颈内动脉眼动脉段动脉瘤血管内治疗进展

目前对于脑动脉瘤的介入治疗进展迅速,但颈内动脉眼动脉段动脉瘤的治疗仍是目前的治疗难点之一。本文就介入治疗颈内动脉眼动脉段动脉瘤的技术现状与进展进行综述。     

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。     

颈内动脉眼动脉段动脉瘤的血管内治疗

目的 探讨颈内动脉眼动脉段动脉瘤血管内治疗的疗效。方法 回顾性分析2012年9月至2017年11月宁夏医科大学总医院神经外科应用血管内栓塞治疗的36例颈内动脉眼动脉段动脉瘤的临床资料。结果 36例共44枚动脉瘤,其中采用单纯弹簧圈栓塞10枚,LVIS支架辅助栓塞13枚,Enterprise支架辅助栓塞19枚,Neuroform支架辅助栓塞2枚。术后即刻DSA显示Roymond分级Ⅰ级22枚,Ⅱ 级20枚,Ⅲ级2枚;栓塞有效率为95.5%。2例栓塞术中发生血栓事件,2例术中动脉瘤破裂,1例术后动脉瘤2次破裂。术后随访4~19个月,改良Rankin量表评分0~2分32例,3~6分4例。30例（34枚）DSA复查,6枚复发。结论 血管内栓塞治疗颈内动脉眼动脉段动脉瘤安全有效,积极预防及治疗并发症可改善预后,但需长期随访观察复发情况。     

颈内动脉眼动脉段动脉瘤手术治疗分析

目的 探讨颈内动脉眼动脉段动脉瘤（OSAs）的手术治疗方法及其疗效。方法 回顾性分析2005年8月至2015年12月年收治的88例OSAs的临床资料。88例共109枚动脉瘤。无眼部症状的48例69枚小型动脉瘤中,支架辅助弹簧圈栓塞49枚,单纯弹簧圈栓塞20枚;无眼部症状的17例单发大型或巨大动脉瘤中,球囊辅助栓塞2例,支架辅助栓塞13例,球囊联合支架辅助栓塞2例;合并视力障碍的23例（均为单发动脉瘤,小型动脉瘤12枚,大型或巨大型动脉瘤11枚）,12例栓塞,11例行动脉瘤夹闭术。结果 栓塞治疗的98枚动脉瘤术后即刻造影示,致密栓塞87枚,瘤颈部分显影11枚。88例术后平均随访18个月,术后6个月DSA或CTA随访,致密栓塞的47枚小型动脉瘤中,复发2枚（4.2%）;17例大型或巨大型动脉瘤中,复发5例（29.4%）。合并视力障碍的23例中,术后眼部症状改善13例（栓塞6例,夹闭7例）,未见明显变化6例（栓塞3例,夹闭3例）,加重4例（栓塞3例,夹闭1例）。结论 血管内栓塞治疗OSAs微创、安全、有效,但对改善视力障碍而言,夹闭术可能优于栓塞术。     

LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤

目的 探讨LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤（DA-SICA）的可行性、有效性。方法 回顾性分析2015年1月至2020年7月运用LVIS支架辅助弹簧圈栓塞治疗的28例DA-SICA的临床资料。结果 双LVIS支架辅助栓塞13例,术后即刻造影显示Raymond分级Ⅰ级10例,Ⅱ级3例;单LVIS支架辅助栓塞15例,术后即刻造影显示均为Raymond分级Ⅰ级。术中动脉瘤破裂出血2例。围手术期死亡3例,其中2例死于恶性脑肿胀,1例死于再出血。存活25例术后随访3~49个月,平均（26.5±2.5）个月;2例术后复发,再次使用LVIS支架辅助弹簧圈栓塞治愈;其余23例术后3个月复查DSA无动脉瘤复发及载流动脉狭窄。结论 LVIS支架辅助弹簧圈栓塞治疗DA-SICA,是一种有效、可行的选择,使用支架的数目应根据术中具体情况决定,术后应制定个体化的抗血小板治疗方案。     

支架辅助弹簧圈栓塞治疗大脑前动脉A1段起始处破裂微小动脉瘤

目的 探讨支架辅助弹簧圈栓塞治疗大脑前动脉A1段起始处破裂微小动脉瘤的安全性和有效性.方法 回顾性分析2010～2018年支架辅助弹簧圈栓塞治疗的11例大脑前动脉A1段起始处破裂微小动脉瘤的临床资料.结果 11例中,6例微导管塑形成“S”形,4例“Z”形,1例“猪尾形”.术后即刻造影显示,Raymond分级Ⅰ级9例,Ⅱ...     

颈内动脉眼动脉段动脉瘤的手术治疗

目的探讨颈内动脉眼动脉段动脉瘤和床突间隙的解剖学特点及夹闭术技巧和预后。方法经翼点入路手术治疗颈内动脉眼动脉段动脉瘤患者共13例（13个动脉瘤）,包裹2例（2个动脉瘤）,术中采用颅内外颈内动脉临时阻断方法。结果手术后经DSA或CTA检查显示,13例患者动脉瘤夹闭满意,载瘤动脉和远端动脉血流通畅;2例视力障碍患者手术后视力改善。手术后仅1例出现对侧肢体轻度偏瘫,无一例发生手术相关严重并发症。随访3～10个月（平均5个月）,均恢复良好。结论经翼点入路辅助颅内外颈内动脉临时阻断是治疗颈内动脉眼动脉段动脉瘤安全有效的手术方法。术中荧光造影可即时发现动脉瘤是否残留及载瘤动脉有无狭窄,从而指导手术医师调整动脉瘤夹位置而达到夹闭满意。     

颈内动脉眼动脉段动脉瘤的手术治疗

目的探讨颈内动脉眼动脉段动脉瘤和床突间隙的解剖学特点及夹闭术技巧和预后。方法经翼点入路手术治疗颈内动脉眼动脉段动脉瘤患者共13例(13个动脉瘤),包裹2例(2个动脉瘤),术中采用颅内外颈内动脉临时阻断方法。结果手术后经DSA或CTA检查显示,13例患者动脉瘤夹闭满意,载瘤动脉和远端动脉血流通畅;2例视力障碍患者手术后视力改善。手术后仅1例出现对侧肢体轻度偏瘫,无一例发生手术相关严重并发症。随访3～10个月(平均5个月),均恢复良好。结论经翼点入路辅助颅内外颈内动脉临时阻断是治疗颈内动脉眼动脉段动脉瘤安全有效的手术方法。术中荧光造影可即时发现动脉瘤是否残留及载瘤动脉有无狭窄,从而指导手术医师调整动脉瘤夹位置而达到夹闭满意。     

多支架辅助弹簧圈栓塞基底动脉夹层动脉瘤1例

<正>患者男,60岁,主因间断头晕8年余,加重1个月于2013年5月23日入住大连医科大学附属第一医院介入治疗科。患者于8年前在我院脑血管造影诊断为"基底动脉延长扩张症"(vertebrobasilar dolichoectasia,VBD)(图1),患者拒绝行介入治疗。本次入院行CTA提示基底动脉增粗扩张伴夹层动脉瘤形成,行脑血管造影检查显示:基底动脉弥漫性扩张、迂曲,直     

双支架错位重叠技术辅助弹簧圈栓塞治疗颈内动脉床突上段血泡样动脉瘤

目的 探讨双支架错位重叠技术辅助弹簧圈栓塞治疗颈内动脉床突上段血泡样动脉瘤（BBAs）的可行性、有效性及预后。方法 回顾性分析2014年7月至2018年6月采用双支架技术辅助弹簧圈栓塞治疗的9例BBAs的临床资料。结果 9例均成功实施双支架错位重叠技术辅助弹簧圈栓塞治疗,术中即刻影像Raymond分级Ⅰ级5例,Ⅱ级1例,Ⅲ级3例。出院时改良Rankin量表（mRS）评分0分4例,3分2例,4分1例,死亡2例;术后90 d mRS评分0分5例,1分1例,3分1例。7例存活病人影像学随访1周~24个月,动脉瘤均完全闭塞,载流动脉无狭窄。结论 双支架错位重叠技术辅助弹簧圈栓塞治疗颈内动脉床突上段BBAs是一种可行、有效的方法,可降低动脉瘤术后复发率,改善病人预后。     

颅内动脉瘤栓塞结果与动脉瘤瘤体和瘤颈的关系

目的 :探讨颅内动脉瘤栓塞治疗与其瘤颈和瘤体的关系。方法 :测量 12 0例 12 1个用可控性弹簧圈栓塞治疗的颅内动脉瘤瘤体、瘤颈和栓塞百分比 ,并进行分析。结果 :动脉瘤瘤体大小与瘤颈宽度相关。 10 0 %栓塞的和 90 %～ 95 %栓塞的动脉瘤分别与≤80 %栓塞的动脉瘤比较 ,其瘤颈宽窄和瘤体长径有显著性差异 (t检验P值均 <0 0 2 5 )。结论 :颅内动脉瘤栓塞治疗结果与动脉瘤颈宽窄和瘤体长径相关 ,瘤颈越宽、瘤体越大则越难达到完全栓塞     

Stent-assisted aneurysm coil embolization: safety and efficacy at a low-volume center

Abstract

Background and purpose: To compare safety and efficacy of cerebral aneurysm embolization with and without Neuroform stent placement at a low procedural volume center.

Methods: Retrospective cohort study of unruptured aneurysm coil embolization with and without Neuroform stent assistance over a period of 53 months at a center performing 14·4 interventions per year. Neuroform stent-assisted embolization was performed for 26 aneurysms in 25 patients (mean age: 61·3 years). Twelve patients (mean age: 64·3 years) with 12 unruptured aneurysms were treated without stent support. Comparative analysis of complications, angiographic findings, and clinical outcomes was performed.

Results: Procedural complications for the Neuroform stent group was 7·69% (2/26) versus 8·34% (1/12) for aneurysms without (P=0·7; OR: 1·1; CI: 0·09-13·35).The Modified Rankin Scale (MRS) and Glasgow Outcome Scale (GOS) scores for all patients in the stent and non-stent groups were 0 and 5, respectively. Three out of 20 aneurysms (15%) were retreated for major recurrence in the stent group and two of 10 (20%) in the non-stent group (P=0·55; OR: 1·42; 95% CI: 0·20-10·23). At a mean follow-up of 16·9 months, persistent complete occlusion was observed in 36·8% (7/19) of aneurysms with stent support. At a mean of 15·9-month follow-up in 10 non-stented aneurysms, persistent complete occlusion was observed in 50% of aneurysms (P=0·69; OR=2·3; 95% CI: 0·38-14·2).

Conclusion: Neuroform stent-assisted coil embolization at a low volume center is efficacious and does not increase procedural risk with optimal operator experience.     

Stent-assisted coiling of cerebral aneurysms using the Enterprise and the Solitaire devices

Abstract

Objective:

To evaluate the technical feasibility, peri- and post-procedural morbidity and mortality as well as clinical and angiographic follow-up using the Enterprise and the Solitaire stent currently available to be used for stent-assisted coiling of broad-based cerebral aneurysms.

Material and methods:

We conducted a retrospective study to investigate differences in aneurysms stented with the Enterprise (n = 58) and Solitaire stents (n = 19). Angiographic follow-up (mean: 8·25 onths) was available in 82·6% of patients treated with stent-assisted coiling.

Results:

All stents were successfully deployed. There is a higher acute in-stent thrombosis complication in Solitaire stent placement (P = 0·012). However, we observed no significant differences in peri-procedural morbidity and mortality rate (P = 0·253), angiographic results (P = 0·411), recurrence rate (P = 1·000), or long-term neurological deficit (P = 0·435).

Conclusion:

Both stents exhibited similar immediate and mid-term results with major neurological morbidities and mortality rate being low. More thrombogenic complications overall were found in Solitaire group.     

替罗非班治疗颅内动脉瘤介入围手术期支架内血栓的单中心经验

目的 探讨应用替罗非班治疗颅内动脉瘤支架辅助栓塞围手术期支架内血栓的有效性及安全性.方法 回顾性分析2018年6月-2020年12月于华中科技大学同济医学院附属同济医院神经外科行支架辅助颅内动脉瘤栓塞术围手术期发生支架内血栓患者的临床资料,评估应用替罗非班对支架辅助颅内动脉瘤栓塞术围手术期血栓的治疗效果,包括血栓是否溶...     

支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤

目的 分析支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤的安全性和有效性.方法 该回顾性研究纳入昆明医科大学第二附属医院脑血管病科2016年7月-2020年7月经DSA诊断的应用支架辅助栓塞治疗的前交通动脉宽颈动脉瘤患者.收集所有患者的临床相关资料,评价支架辅助栓塞治疗的疗效和安全性.治疗技术指标采用术后即刻DSA Ray...     

Neuroform Stent-Assisted Coil Embolization of a Ruptured A1 Segment Anterior Cerebral Artery Aneurysm

We report a case of a 71-year-old woman who presented with a ruptured wide-necked proximal anterior cerebral artery (ACA) aneurysm that was successfully embolized using Neuroform stent-assisted coiling.     

Unruptured Intracranial Aneurysms with Oculomotor Nerve Palsy : Clinical Outcome between Surgical Clipping and Coil Embolization

Objective

To evaluate the clinical outcome of coil embolization for unruptured intracranial aneurysm (UIA) with oculomotor nerve palsy (ONP) compared with surgical clipping.

Methods

A total of 19 patients presented with ONP caused by UIAs between Jan 2004 and June 2008. Ten patients underwent coil embolization and nine patients surgical clipping. The following parameters were retrospectively analyzed to evaluate the differences in clinical outcome observed in both coil embolization and surgical clipping : 1) gender, 2) age, 3) location of the aneurysm, 4) duration of the symptom, and 5) degree of ONP.

Results

Following treatment, complete symptomatic recovery or partial relief from ONP was observed in 15 patients. Seven of the ten patients were treated by coil embolization, compared to eight of the nine patients treated by surgical clipping (p = 0.582). Patient''s gender, age, location of the aneurysm, size of the aneurysm, duration of symptom, and degree of the ONP did not statistically correlate with recovery of symptoms between the two groups. No significant differences were observed in mean improvement time in either group (55 days in coil embolization and 60 days in surgical clipping).

Conclusion

This study indicates that no significant differences were observed in the clinical outcome between coil embolization and surgical clipping techniques in the treatment of aneurysms causing ONP. Coil embolization seems to be more feasible and safe treatment modality for the relief and recovery of oculomotor nerve palsy.