneous aneurysmal rupture, stroke, and rehabilitation; and discount rate. Cost-utility ratios below $50000 per quality-adjusted life year saved were considered acceptable. Sensitivity analyses were performed for all relevant input variables.RESULTSBaseline input values resulted in acceptable cost-utility ratios for GDC embolization of unruptured intracranial aneurysms. These ratios remained within acceptable limits across wide ranges of various input parameters. Cost-effectiveness was markedly affected by the natural course of unruptured, untreated aneurysms; rates of spontaneous rupture greater than 2% per year resulted in favorable cost-utility ratios that were relatively unaffected by variation in GDC efficacy, while rates of rupture less than 1% per year resulted in unfavorable ratios that were highly dependent on GDC efficacy. Many of the GDC efficacy indexes, such as rate of failed coiling, early recanalization, and progressive aneurysmal thrombosis, have mild effects on the cost-utility ratios. GDC complication rate as well as life expectancy had moderate effects on the analysis. The influence of late aneurysmal recanalization was mild unless high rates of rupture for partially coiled aneurysms were applied. Suboptimal clip placement resulting from the presence of GDC coils within a ruptured aneurysm had no demonstrable consequence on cost-utility ratios.CONCLUSIONSThe single most influential variable determining the cost-effectiveness of GDC embolization in our analysis was the natural course of untreated aneurysms. Other important variables included GDC-related morbidity and life expectancy at the time of GDC embolization.     

Endovascular treatment of basilar and ICA termination aneurysms: effects of the use of HydroCoils on treatment stability in a subgroup of patients prone to a higher recurrence rate

PURPOSE: The aim of this study was to evaluate the stability of occlusion of terminal bifurcation aneurysms after embolization with hydrogel-coated coils. METHODS: Of 35 bifurcation aneurysms, 34 were treated with hydrogel-coated coils in combination with platinum coils, and 1 was treated with hydrogel-coated coils only. Aneurysms were located at the basilar tip in 17 patients, and the internal carotid artery (ICA) bifurcation in 18 patients. The patient population consisted of 20 women and 15 men with ages ranging from 21 to 65 years. The aneurysm was found in 16 patients on presentation for subarachnoid hemorrhage, and in 19 patients the finding was incidental. Of the 35 aneurysms, 25 were small, 9 were large and 1 was giant. The giant aneurysm was located at the basilar tip and showed partial thrombosis. All except two basilar tip aneurysms were treated with balloon assistance. The remaining two basilar tip aneurysms were embolized with the assistance of an aneurysmal neck bridge device. RESULTS: The mean percentage occluded aneurysm volume for all devices was in the range 34-100%. Follow-up angiograms were obtained at 1 year in 6 patients, 2 years in 11 patients, and 3 years in 18 patients. Angiograms obtained immediately after embolization demonstrated a Raymond class 1 occlusion in 29 patients (82.9%) and a Raymond class 2 occlusion in 6 patients (17.1%). In four of these six patients follow-up angiograms demonstrated regrowth with resultant Raymond class 3 occlusion. In the other two patients, Raymond class 2 occlusion remained stable on follow-up angiograms. In patients who had a Raymond class 1 occlusion on the angiogram obtained immediately after embolization, no regrowth was seen on the follow-up angiograms. The overall recanalization rate was 11.4% (three large, one giant) at 6 months. Retreatment was not considered in three of these patients and they were to be followed; the other patient was retreated. CONCLUSION: Our initial procedural data demonstrate that higher volumetric occlusion was achieved with hydrogel-coated coils and the long-term follow-up results showed a favorably low recanalization rates among the terminal bifurcation aneurysms.     

Endovascular treatment of scalp arteriovenous fistulas associated with a large varix

Ten patients with scalp arteriovenous fistulas associated with a large varix (cirsoid aneurysms) were treated with a combination of interventional neuroradiologic procedures. These procedures included transarterial embolization, transarterial embolization followed by surgical excision, and two new methods of treatment of cirsoid aneurysms: transvenous embolization and direct puncture of the fistula for embolization. The embolic materials included liquid adhesive agents, particulate agents, detachable balloons, and wire coils. The embolization was performed to lodge the embolic agents in the fistula or proximal draining vein, not just the feeding vessels. Surgery was performed in two cases to remove a small residual nidus of fistula that could not be completely treated with intravascular embolization. With the use of these forms of treatment, cures were obtained in seven patients, and clinical and angiographic improvement was achieved in three patients. No major morbidity, blood loss, or mortality occurred during the treatment of these patients. The follow-up period ranged from 1 month to 8 years.     

Follow-up of intracranial aneurysms treated with matrix detachable coils: a single-center experience

BACKGROUND AND PURPOSE: Matrix coils are polymer-coated bioactive coils used in treatment of intracranial aneurysms. The current study is aimed at evaluating the efficacy and safety of these coils in treatment of ruptured and unruptured aneurysms. METHODS: Seventy-seven consecutive patients with 84 aneurysms were included in the study. Forty-six aneurysms were treated with Matrix coils alone, and 38 were treated with Matrix coils in combination with other coils/devices. Angiographic follow-up was available in 64 patients with 70 aneurysms. Length of follow-up ranged from 6 to 28 months with mean of 10 months. Both postembolization and follow-up angiograms were graded on a 3-point Raymond scale. Aneurysms were classified as stable, improved, or recanalized based on the follow-up angiograms. Recanalization was considered major if it was saccular and its size would theoretically permit retreatment with coils. RESULTS: At the end of the initial procedure, 47 (56.0%) aneurysms showed complete occlusion (Raymond 1), 20 (23.8%) showed contrast filling the neck of the aneurysm (Raymond 2), and 16 (19.0%) showed contrast filling the sac of the aneurysm (Raymond 3). Of the 70 aneurysms in which follow-up angiograms were available, 55.7% remained stable in appearance, 20.0% showed improved occlusion, and 24.3% demonstrated recanalization; 8.6% demonstrated major recanalization. There were 2 aneurysm rebleeds (both incompletely packed); one resulted in death. CONCLUSION: Matrix coils are safe to use and the recanalization rate of aneurysms treated with these coils appears to be at least comparable with historical studies with Guglielmi detachable coils.     

Endovascular coiling of intracranial aneurysms using bioactive coils: a single-center study

BACKGROUND: Some degree of recanalization is reported in up to one-third of intracranial aneurysms treated with endovascular coiling. A technical development potentially effective in avoiding recanalization is the Matrix Detachable Coil (MDC), which is covered with a biodegradable polymeric material that enhances intra-aneurysmal clot organization and fibrosis. Purpose: To report the initial clinical experience of MDC for endovascular aneurysm coiling in a single-center, single-operator, and well-defined population setting. MATERIAL AND METHODS: 118 aneurysms in 104 patients (73 with subarachnoid hemorrhage, SAH) were embolized with MDC alone (n = 52) or combined with bare platinum coils (n = 66). RESULTS: Initial aneurysm obliteration was class 1 (complete obliteration) in 45 aneurysms (38.1%), class 2 (residual neck) in 44 (37.3%), and class 3 (residual aneurysm) in 29 (24.6%). Procedure-related morbidity was 4.8%, and mortality 0.96%. Clinical follow-up of 61 patients with SAH (mean 5.9 months, range 1-17 months) showed good outcome (Glasgow Outcome Scale, GOS 4-5) in 39 (63.9%), and poor outcome or death (GOS 1-3) in 22 (36.1%). Imaging follow-up of 73 aneurysms (average 6.5 months, range 1-17 months) showed class 1 in 47 (64.4%), class 2 in 18 (24.7%), and class 3 in eight (10.9%). Recanalization occurred in 11 aneurysms (15%), of which four (5.5%) required re-treatment. CONCLUSION: This study confirms that aneurysm coiling with MDC is feasible, effective, and safe.     

支架辅助弹簧圈介入栓塞颅内宽颈动脉瘤

目的探讨支架辅助弹簧圈介入栓塞治疗颅内宽颈动脉瘤的方法和疗效。方法回顾性分析16例患者的临床资料,应用支架包括Neuroform 6枚和Fnterprise 10枚。结果所有支架均成功释放并行弹簧圈栓塞,即刻造影动脉瘤获得完全及大部分栓塞13例,瘤颈残留1例,部分栓塞2例.14例患者术后3～12个月复查,13例完全及大部分栓塞中11例复查未见复发,瘤颈残留1例6个月后复查复发,再次行支架植入完全栓塞.部分栓塞2例复查时瘤腔消失。结论通过支架辅助对宽颈动脉瘤瘤颈重塑及弹簧圈的介入栓塞作用,使动脉瘤栓塞疗效满意。     

The retrograde approach: a consideration for the endovascular treatment of aneurysms

BACKGROUND AND PURPOSE: The traditional endovascular approach to a cerebral aneurysm is anterograde, with the embolization and balloon protection catheters introduced via the parent vessel. Unfortunately, this approach may be restrictive, because these catheters cannot always be navigated at an optimal angle into the arterial branch that needs balloon protection or the part of the aneurysm that needs coiling. The purpose of this study was to determine the efficacy of a retrograde approach. METHODS: Twelve patients, seven women and five men, 28 to 65 years old (mean age, 45 years), were treated via the retrograde approach between March 1998 and February 1999. Three patients were treated for acutely ruptured aneurysms following subarachnoid hemorrhage. The rest had asymptomatic, unruptured aneurysms. RESULTS: We were able to accomplish endovascular treatment in 10 cases. In the other two, the attempted retrograde route of access could not be achieved. The treatment afforded complete embolization in nine of the 10 patients. Symptomatic distal clot embolization occurred in one patient who had some residual, albeit improving, deficits at discharge. No other patients worsened with the treatment. There were two intraprocedural aneurysmal ruptures. None of the aneurysms restudied within 6 months (eight of 12) showed evidence of recanalization. CONCLUSION: Our results indicate that it is possible to safely and effectively access a cerebral aneurysm via a retrograde approach. We believe that the anatomic benefits afforded by this technique outweigh the potential risks associated with the catheterization of another major cerebral arterial feeder.     

Management of inferior pancreaticoduodenal artery aneurysms: A 4-year,single center experience

Inferior pancreaticoduodenal artery aneurysms are uncommon visceral artery aneurysms usually difficult to resect, and, if untreated, have a propensity to rupture with catastrophic results. We reviewed the clinical and treatment records of four patients encountered in our institution within the last 4 years. Three patients presented as bleeding emergencies from single aneurysms and were successfully treated by transcatheter embolization using coaxial technique and a variety of embolic agents. One nonemergent, asymptomatic patient had surgical resection of two inferior pancreaticoduodenal artery aneurysms due to unfavorable anatomy for embolization. Embolization therapy appears to be the treatment of choice in the emergency setting. Patients with unsuitable anatomy for embolization may still re quire surgical intervention.     

Endovascular treatment of intracranial aneurysms with a branch arising from the sac

BACKGROUND AND PURPOSE: The endovascular treatment (EVT) of intracranial aneurysms is no more limited by the presence of a branch at the neck or by the neck width. Saccular aneurysms with a branch arising from the sac, however, are mostly candidates for surgery rather than embolization. We prospectively evaluated the feasibility and safety of the EVT in such cases. METHODS: Between May and November 2004, 9 consecutive patients with a saccular aneurysm that presents a branch arising from the sac were treated by embolization. There were 7 women and 2 men (mean age, 58 years). Six patients presented with a subarachnoid hemorrhage (SAH), and 3 were asymptomatic. All patients were treated by selective coiling with (n = 6) or without (n = 3) the remodeling technique. Clinical outcome was assessed with a modified Glasgow Outcome Scale at 3 months. RESULTS: EVT was successfully performed in all patients and resulted in 7 excellent outcomes and 2 deaths related to SAH complications. The arterial branch could be preserved in 7 cases and intentionally occluded in 2. Neither embolic nor ischemic complication occurred in the vascular territory of the involved branch. Angiographic results showed 5 neck remnants, 2 incomplete occlusions, and 2 complete occlusions. No rebleeding occurred. CONCLUSION: Our study, though limited by its small patient population, suggests that saccular intracranial aneurysms with a branch arising from the sac may be treated by endovascular approach with excellent clinical results; however, larger series with long-term follow-up are mandatory to confirm these preliminary results mostly in terms of anatomic stability.     

经血管治疗颅内动脉瘤：可脱性弹簧（GDC）的临床应用

目的：评价可脱性弹簧（ＧＤＣ）栓塞颅内动脉瘤的临床效果。材料和方法：对３２例临床表现为急性蛛网膜下腔出血、颅内占位、颅神经压迫、癫痫，并经影像学证实的颅内动脉瘤患者，经血管途径用ＧＤＣ栓塞动脉瘤腔，分别在栓塞后当时，１周，３个月，６个月，１２个月后随访血管造影，观察栓塞效果和临床情况。结果：３２只动脉瘤中，获完全栓塞１８例（５６％）．部分栓塞１２例（３８％）．２例手术失败（４％）。手术并发症７例，其中４例脑内动脉血栓，１例动脉瘤破裂，２例术后５天死亡。２例部分栓塞患者术后６个月随访血管造影示残留腔扩大行第二次栓塞。存在临床症状的所有患者经治疗后临床症状改善。结论：ＧＤＣ可控性好，可靠性、安全性强，是目前经血管治疗颅内动脉瘤的较为成熟的材料。     

Onyx联合支架辅助弹簧圈治疗复杂性颅内破裂动脉瘤

目的 探讨应用Onyx联合支架辅助弹簧圈治疗颅内复杂破裂动脉瘤的可行性和疗效.方法 回顾性分析2例应用Onyx联合支架辅助弹簧圈技术方法,进行治疗的颅内复杂破裂动脉瘤.并对Onyx栓塞治疗颅内动脉瘤相关文献进行回顾.结果 应用该技术栓塞治疗2例复杂性颅内动脉瘤(1例为右侧颈内动脉分叉部动脉瘤,1例为颈内动脉前壁复发动脉...