眼动脉段动脉瘤血管内栓塞治疗方法探讨

目的 探讨颈内动脉眼动脉段动脉瘤血管内栓塞治疗方法及技术要点.方法 回顾性分析2012年5月至2015年4月郑州大学第一附属医院采用血管内栓塞术治疗48例眼动脉段动脉瘤患者影像及临床资料、治疗效果及随访结果,探讨治疗方法及技术要点.结果 48例患者49枚动脉瘤均栓塞成功,其中单纯弹簧圈栓塞17枚(双微导管3枚),球囊辅助栓塞2枚,支架辅助栓塞28枚(Leo支架3枚,Lvis支架5枚,Enterprise支架14枚,Solatire AB支架6枚),Willis覆膜支架隔绝1枚,Pipeline密网支架植入1枚.术后即刻DSA造影显示,Raymond栓塞分级I级34枚(69％),Ⅱ级9枚(18％),Ⅲ级6枚(13％).术中发生支架内血栓形成2例.48例均达到临床治愈,出院时改良Rankin量表(mRS)评分0分44例,1分2例,4分2例(该2例治疗前≥4分);出院后3个月至1年mRS评分0分46例,2分1例,4分1例,均无新发神经功能障碍及出血.20例DSA随访1～21个月,18例痊愈,1例明显好转,1例明显复发,再次手术致密栓塞.结论 血管内栓塞治疗眼动脉段动脉瘤是一种微创、安全有效的方法,选择不同栓塞技巧是保证手术成功、减少术后并发症、提高治愈率的关键.     

支架技术在颅内复杂动脉瘤治疗中的应用

目的探讨支架在颅内复杂动脉瘤中的治疗技术及应用价值。方法回顾性分析应用支架技术辅助栓塞治疗的31例颅内动脉瘤患者（宽颈动脉瘤28例,梭形动脉瘤3例）的临床资料。术中将支架引至动脉瘤处释放支架覆盖动脉瘤颈,并结合弹簧圈栓塞术。结果 31例共置入支架32枚,其中Enterprise支架24枚,LEO支架5枚,Solitaire AB支架3枚。采用单纯支架置入技术2例,此2例微小动脉瘤术后见瘤腔内造影剂滞留。支架结合弹簧圈治疗29例,其中支架先释放技术7例,支架后释放技术22例,支架结合弹簧圈治疗组取得满意疗效。术后即刻栓塞结果按改良的Raymond分级：动脉瘤体完全栓塞20例（Ⅰ级）,瘤颈残留7例（Ⅱ级）,瘤体显影2例（Ⅲ级）。随访1～6个月未发生再出血及缺血并发症。结论支架辅助栓塞技术是治疗颅内动脉瘤安全有效的方法,可提高动脉瘤栓塞的致密程度,采用支架后释放技术使绝大多数颅内复杂动脉瘤的介入治疗成为可能。     

Neuroform3支架在急诊血管内栓塞破裂性颅内宽颈动脉瘤中的应用

目的 评价急诊血管内Neuroform3支架辅助下可解脱弹簧圈栓塞破裂的颅内宽颈动脉瘤的疗效和中期随访.方法 回顾性分析最近18个月急诊介入栓塞治疗的破裂出血性颅内动脉瘤48例,其中26例在72 h内实施Neuroform3支架辅助下弹簧圈栓塞术.其中3例动脉瘤位于大脑前动脉A1段,3例位于大脑中动脉M1和M2段,13例位于后交通,2例位于颈内动脉眼动脉段,2例位于基底动脉顶端,2例位于椎动脉V2和V4段,1例位于小脑后下动脉;3例在第1枚弹簧圈释放后植入支架,1例在第2枚弹簧圈释放后植入支架,2例在第4枚弹簧圈释放后植入支架,10例在第1枚弹簧圈无法在瘤腔内成篮后植入支架,其余10例先植入支架再进行弹簧圈栓塞,所有微导管均通过支架网眼进入动脉瘤.结果 所有病例均成功释放支架(100%),覆盖了瘤颈,同期行弹簧圈填塞动脉瘤.术后即刻造影显示动脉瘤完全栓塞23例(88.5%),次全栓塞3例(11.5%);术中1例支架轻度回撤,无血栓事件和动脉瘤再破裂出血发生,所有患者均恢复良好出院.栓塞术后随访到23例,至少复查1次脑血管造影,最多复查3次;完全致密栓塞14例(60.8%)动脉瘤均末显影,6例瘤颈少许显影病例中3例(11.5%)存在血栓形成,次全栓塞1例(3.3%)瘤体再通,另外2例始终稳定,所有病例载瘤动脉通畅,狭窄2例(7.7%),临床上无任何症状,术后所有患者均无再出血.结论 急症血管内应用Neuroform3支架辅助弹簧圈栓塞破裂出血的颅内宽颈动脉瘤足方便的、安全的和有效的.     

球囊联合支架辅助弹簧圈栓塞颅内分叉部宽颈动脉瘤

目的：分析球囊联合支架辅助弹簧圈栓塞术治疗颅内分叉部宽颈动脉瘤的优势。方法回顾性分析2014年1月至4月昆明医科大学第一附属医院采用球囊联合支架辅助弹簧圈栓塞术治疗20例共25枚颅内分叉部宽颈动脉瘤患者的临床资料。20例患者中曾患蛛网膜下腔出血12例,无出血史8例;25枚颅内分叉部宽颈动脉瘤中位于基部动脉未端分叉部14枚,大脑中动脉分叉部8枚,颈内动脉末端分叉部3枚。根据Raymond分级评价介入治疗术后即刻和3个月后三维DSA检查结果,根据改良Rankin 量表（mRS）评分评价术后3个月临床疗效。结果球囊联合支架辅助弹簧圈栓塞术后即刻三维DSA检查显示25枚颅内分叉部宽颈动脉瘤中RaymondⅠ级21枚,Ⅱ级2枚,Ⅲ级2枚;术后3个月DSA随访显示RaymondⅠ级20枚,Ⅱ级3枚,Ⅲ级2枚。术后3个月mRS评分显示17例患者0分,1例患者1分,均预后良好;2例患者4～6分,预后不良。结论球囊联合支架辅助弹簧圈栓塞术在颅内分叉部宽颈动脉瘤介入治疗术中具有明显优势。     

双容积重建评价脑动脉瘤介入栓塞中的应用价值

目的 评价双容积重建技术在显示脑动脉瘤栓塞程度中的应用价值.方法 采用西门子Artis Zeego数字血管造影系统对17例动脉瘤致密栓塞患者进行旋转DSA造影,然后进行双容积重建.结果 17例患者中,14例患者动脉瘤有对比剂显影,14例患者瘤体内中部的弹簧圈中有对比剂显影,4例瘤体远端有对比剂显影,14例瘤颈处有对比剂显影,阴性3例.结论 在介入手术以及栓塞术后复查的过程中使用双容积重建可以清晰显示出对比剂在弹簧圈中显影的程度以及位置.评价弹簧圈栓塞的效果以及确定后续治疗和手术策略上有着一定的参考价值.     

双源CT双能量冠脉成像对冠脉支架术后的临床价值

目的 探讨双源CT双能量冠脉成像对冠脉支架术后的临床价值.方法 对32例冠心病支架术后患者行双能量扫描,对比分析冠脉支架CT血管成像和选择性冠脉造影检查,将14例临床确诊陈旧性心梗患者进行心肌灌注分析.结果 32例患者置入46枚支架均成功显示,1例患者2枚支架因钙化评价受限.14例确诊为陈旧性心梗的患者均显示不同程度的心肌灌注缺损.结论 双源CT双能量扫描不但能较好的评价冠脉支架植入术后支架情况,还能对心肌灌注改变做出判断.     

高分辨率对比增强锥形束CT在颅内支架成形术后评估中的应用价值

【摘要】目的：探讨高分辨率对比增强锥形束 CT(VasoCT)在评估颅内动脉支架植入术后支架贴壁、内膜增生及支架内血栓情况的应用价值。方法：回顾性搜集2019年11月至2021年10月在昆明医科大学第一附属医院因颅内动脉瘤行支架植入治疗术后3个月复查患者共32例,对比分析三维DSA、常规XperCT、VasoCT及VasoCT结合去金属伪影（MAR）技术对支架植入后支架贴壁、内膜增生及支架内血栓的显示情况,结果由2位神经介入医师对图像质量进行综合量化评分。结果：32例患者共植入34枚支架,单纯Pipline支架植入23例（双支架植入2例）,Pipline支架辅助弹簧圈栓塞动脉瘤患者7例,LVIS及Solitaire支架辅助弹簧圈栓塞各1例。所有患者术后3个月均成功进行随访。VasoCT在评估支架贴壁、内膜增生、支架内血栓等方面优于三维DSA及常规XperCT（P<0.001）。VasoCT结合去金属伪影（MAR）技术可更清晰显示支架与弹簧圈、靶血管的关系。结论：VasoCT能清晰显示颅内支架贴壁、内膜增生及支架内血栓情况;对支架辅助弹簧圈栓塞动脉瘤患者,VasoCT结合MAR技术评估支架情况具有独特优势。     

颈内动脉床突上段微小动脉瘤的血管内治疗和长期随访

目的 评价血管内支架辅助弹簧圈栓塞治疗颈内动脉床突上段宽颈微小动脉瘤的稳定性和有效性.资料与方法 回顾性分析2006至2008年接受支架辅助弹簧圈栓塞治疗的12例患者的临床资料(共14枚动脉瘤).根据血管造影表现,分为完全栓塞、次全栓塞和部分栓塞.术后进行长期随访并搜集造影和临床结果.结果 所有动脉瘤使用弹簧圈均成功填塞.术后即刻造影显示,12例共14枚动脉瘤中,次全栓塞8枚,部分栓塞6枚.3例弹簧圈部分残留于载瘤动脉.未出现弹簧圈移位及血栓形成.12例均经1～2年随访.随访造影显示动脉瘤完全栓塞.临床随访显示所有患者未出现动脉瘤再次破裂出血及神经系统缺血症状.结论 初步结果显示,支架辅助弹簧圈技术栓塞颈内动脉床突上段宽颈微小动脉瘤稳定、有效.长期随访证明次全栓塞者也可发展为完全栓塞.     

椎基动脉夹层动脉瘤支架应用探讨

目的 探讨椎基动脉夹层动脉瘤支架应用的价值.方法 12例椎基夹层动脉瘤,其中椎动脉3例,椎基动脉6例,基底动脉3例.2例动脉瘤位于小脑后下动脉处,各置入2枚支架,重叠在动脉瘤段载瘤动脉内,10例经支架网眼送入弹簧圈.结果 12例置入支架16枚,7例填塞致密,3例疏松填塞,栓塞临床症状消失.6例在术后分别随访6～48个月,脑血管造影复查见动脉瘤消失.但有2例出现新的动脉瘤,1例在置入支架上段出现夹层动脉瘤,再次置入支架和1枚弹簧圈栓塞,动脉瘤消失,1例在原动脉瘤对侧动脉壁出现动脉瘤,再置入1枚支架重叠在原支架内,造影动脉瘤血液循环慢.2例小脑后下动脉夹层动脉瘤,24个月造影复查见动脉瘤缩小70%,小脑后下动脉瘤循环良好.其余4例因无症状不同意复查血管造影,遂行MRA、CTA检查,未见动脉瘤复发.结论 支架辅助弹簧圈治疗椎基夹层动脉瘤是行之有效的方法.     

三维DSA容积重建在颅内小动脉瘤中的诊断价值

目的：评价三维数字减影血管造影（DSA）容积重建在颅内小动脉瘤的诊断价值。方法对129例可疑颅内动脉瘤患者在行弹簧圈栓塞前进行二维DSA和三维容积重建-数字减影血管造影（VR-DSA）检查。结果三维VR-DSA显示105例患者有123枚动脉瘤，24例无动脉瘤。3例患者检测到3枚动脉瘤；12例患者同时检测到2枚动脉瘤；90例患者检测到1枚动脉瘤。所有的动脉瘤的形态在三维VR-DSA上均可清晰显示。二维DSA显示98例患者有110枚动脉瘤，31例无动脉瘤。1例患者检测到3枚动脉瘤；10例患者同时检测到2枚动脉瘤；87例患者检测到1枚动脉瘤。仅65例患者的动脉瘤的形态在二维DSA上可清晰显示。三维VR-DSA发现13例额外动脉瘤，位于颈内动脉（10例，77％），位于前交通动脉（3例，33％）。大脑中动脉与椎基底动脉未发现额外动脉瘤。结论三维容积DSA不仅能清晰显示动脉瘤的大小及形态，而且能检测出二维DSA未检出的动脉瘤，特别是微小动脉瘤。     

Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: a single center experience

Objective

The aim of the present retrospective study is to compare outcome of the endovascular treatment using the Enterprise stent in intracranial wide-necked saccular and dissecting aneurysms.

Methods

Forty-six patients with 50 complex intracranial aneurysms admitted between June 2009 and November 2010 were treated using Enterprise stents. Thirty-one aneurysms were wide-necked saccular, 19 aneurysms dissecting. In 48 cases, aneurysms were occluded by stent-assisted coiling; in 2 cases, by stent alone.

Results

Among the aneurysms treated with the Enterprise stent, patient sex, aneurysm location, hypertension history and the immediate angiographic results differed significantly between the saccular and dissecting aneurysm groups. However, recurrence rate, clinical follow-up outcomes did not differ significantly between the saccular and dissecting groups. There was 1 (2%) procedure-related complication, which caused death in the saccular group. At mean 9.1-month follow-up, the result was good in all dissecting cases and good in 30 saccular cases. There was 1 recurrence in each group.

Conclusions

Enterprise stent is very useful for endovascular embolization of intracranial wide-necked saccular and dissecting aneurysms because it is easy to navigate and place precisely. The overall morbidity and mortality rates were low.     

新型颅内支架Enterprise结合水解脱弹簧圈栓塞治疗颅内微小宽颈动脉瘤

目的总结应用新型颅内支架Enterprise结合水解脱弹簧圈栓塞治疗颅内微小宽颈动脉瘤的技术及疗效。方法6例颅内微小宽颈动脉瘤(直径<3mm,体/颈比<1.5)采用Enterprise支架结合水解脱弹簧圈栓塞,其中5例采用先放置支架覆盖动脉瘤颈再将微导管经支架网孔放入动脉瘤腔填塞弹簧圈进行栓塞,1例将微导管进入瘤腔后再释放支架进行弹簧圈栓塞。术后3～6个月进行临床随访。结果6例全部技术成功,支架均满意到位,载瘤动脉通畅,无手术并发症;动脉瘤完全闭塞4例,闭塞95%以上2例。术后患者均恢复良好,3～6个月临床随访无再出血及脑血栓形成。结论联合使用Enterprise支架和水解弹簧圈栓塞治疗颅内微小宽颈动脉瘤是一种安全有效的方法,但其长期疗效仍需进一步观察。     

A novel self-expanding fully retrievable intracranial stent (SOLO): experience in nine procedures of stent-assisted aneurysm coil occlusion

Introduction The endovascular treatment of large and broad-necked aneurysms may require the use of a remodelling balloon or a stent system to achieve proper occlusion while maintaining the patency of the parent vessel. With the advent of self-expanding stents that can be delivered through a microcatheter, this kind of treatment has improved and problems with the previously used balloon expandable stents have largely been overcome. However, rigidity, insufficient trackability, and limited or non-existent retrievability may still restrict the application of self-expanding stents in some situations. Methods Recently, a stent system with a new and different design has been introduced. This stent is highly flexible, fully retrievable, and can be delivered through a standard 0.021-inch microcatheter without a wire. We describe the first nine cases of stent-assisted coil occlusion of intracranial aneurysms with the use of this stent system. Between May and June of 2004, nine patients with large or broad-necked aneurysms were treated in two endovascular centres. The anatomy of the aneurysms and parent vessels, technical details of the procedure, performance of the stent system, and follow-up results were evaluated. Results In all procedures, the SOLO stent could be introduced without difficulty, in one procedure after positioning of a different self-expanding stent system had failed due to vessel tortuosity. Overlapping stents were placed in one patient and stent retrieval or repositioning was successfully performed in two procedures. There was no interference or limitation of subsequent coil occlusion after stenting. With regard to the stent, immediate postprocedure and follow-up angiograms were unremarkable in terms of thromboembolic events and signs of intimal hyperplasia. Conclusion From our experience, we conclude that the SOLO stent shows satisfactory performance overall. Its unique design gives the stent properties that may help overcome some of the difficulties experienced with other self-expanding intracranial stent systems.     

Neuroform EZ支架治疗颅内动脉瘤安全有效性单中心观察

目的探讨Neuroform EZ支架治疗颅内动脉瘤的安全性和有效性。方法回顾性分析2016年7月至2018年7月解放军总医院第一医学中心采用Neuroform EZ支架辅助栓塞治疗的39例(41枚)颅内动脉瘤患者临床资料。根据术后即刻和复查DSA造影,评价Neuroform EZ支架在辅助动脉瘤栓塞中的安全有效性。结果 41枚动脉瘤中破裂13枚(31.7%),未破裂28枚(68.3%)。共应用Neuroform EZ支架47枚,均准确释放(100%)。其中单枚支架辅助栓塞35枚,双支架辅助栓塞6枚(双支架套叠4枚,Y形支架2枚)。栓塞后即刻mRaymond分级1级19枚(46.3%),2级7枚(17.0%),3a级11个枚(26.8%),3b级4枚(9.6%),其中破裂、未破裂动脉瘤分别为1级10枚(76.9%)、9枚(32.1%)。术中发生血栓事件1枚(2.4%)。术后6个月复查造影显示,mRaymond分级改善13枚,变差2枚,发现载瘤动脉再狭窄1枚(2.4%)。结论 Neuroform ZE支架辅助弹簧圈栓塞颅内动脉瘤安全有效,仍需多中心研究和远期随访验证。     

新型可回撤自膨胀支架在颅内动脉瘤治疗中的应用

目的评价新型可回撤自膨胀支架(LEO)在颅内动脉瘤治疗中的应用价值。方法回顾分析应用LEO支架治疗的43例患者44枚颅内动脉瘤,其中单纯支架治疗16例,支架结合弹簧圈治疗25例,双支架治疗2例,双支架结合弹簧圈治疗1例。并对其进行影像学及临床随访。结果治疗中支架位置调整方便,所有病例支架均成功释放,1例位置欠理想,1例发生急性支架内血栓,随访中1例发生晚期支架内血栓,1例发生内膜过度增生,22枚(50.0%)动脉瘤达即刻致密栓塞,29例获得影像随访的患者中72.4%动脉瘤治愈或较前好转,13.8%动脉瘤稳定,3例夹层动脉瘤发生瘤体短期内增大,2例患者死亡。结论LEO系统具有释放可控性强、简捷安全、可选择型号广泛等优点,在颅内动脉瘤栓塞和管壁重建中有一定优势。     

Dual Stenting Using Low-Profile LEO Baby Stents for the Endovascular Management of Challenging Intracranial Aneurysms

BACKGROUND AND PURPOSE:Endovascular treatment of wide-neck, complex, and distally located cerebral aneurysms is a challenging issue. This study evaluated the safety and efficacy of dual stent placement by using a low-profile stent system (LEO Baby) for the treatment of challenging distal intracranial aneurysms.MATERIALS AND METHODS:We retrospectively reviewed patients in whom at least 1 LEO Baby stent was used in the context of dual stent placement for the treatment of intracranial aneurysms. Patients who were treated with dual stent-assisted coil embolization and telescopic implantation of LEO Baby stents were included in the study. Clinical and angiographic findings, procedural data, and follow-up are reported.RESULTS:Twelve patients were included in this study. Three patients presented with subarachnoid hemorrhage in the subacute-chronic phase, and the remaining patients had unruptured aneurysms. Nine patients were treated by using the dual stent-assisted coiling method. X- (nonintersecting), Y- (intersecting and reversible), T-, and parallel-stent configurations were performed for the dual stent-assisted coiling procedures. Three patients were treated by using telescopic stent placement for a flow diverter–like effect. The procedures were successful in all cases. Technical complications without a significant clinical adverse event developed in 2 patients. The 3- and 6-month control MRAs and DSAs demonstrated complete occlusion of the aneurysms in all patients except 1. All patients had good clinical outcomes on follow-up (mRS ≤1).CONCLUSIONS:The results of this small study showed the feasibility of dual stent placement by using low-profile LEO Baby stents to treat distally located complex intracranial aneurysms.

Coiling of intracranial aneurysms is safe and effective, but endovascular treatment of wide-neck and anatomically complex aneurysms remains challenging.¹ Self-expandable intracranial stents have been used in the past decade to achieve successful and durable coil embolizations of these aneurysms.^2–4 The placement of a stent bridging the ostium of a wide-neck aneurysm creates a scaffold, which prevents the protrusion or herniation of coils into the parent artery and results in denser coil packing. In addition to the mechanical effect, intracranial stents have hemodynamic and biologic effects.^5–8 Stent deployment across the orifice of an aneurysm is thought to redirect blood flow from the sac of the aneurysm toward the distal parent artery and decrease the hemodynamic stress that contributes to thrombosis of the aneurysmal sac.⁹ Furthermore, stent-induced neointimal overgrowth leads to the healing of the neck of the aneurysm.¹⁰ On the basis of these effects, stent monotherapy has been proposed as an alternative strategy for the endovascular treatment of uncoilable and complex intracranial aneurysms.^9–11 The telescopic placement of self-expandable intracranial stents can adequately divert the blood flow, especially for the treatment of blisterlike aneurysms.¹²Recently, low-profile, self-expandable, braided intracranial stents (LEO Baby [Balt, Montmorency, France] and LVIS Jr. [MicroVention, Tustin, California]) have been available for the endovascular treatment of complex and/or distal aneurysms.^13,14 These low-profile intracranial stents can be deployed into arteries with diameters of <3.5 mm and delivered through microcatheters with an internal diameter of 0.0165 inches, which allows easier navigation in small-sized, delicate vessels.A single stent may not suffice for the endovascular treatment of wide-neck and geometrically complex bifurcation aneurysms with involvement of 1 or both side branches. Endovascular treatment of these complex aneurysms often necessitates the implantation of 2 stents (ie, dual stent placement) in various configurations, such as Y-, X-, or parallel configurations.^14–16This retrospective study evaluated the safety and efficacy of dual stent placement by using a low-profile stent system (LEO Baby) for the treatment of challenging intracranial aneurysms.     

Enterprise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤的临床研究

目的初步探讨和总结应用EnterPrise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤的技术及疗效。方法收治8例前交通宽颈动脉瘤(体/颈比<1.5)患者,均采用Enterprise支架辅助水解脱弹簧圈栓塞,其中6例先放置支架覆盖动脉瘤颈再将微导管经支架网孔放入动脉瘤腔填塞弹簧圈进行栓塞,2例在微导管进入瘤腔后再释放支架进行弹簧圈栓塞。术后6～12个月进行临床和DSA随访。结果 8例全部技术成功,支架到位满意,载瘤动脉通畅,无手术并发症;其中动脉瘤完全闭塞7例,闭塞95%以上1例,患者术后均恢复良好,临床随访6～12个月无再出血及脑血栓形成,其中DSA随访6例无支架狭窄及动脉瘤再通。结论 Enterprise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤是一种安全、可靠、有效的治疗方法,但其长期疗效仍需进一步观察。     

Stent conformity in curved vascular models with simulated aneurysm necks using flat-panel CT: an in vitro study

BACKGROUND AND PURPOSE: Radiographic visibility of self-expandable intracranial stents is insufficient for assessment of conformability and deployment characteristics. The purpose of this study was to evaluate stent mechanics in a curved vessel model by using Flat-Panel CT (FPCT). MATERIALS AND METHODS: The following stents were used: Neuroform 2, Neuroform Treo, Enterprise, and LEO. All stents were bent in the same polytetrafluoroethylene tubes with various angles ranging from 150 degrees to 30 degrees . To visualize potential prolapse of the stent struts, 4-, 5-, and 8-mm openings were created. FPCTs were obtained using a C-arm with flat detector. RESULTS: FPCT scans provided excellent visualization of deployment characteristics and stent mechanics and was superior to digital subtraction angiography (DSA) and digital radiography (DR). The Neuroform2/Treo showed, with increasing angle and diameter of the opening, a continuous increase in cell size. These stents also showed an outward prolapse at the convexity and an inwards prolapse of struts at the concavity of the curvature. The Enterprise showed an increasing trend to flatten and to kink with curvatures that are more acute. The LEO showed fewer trends to kink but an inward crimping of its ends with more acute angles. CONCLUSIONS: Deployment characteristics and conformability to a curved vessel model vary considerably, depending on the angle and the stent design. Adverse mechanics such as increased cell opening, strut prolapse, flattening, and kinking occur during stent placement in a curved vessel model, and may gain clinical importance. FPCT is superior to DSA and DR in visualizing small metallic stents and enables accurate detection of adverse stent mechanics.     

椎基底动脉夹层瘤的影像学特征和介入治疗策略

目的　总结椎基底动脉夹层瘤的影像诊断和介入治疗经验。方法　收治临床表现为蛛网膜下腔出血 ,小脑梗死或基底动脉供血不足的椎基底动脉夹层患者 4 8例 ,全部病人进行DSA ,部分作CTA或MRA。 4例患者行单纯口服抗凝治疗 ,6例行血管内孤立治疗 ,4例行单纯血管内支架植入治疗(其中 2例行双支架植入 ) ,34例行支架植入加弹簧圈栓塞治疗。结果　无患者出现严重并发症或再次出血 ,椎基底动脉供血不足者临床症状明显改善 ,无手术死亡病例。结论　椎基底动脉夹层瘤好发于椎动脉PICA上段 ,内膜剥脱造成的血管内充盈缺损、血管狭窄和膨大相混杂呈串珠状或血管线样狭窄、偏心性动脉瘤为椎基底动脉的主要影像学特征。治疗策略应根据临床症状、夹层瘤的部位、形态及其与周围分支的关系而确定。对影像表现为血管轻度狭窄的缺血性颅内外夹层瘤可行药物抗凝治疗 ;对狭窄较重 ,尤其是累及基底动脉者可行支架植入。对出血的颅内夹层瘤均应手术治疗 :非供血主干侧PICA上段或PICA下段夹层瘤可行血管内隔绝 ;与PICA或前脊髓动脉毗邻者行支架植入加弹簧圈栓塞 ;累及PICA或前脊髓动脉者行近端闭塞 ,支架植入或外科手术治疗。优势供血侧或侧支循环不足的椎基底动脉夹层瘤应作支架植入加弹簧圈栓塞治疗。随着支架性能的不断改进