电解可脱弹簧圈栓塞治疗颅内动脉瘤

目的：分析应用电解可脱卸弹簧圈(GDC)栓塞治疗颅内动脉瘤的临床效果。方法：6例因蛛网膜下腔出血或其它神经系统症状入住我科的病人，经CT或(和)MR以及DSA检查证实为颅内动脉瘤，其中左侧后交通动脉3例，右侧后交通动脉1例，前交通动脉1例，C2段1例。瘤体直径在5．0-20．0mm之间。在神经安定 局麻下行动脉瘤栓塞术。先作载瘤动脉造影，明确动脉瘤的大小、形状、体／颈比以及与载瘤动脉的关系。再将微导管和微导丝塑型为相应的形状后经导引导管送至动脉瘤腔中部，选择合适的GDC进行填塞，直至致密填塞。结果：全部病人均一次性栓塞治疗成功，技术成功率为100％。栓塞后即刻行脑血管造影显示动脉瘤腔填塞满意，填充程度均在95％以上。全部病人均无再次出血和并发症产生。结论：GDC栓塞颅内动脉瘤是安全、有效和微创的治疗手段。     

颅内巨大或大型动脉瘤的血管内治疗:三种技术的比较

目的评价可脱卸球囊、可脱卸弹簧圈和颅内覆膜支架治疗颅内巨大动脉瘤的疗效。方法收集资料完整的经血管内治疗的颅内巨大动脉瘤20例,其中球囊/弹簧圈闭塞载瘤动脉9例,可脱卸弹簧圈动脉瘤腔填塞8例,覆膜支架治疗3例,另有2例为经弹簧圈瘤腔栓塞治疗后复发,行覆膜支架治疗。随访9～83个月,平均(41.1±25.3)个月。术后即刻血管造影结果评价标准为：动脉瘤完全闭塞(100%),大部闭塞(95%～99%)和部分闭塞(＜95%)。随访血管造影结果评价标准为：不变、血栓形成和再开放。结果所有动脉瘤血管内治疗均获得成功,无并发症。术后即刻血管造影显示动脉瘤完全闭塞11例,大部闭塞7例,部分闭塞2例,其中1例部分闭塞患者术后7 d再出血死亡。19例健在患者最终血管造影显示：动脉瘤完全闭塞15例,大部闭塞3例,部分闭塞1例。19例中,10例载瘤动脉保持通畅。长期临床随访结果显示11例患者的临床症状消失,8例改善。结论动脉瘤腔可脱卸弹簧圈栓塞治疗颅内动脉巨大动脉瘤的完全闭塞率低且再通率高;可脱卸球囊或弹簧圈闭塞载瘤动脉治疗动脉瘤完全闭塞率高但牺牲载瘤动脉,有潜在或短暂的脑缺血事件发生;覆膜支架治疗操作简单、安全,且可保持载瘤动脉通畅。     

颅内动脉瘤的可脱性球囊栓塞治疗

目的：探讨可脱性球囊在颅内动脉瘤介入治疗中的价值及缺点,并探讨不同大小动脉瘤的栓塞技巧。方法：20例动脉瘤患者中,小动脉瘤8例（12mm）,大动脉瘤7例（12－25mm）,巨大动脉瘤5例（＞25mm）。15例患者行动脉瘤腔内直接栓塞治疗,6例行载瘤动脉闭塞。结果：14个采用球囊行瘤腔内栓塞的动脉瘤中,3个月后DSA随访,10个动脉瘤被完全栓塞,4个动脉瘤部分栓塞。6例采用球囊行载瘤动脉闭塞的动脉瘤患者,3个月DSA随访皆未见动脉瘤显影。结论：颅内大动脉瘤或巨大动脉瘤的可脱性球囊瘤腔内直接栓塞治疗是一种行之有效的治疗方法,外科不能手术或行瘤腔内直接栓塞治疗难度较大的某些动脉瘤,载瘤动脉的闭塞治疗仍不失为一种有效的治疗方法。     

犬实验性颈总动脉动脉瘤的血管内支架治疗系列研究之二：载 …

目的：探讨将血管内支架置于动脉瘤附近载瘤动脉后发生的血流动力学改变，为动脉瘤的载瘤动脉内支架治疗提供实验依据。材料与方法：向６只犬７个颈总动脉侧壁动脉瘤附近载瘤动脉内置入血管内支架，而后作血管造影，比较支架置入前后瘤胚闭褰主载瘤动脉通畅情况。结果：７个动脉瘤载瘤动脉内支架置入后３天瘤腔均发生闭塞，载瘤动脉保持通畅；３周后瘤腔仍见闭塞且载瘤动脉保持通畅。结论：向动脉瘤附近载瘤动脉内置入血压管内支架。     

颅内动脉瘤的介入放射治疗

目的：分析２０例颅内囊状动脉瘤微弹簧圈和可脱球囊栓塞治疗方法、结果、技术特点、弹簧圈理化特性和并发症处理等。材料和方法：１７例囊状动脉瘤采用微弹簧圈栓塞，３例采用球囊栓塞。１５例颈动脉穿刺入路，途径短，成功率高。５例股动脉穿刺入路。结果：栓塞后动脉瘤完全闭塞，载瘤动脉通畅１４例；动脉瘤栓塞９０％，载瘤动脉通畅３例；动脉瘤同时与载瘤动脉完全闭塞３例。２０例颅内囊状动脉瘤栓塞后３个月随诊无一例死亡和发生栓塞并发症；动脉瘤闭塞９０％的３例，ＤＳＡ证实动脉瘤完全消失。结论：介入放射治疗颅内动脉瘤效果良好，能保持载瘤动脉通畅而达到不开颅治愈病人的目的。     

铂■治疗椎基底动脉复合性动脉瘤

作者报道了2例铂圈治疗的椎基底动脉复合性动脉瘤。例1为48岁的女性,CT示弥散性蛛网膜下腔出血,导致脑基底池内积血。椎动脉造影示基底动脉顶端有一较大的囊状动脉瘤(宽颈),右大脑后动脉(PCA)直接起源于其基底部;同时,右侧后交通动脉有一小囊状动脉瘤(已经手术夹闭)。术后一周,上述宽颈的基底动脉瘤因手术治疗难度大,而采用铂圈治疗。起初使用7个铂圈(直径为4mm,长6 cm),经Tracker-18号导管送到动脉瘤处,闭塞了大约40%的瘤腔。一周后血管造影显示瘤腔内无血栓形成。因此又使用8个0.018吋缠绕涤纶纤维的铂圈(直径5 mm,长1.5cm),经导管送到动脉瘤处,闭塞了大约60%的瘤腔,动脉瘤的     

电解脱弹簧圈(GDC)在颅内动脉瘤腔栓塞治疗中的临床应用

目的：评价颅内动脉瘤GDC栓塞术的效果和并发症。材料和方法：应用GDC栓塞治疗颅内动脉瘤270例273枚.其中5例在载瘤动脉内支架置放后再行瘤腔内GDC栓塞。临床表现为动脉瘤性蛛网膜下腔出血236例，脑神经压迫症状18例，其他16例。131例在栓塞后3－15个月作了随访血管造影。结果：262例265枚动脉瘤栓塞成功，8例手术失败。动脉瘤完全闭塞或几近完全闭塞（闭塞范围＞95％）217枚，大部闭塞（闭塞范围70％－95％）31枚，部分闭塞（闭塞范围＜70％）17枚，与手术相关的死亡4例，与手术相关的并发症18例（其中13例经处理后无后遗症；4例轻残，1例重残）。随访脑血管造影显示动脉瘤复发9例,均为原部分栓塞患者.结论：颅内动脉瘤腔内GDC完全致密堵塞的效果肯定，与手术相关的并发症发生率与操作者经验有关。     

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）。     

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。     

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     

Aneurysms of the posterior cerebral artery: classification and endovascular treatment

BACKGROUND AND PURPOSE: We present a retrospective review of our experience in the endovascular treatment of posterior cerebral artery (PCA) aneurysms. We detail the anatomic location of these aneurysms, the technique of endovascular treatment, morphologic results, and clinical outcome. We also discuss the segmental anatomy of the PCA as it relates to the various neurologic deficits that may result from occlusion of the parent artery. METHODS: From 1993 to 1998, 20 patients (12 female, eight male; mean age, 44 yrs) harboring a PCA aneurysm were treated via an endovascular approach. One patient had two aneurysms, comprising a total of 21 lesions. Fourteen (66%) of 21 aneurysms were saccular in nature, five (24%) were giant serpentine aneurysms, and two (10%) were posttraumatic. All aneurysms were treated using Guglielmi detachable coils (GDC) either by selective obliteration of the aneurysm sac or by parent artery occlusion. RESULTS: Fourteen (66%) of the 21 aneurysms were successfully treated with preservation of the parent artery. In the remaining seven (33%), the parent artery was permanently occluded. The overall complication rate in this series was 15%, with a permanent morbidity rate of 10% and a 0% mortality rate. CONCLUSION: Aneurysms of the PCA are rare compared with other locations in the intracranial circulation. Saccular PCA aneurysms can be treated effectively, by use of GDC, to obliterate the aneurysm yet preserve the parent artery. Fusiform and giant serpentine aneurysms of the PCA can effectively be treated by permanent occlusion of the parent artery; in these cases, thorough knowledge of the PCA segmental anatomy is crucial in order to select the site of occlusion and to avoid major neurologic deficits.     

Giant serpentine aneurysms: radiographic features and endovascular treatment.

PURPOSETo describe the characteristic CT, MR, and angiographic features of giant serpentine aneurysms and discuss their endovascular treatment.METHODSThirteen patients with giant serpentine aneurysms were studied at our institution in the last 3 years. They all underwent CT and MR studies as well as cerebral angiography. More recently, some of the patients were studied with MR angiography. Seven patients had endovascular occlusion of the giant serpentine aneurysms, 3 with N-butyl cyanoacrylate, 2 with Guglielmi detachable coils, and 2 with detachable balloons.RESULTSGiant serpentine aneurysms mimic cerebral neoplasms on CT and MR studies; they are often associated with mass effect and adjacent edema, and they enhance with contrast medium. The cerebral angiogram shows a residual irregular lumen of the partially clotted aneurysm, which continues into normal branches supplying the distal arterial territory. Six patients were treated successfully with an endovascular approach consisting of complete and permanent occlusion of the parent artery.CONCLUSIONGiant serpentine aneurysms from a subgroup of large intracranial aneurysms that have specific CT, MR, and angiographic features, which should be recognized before their treatment. The endovascular treatment of the aneurysm consists of permanent occlusion of the parent artery.     

Bilateral cavernous carotid artery aneurysms in a 4-year-old child: endovascular treatment with mechanically detachable coils

We present a 4-year-old child who suffered bilateral third nerve palsies secondary to bilateral giant saccular cavernous carotid artery aneurysms. Endovascular treatment was performed by means of direct endosaccular aneurysm occlusion on the right side and parent vessel occlusion on the left, using mechanically detachable coils. No complication occurred during or after the procedure. The bilateral third nerve palsies resolved over 3 months. Follow-up angiography at 1 year is presented. Received: 13 May 1996 Accepted: 9 August 1996     

Thrombus formation and structure and the evolution of mass effect in intracranial aneurysms treated by balloon embolization: emphasis on MR findings

This study was designed to further assess the capabilities of MR as a tool for the diagnostic evaluation of patients with giant intracranial aneurysms, to determine MR's ability to define the degree of thrombosis present within giant aneurysms before and after treatment with balloon occlusion, and to delineate the MR characteristics of both spontaneous and induced thrombus within giant aneurysms. Nine patients with unclippable intracranial aneurysms treated by parent artery occlusion with detachable balloons were evaluated with MR, angiography, and CT. Pretreatment and posttreatment MR studies were evaluated for their ability to (1) define the size, configuration, and anatomic relationships of an aneurysm; (2) detect and characterize thrombus within an aneurysm; and (3) determine if treatment successfully caused complete aneurysm thrombosis. MR imaging does not replace angiography in either the pretreatment or the posttreatment evaluation of patients with giant intracranial aneurysms. Thrombus formation and dissolution is a complex, dynamic process. Active thrombus in incompletely thrombosed aneurysms differs from isolated organizing thrombus in completely thrombosed aneurysms. Induced and spontaneous thrombi differ in mechanisms of formation and in composition; their MR characteristics are also different. Reduction in mass effect is common after complete thrombosis of giant intracranial aneurysms.     

Endovascular therapy of idiopathic cavernous aneurysms over 11 years.

PURPOSEWe report our experience with 42 patients with 48 cavernous carotid aneurysms, of whom 32 were treated with endovascular techniques and 10 were managed conservatively.METHODSThe 48 aneurysms were divided into two subgroups by location: 23 were at the C-3 portion of the carotid artery (small, saccular aneurysms with an epidural, partly intracavernous location) and 25 originated at the C4-5 segment (large or giant often fusiform aneurysms with a true intracavernous location). Morphologic features in both groups correlated well with differences in clinical presentation and also influenced therapy. Sixteen of the 25 C4-5 aneurysms (all large or giant) were treated by balloon occlusion of the parent artery, four (with narrow necks) were treated with Guglielmi detachable coils (GDCs), and five were not treated (asymptomatic or minimally symptomatic). Twelve of 13 C-3 aneurysms were treated with GDCs. Ten C-3 aneurysms were not treated.RESULTSOphthalmoplegia resolved or improved in nine of 12 patients treated with parent artery occlusion. All aneurysms treated by carotid occlusion thrombosed. Twelve of the 17 aneurysms treated with GDCs were 100% filled by the coils, four were 80% to 95% filled, and one was only 40% filled. Seven of the 100% filled aneurysms remained completely occluded, two showed slight coil compaction, and in three, follow-up angiography was not available. Among the incompletely filled aneurysms, two remained unchanged, one showed progressive thrombosis, a fourth revealed coil compaction, and in one, follow-up angiography was not available. One thromboembolic stroke and three transient ischemic attacks occurred perioperatively, for a permanent morbidity of 3.5% and a transient morbidity of 9%. There was no mortality. Mean clinical follow-up was 33 months; mean angiographic follow-up of patients treated with GDCs was 11 months.CONCLUSIONSurgically difficult cavernous aneurysms can be obliterated by embolization with excellent clinical results. Detachable coils have become an important endovascular tool, especially for narrow-necked cavernous aneurysms of the C-3 segment, which can be protected against rupture in the subarachnoid space in most cases.     

Spontaneous regression of two supraophthalmic internal cerebral artery aneurysms following flow pattern alteration

We report on a patient with fibromuscular dysplasia who presented with a right-sided giant calcified cavernous internal carotid artery (ICA) aneurysm and two additional supraophthalmic ICA aneurysms. Endovascular closure of the right ICA using detachable balloons was performed with collateralisation of the right hemisphere via the right-sided posterior communicating and the anterior communicating arteries. Repeat angiography after 6 months demonstrated spontaneous complete regression of the two supraophthalmic aneurysms, although the parent vessel was still perfused. In comparison to the former angiography, the flow within the parent vessel was reversed due to the proximal ICA balloon occlusion. MRI demonstrated that the aneurysms were not obliterated by thrombosis alone, but showed a real regression in size. This case report demonstrates that changes in cerebral hemodynamics potentially lead to plastic changes in the vessel architecture in adults and that aneurysms can be flow-related, even if not associated with high flow fistulas or arteriovenous malformations, especially in cases with an arterial wall disease.     

Neuroform颅内支架辅助栓塞宽颈颅内动脉瘤的初步经验

目的　报道我科使用Neuroform支架辅助可脱式弹簧圈栓塞宽颈脑动脉瘤的初步经验。方法　 2 2例 2 4枚宽颈颅内动脉瘤采用Neuroform支架和弹簧圈进行栓塞 ,其中急性破裂动脉瘤 19枚、未破裂动脉瘤 5枚。结果　支架均成功地释放 ,支架置入后的造影未发现有瘤内造影剂滞留的血流动力学改变。 10 0 %闭塞动脉瘤 18枚 ,90 %以上闭塞 5枚 ,1枚伴发的未破裂小型宽颈动脉瘤在支架置入后微导管无法超选 ,载瘤动脉均通畅。有 2枚动脉瘤虽有支架阻挡 ,但仍有部分弹簧圈畔进入载瘤动脉。所有患者没有出现与支架置入有关的症状性缺血性并发症。 17例造影随访中 ,有 1例在 3个月复查时发现再通 ,进行 2次栓塞完全闭塞动脉瘤 ,其余未见复发 ,结论　Neuroform颅内支架使用安全有效 ,适合于宽颈颅内动脉瘤的支架辅助弹簧圈栓塞 ,特别适合于迂曲的脑血管 ;其径向支撑力较差 ,在输送微导管时应防止其移位 ;其支架网眼较大 ,对血流动力学改变不明显 ,致密填塞是重要的 ,在输送弹簧圈时仍应防止弹簧圈畔进入载瘤动脉 ;术前、术后抗血小板药物的应用以及术后严格的系列造影随访是必要的。     

Thrombus formation at the neck of cerebral aneurysms during treatment with Guglielmi detachable coils

BACKGROUND AND PURPOSE: Thromboembolic events are a common source of complications during Guglielmi detachable coil (GDC) treatment of intracranial aneurysms. Thrombus formation at the coil-parent artery interface is not commonly reported but is an important potential source of emboli. We describe nine cases in which thrombus propagated from GDCs into the parent artery during coil therapy of cerebral aneurysms and subsequent treatment of the thrombus. METHODS: A retrospective review of a procedural database was performed to identify cases in which thrombus occurred during GDC treatment of cerebral aneurysms during a 30-month period. All images were reviewed at the time of the procedure. Nine cases of thrombus forming at the coil-parent artery interface and five cases of distal emboli were identified among 210 cases. All patients underwent anticoagulation with heparin during GDC treatment procedures. RESULTS: Thrombus was identified at the coil-parent artery interface during GDC treatment in nine (4.3%) of 210 cases. In each case, the thrombus was recognized before distal embolic complication occurred and was successfully treated with heparin alone (five patients) or with heparin plus a glycoprotein IIb-IIIa inhibitor (four patients). CONCLUSION: Potential clinical complications can be avoided by early recognition of thrombus at the coil-parent artery interface and by administering appropriate medical therapy.     

Post-procedure migration of Guglielmi detachable coils and Mechanical detachable spirals

We describe a previously unreported complication of the use of Guglielmi detachable coils and Mechanical detachable spirals in endovascular treatment of intracranial aneurysms. We document four cases in which migration of part of a coil into the parent artery occurred after completion of the procedure. Possible mechanisms are discussed. Received: 18 August 1998 Accepted: 26 October 1998     

Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results

BACKGROUND AND PURPOSE: Initial complete occlusion of very large or giant aneurysms often cannot be accomplished, and most will partially reopen over time. This study was performed to assess the clinical and angiographic outcome of patients with very large or giant cerebral aneurysms treated with detachable coils. METHODS: During 6 years, 29 patients with 31 very large or giant (20-55-mm) cerebral aneurysms were initially treated with detachable coils. Nineteen patients presented with subarachnoid hemorrhage (SAH), and eight patients had symptoms of mass effect. One patient had an incidental aneurysm, and one patient had an additional aneurysm. RESULTS: Twenty-three (79%) of 29 patients had a good clinical outcome at a median follow-up of 50 months. One of 19 patients presenting with SAH had repeat bleed (annual rebleeding rate, 1.45%). After initial coiling, seven of 31 aneurysms were incompletely occluded; this rate increased to 20 of 29 aneurysms at 6-month follow-up angiography. After 16 repeat coiling procedures in 13 aneurysms, 12 of 29 aneurysms in surviving patients were still incompletely occluded. After additional treatment other than coiling (parent-vessel occlusion and/or surgery) in eight aneurysms, three of 25 aneurysms in 24 surviving patients were incompletely occluded. Only 13 (42%) of 31 aneurysms had one coiling as a sole therapy. CONCLUSION: Coiling of very large or giant aneurysms can be considered. Long-term clinical outcomes were good in 79% of patients. The stability of the coil mesh over time was poor, requiring repeat coiling, surgery, and/or parent-vessel balloon occlusion in 58% of the aneurysms primarily treated with coils.