血管内治疗基底动脉顶端动脉瘤14例

目的总结血管内栓塞治疗基底动脉顶端动脉瘤的疗效和特点。方法回顾性分析血管内栓塞治疗14例基底动脉顶端动脉瘤的临床资料。术前均经DSA检查证实为基底动脉顶端动脉瘤,Hunt-HessⅠ~Ⅱ级8例,Ⅲ~Ⅳ级5例,未破裂动脉瘤1例。单纯栓塞6例,球囊辅助弹簧圈栓塞1例,双微导管栓塞2例,支架辅助弹簧圈栓塞4例。支架导管无法到位终止手术1例。结果 8例完全栓塞,4例近全栓塞,2例部分栓塞,术中无动脉瘤破裂病例。GOS示恢复良好11例;轻度病残,但生活能自理2例。13例随访6~40个月,无术后再出血病例。结论对于大多数基底动脉顶端动脉瘤,血管内栓塞治疗是一种安全有效的治疗方法。     

颅内后循环动脉瘤的血管内治疗

目的探讨血管内治疗后循环动脉瘤的疗效。方法回顾性分析经血管内治疗的20例颅内后循环动脉瘤患者的临床资料,其中动脉瘤位于基底动脉顶端10例、大脑后动脉2例、小脑后下动脉4例、椎动脉动脉4例;12例采用微弹簧圈栓塞治疗,8例采用支架辅助弹簧圈栓塞治疗。结果术后即刻造影示动脉瘤90%~94%栓塞6例,≥95%栓塞14例。本组术后死亡2例。18例患者出院后随访3~24个月,无动脉瘤再次破裂出血病例;12例患者复查CT血管造影,未见动脉瘤复发;13例患者恢复良好,3例中残,1例重残,1例植物生存。结论血管内治疗是一种微创、安全、有效的治疗后循环动脉瘤的方法。     

基底动脉顶端动脉瘤的血管内治疗

目的分析和总结后循环基底动脉顶端动脉瘤的血管内治疗的效果和特点。方法13例患者术前均行CTA和DSA检查,诊断为基底动脉顶端动脉瘤,其中直径在15mm以上的1例,5-10mm8例,5mm以下4例。Hunt-HessⅠ-Ⅱ级8例,Hunt-HessⅢ-Ⅳ级5例,全部行血管内介入治疗,其中2例术前无症状,动脉瘤比较复杂,行单纯支架治疗,其余均达到满意填塞。结果13例患者全部栓塞成功,其中8例100%栓塞,2例95%栓塞,3例90%栓塞。术后9例有效造影随访3-9个月,7例100%栓塞的患者动脉瘤无复发,2例单纯放置自膨式支架的患者动脉瘤仍然存在,准备2期随诊DSA,再应用电解可脱性弹簧圈填塞,另3例电话随访未发现异常,1例失随访。结论基底动脉顶端动脉瘤血管内治疗目前仍是首选方法,效果满意,并发症少,患者残死率低,但有潜在的风险,一旦出现痉挛、缺血,后果严重。     

后循环动脉瘤血管内治疗14例报告

目的 探讨后循环动脉瘤血管内治疗的方法选择及疗效.方法 新疆石河子大学医学院第一附属医院2010年9月至2011年12月收治后循环动脉瘤14例,其中基底动脉顶端动脉瘤8例,小脑上动脉瘤3例,小脑后下动脉瘤1例、椎动脉解离性动脉瘤2例.6例采用微弹簧圈栓塞治疗,3例采用球囊辅助微弹簧圈栓塞,4例采用Neuroform支架结合微弹簧圈治疗,1例椎动脉动脉瘤采用单纯Neuroform支架瘤颈成形术.结果 100％栓塞11例,95％栓塞3例.短期随访无再次蛛网膜下腔出血,3例复查脑血管造影,显示载瘤动脉通畅,动脉瘤无复发,1例单纯支架成形患者复查造影动脉瘤消失.结论 血管内治疗是治疗后循环动脉瘤的安全有效的治疗手段.     

椎-基底动脉夹层动脉瘤的血管内治疗 （附48例分析）

目的 探讨血管内栓塞治疗椎-基底动脉夹层动脉瘤（VBDAs）的效果。方法 回顾性分析2010年6月至2015年8月血管内栓塞治疗的48例（破裂动脉瘤25例,未破裂23例）VBDAs的临床资料,采用支架辅助弹簧圈栓塞术29例,单纯支架置入术4例,动脉瘤并载瘤动脉闭塞术15例。结果 术后即刻造影示完全栓塞28例,近全栓塞12例,不全栓塞8例。38例术后随访3个月至3年,无再出血或梗死,32例（破裂13例,未破裂19例）预后良好,6例（破裂5例,未破裂1例）不佳;术后复发5例（破裂2例,未破裂3例）。结论 血管内治疗VBDAs是安全有效的,但存在动脉瘤复发可能,长期随访很有必要。     

基底动脉主干旁及其分支起始部动脉瘤的血管内治疗

目的 探讨基底动脉主干旁及其分支起始部动脉瘤的血管内治疗特点及结果.方法 动脉瘤病例14例,其中合并其他病变者7例.囊性动脉瘤12例,采用弹簧圈栓塞治疗,保留载瘤动脉,必要时辅以支架或球囊；梭形及夹层动脉瘤2例,栓塞动脉瘤时闭塞载瘤动脉.对于伴随疾病根据术中情况进行处理.结果 术后随访1-2年.预后良好者12例,DSA复查未见复发；再出血而死亡者2例.结论 对于基底动脉主干旁及其分支起始部动脉瘤应积极进行血管内治疗,以防破裂出血引发严重的后果,若治疗得当可获得较好的效果.     

破裂的椎基底动脉瘤的治疗选择

目的 探讨破裂的椎基底动脉瘤血管造影的影像学表现与治疗方法选择的关系.方法 共收治42例,计43个椎基底破裂动脉瘤,其中手术夹闭9例,载瘤动脉闭塞术8例,单纯微弹簧圈栓塞12例,支架结合微弹簧圈栓塞13例.结果 40例病人术后即刻造影显示完全闭寨,2例大部闭塞,34例术后3-12个月随访,2例复发,1例病人死亡.结论 椎基底动脉瘤的治疗方法应根据动脉瘤的部位、形态与周围血管的关系而选择,血管内介入治疗应作为首选;手术夹闭适合病变相对易于暴露、术前全身状态较好或急需清除血肿挽救生命的病例.     

显微外科手术治疗基底动脉顶端动脉瘤

颅内基底动脉顶端动脉瘤约占后循环动脉瘤的50％，位置深在，与重要的丘脑穿通动脉关系密切，直接夹闭动脉瘤颈难度很大，是神经外科中极具挑战性的手术。近年来虽然大多数病例是通过血管内栓塞治疗，但仍存在栓塞后动脉瘤复发、蛛网膜下腔再出血等致命的风险，另外一些瘤颈较宽和巨大的动脉瘤也不适于血管内栓塞治疗，因此神经外科医生还需要掌握基底动脉顶端动脉瘤的显微手术治疗方法。     

血管内治疗颅内巨大动脉瘤(附40例报告)

目的探讨颅内巨大动脉瘤的血管内治疗方法，并对疗效进行评价。方法对40例颅内巨大动脉瘤行血管内治疗，其中33例行载瘤动脉闭塞术．5例行动脉瘤栓塞术，2例行颞浅-大脑中动脉搭桥术后闭塞载瘤动脉。结果载瘤动脉闭塞术后死亡3例，动脉瘤栓塞术后死亡1例．其余病人临床状况良好。临床随访28例，状况均良好；CT随访18例，示8例动脉瘤缩小或消失；造影随访15例．示9例动脉瘤不显影．3例瘤体缩小，2例载瘤动脉再通，1例栓塞后动脉瘤复发。结论对于手术罔难的颅内巨大动脉瘤，血管内治疗是一种安全、有效的方法。     

远侧大脑前动脉动脉瘤的血管内栓塞治疗

目的探讨远侧大脑前动脉动脉瘤的临床与影像学特征及其血管内栓塞治疗的安全性与疗效。方法回顾性分析29例远侧大脑前动脉动脉瘤的血管内治疗经验。采用载瘤动脉闭塞3例,支架辅助弹簧圈栓塞2例,单纯瘤内弹簧圈栓塞23例,单纯弹簧圈治疗失败后改行开颅手术1例。结果28例血管内栓塞治疗获得成功。25例采用弹簧圈瘤内填塞病人中,致密栓塞22例（88．0％）．大部栓塞2例（8．0％）,部分栓塞1例（4．0％）。术后死亡2例（6．9％）,重残2例（6．9％）,轻残2例（6．9％）,余病人恢复良好。采用DSA随访14例,MRA随访5例;显示复发2例（10．5％）,其中1例为术后3年发生再出血病例,行再次栓塞治疗。结论血管内栓塞治疗远侧大脑前动脉动脉瘤安全有效,但具有一定的复发率,需长期密切随访。     

An endovascular approach to ruptured aneurysms of the circumferential branch of the basilar artery

Aneurysms of the basilar perforating arteries are uncommon and those of the circumferential artery are particularly rare. Microsurgical clipping or trapping is the preferred treatment as these aneurysms are usually not accessible for endovascular treatment. We report two patients with ruptured aneurysms arising from the basilar circumferential artery. The first patient, a 66-year-old male, presented with a prepontine hematoma and a delayed filling aneurysm of the basilar circumferential artery. The second patient, a 28-year-old female, presented with a narrow-neck aneurysm of the basilar circumferential artery, associated with an arteriovenous malformation in the left cerebellum. Both patients were treated successfully with endovascular coiling, flow was preserved in the perforating parent vessels and the patients had excellent outcomes. This is the first report of this type of aneurysm being successfully treated by endovascular coiling. The treatment challenges regarding microsurgical and endovascular approaches are discussed.     

Sole Stenting Technique for Treatment of Complex Aneurysms

Objective

Complex aneurysms such as fusiform and very small aneurysms (< 3 mm) are challenging in neurovascular and endovascular surgery. Author reports follow-up results of 9 cases treated by sole stent technique with pertinent literature review.

Methods

A retrospective study was made of 9 patients who were treated by sole stenting technique for cerebral aneurysm between January 2003 and January 2009. Two of them had fusiform aneurysm, 5 had very small aneurysm, and 2 had small saccular aneurysm. Five patients had ruptured aneurysms and four had unruptured aneurysms. Seven aneurysms were located in the internal carotid artery (ICA), 1 in the middle cerebral artery (MCA) and 1 in the basilar artery. Follow-up cerebral angiography was performed at post-procedure 3 months, 6 months, and 12 months. Mean follow-up period is 30 months (ranged from 3 days to 30 months).

Results

Aneurysm size was decreased in 6 of 9 cases on follow-up images and was not changed in 3 cases. Although total occlusion was not seen, patients had stable neurological condition and angiographic result. The procedural complication occurred in 2 cases. One was coil migration and the other was suboptimal deployment of stent, and both were asymptomatic. Re-bleeding and thromboembolic complication had not been occurred.

Conclusion

Sole stenting technique is relatively effective and safe as an alternative treatment for fusiform and very small aneurysms.     

Y-Stenting Endovascular Treatment for Ruptured Intracranial Aneurysms : A Single-Institution Experience in Korea

Objective

Stent-assisted coiling on intracranial aneurysm has been considered as an effective technique and has made the complex aneurysms amenable to coiling. To achieve reconstruction of intracranial vessels with preservation of parent artery the use of stents has the greatest potential for assisted coiling. We report the results of our experiences in ruptured wide-necked intracranial aneurysms using Y-stent coiling.

Methods

From October 2003 to October 2011, 12 patients (3 men, 9 women; mean age, 62.6) harboring 12 complex ruptured aneurysms (3 middle cerebral artery, 9 basilar tip) were treated by Y-stent coiling by using self-expandable intracranial stents. Procedural complications, clinical outcome, and initial and midterm angiographic results were evaluated. The definition of broad-necked aneurysm is neck diameter over than 4 mm or an aneurysm with a neck diameter smaller than 4 mm in which the dome/neck ratio was less than 2.

Results

In all patients, the aneurysm was successfully occluded with no apparent procedure-related complication. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. Follow-up studies showed stable and complete occlusion of the aneurysm in all patients with no neurologic deficits.

Conclusion

The present study did show that the Y-stent coiling seemed to facilitate endovascular treatment of ruptured wide-necked intracranial aneurysms. More clinical data with longer follow-up are needed to establish the role of Y-stent coiling in ruptured aneurysms.     

破裂颅内椎动脉动脉瘤的血管内介入治疗

目的 探讨血管内介入治疗在破裂颅内椎动脉夹层及梭形动脉瘤中的应用.方法 回顾性分析21例血管内介入治疗的颅内椎动脉夹层及梭形动脉瘤患者,其中8例采用微弹簧圈或球囊进行载瘤动脉闭塞术,13例应用支架辅助弹簧圈进行栓塞治疗.结果 8例载瘤动脉闭塞的患者,载瘤动脉完全闭塞,小脑后下动脉保持通畅;随访3-12个月,未遗留明显的神经功能障碍.13例支架辅助弹簧圈栓塞的患者,术中1例因再出血死亡;余12例中,致密栓塞10例,接近完全栓塞2例.9例患者(包括接近完全闭塞的2例患者)有效造影随访3-11个月,致密栓塞的患者中动脉瘤无复发,载瘤动脉及PICA保持通畅;接近完全闭塞的2例患者中有1例部分复发,给予再次致密栓塞,另1例达稳定状态;另3例电话随访,未发现遗留明显的神经功能障碍.结论 载瘤动脉闭塞术治疗破裂的椎动脉梭形及夹层动脉瘤效果肯定,但有潜在缺血的风险;支架辅助弹簧圈栓塞术近期效果较好,但远期疗效有待长期随访的验证.     

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。     

血管内栓塞治疗颅内动脉瘤48例临床分析

目的 探讨血管内栓塞治疗颅内动脉瘤的疗效. 方法 回顾性分析汕头大学医学院第一附属医院神经外科自2001年1月至2009年12月经血管内栓塞治疗的48例颅内动脉瘤患者(共53个动脉瘤)的临床资料和疗效. 结果 本组颅内动脉瘤成功栓塞51个,其中100％栓塞40个,95％栓塞6个,90％栓塞5个;栓塞失败2个,改为二期栓塞治疗.术中动脉瘤破裂2例,无术中死亡病例.46例患者随访6～12个月,CTA或DSA检查显示2例动脉瘤复发,2例留下重度残疾,5例有轻度神经功能缺失症状,其余均恢复良好. 结论 颅内破裂动脉瘤采用可脱性弹簧圈进行血管内栓塞治疗具有微创、安全等优点,个体化栓塞及有效的术后处理能改善患者的预后.     

Blister-like aneurysms of the supraclinoid internal carotid artery: Challenging endovascular treatment with stent-assisted coiling

'Blister-like' aneurysms of the supraclinoid segment of the internal carotid artery are usually small and have fragile walls, necessitating special care to prevent rebleeding. These lesions are considered high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. In this report, we describe the use of stent-assisted, repeated coil embolization in the treatment of a ruptured blister-like aneurysm that experienced rapid growth. Stent-assisted coil embolization is an alternative, but sometimes hazardous, treatment for select blister-like aneurysms. Careful serial follow-up angiography will provide documentation as to the long-term stability of the endovascularly treated blister-like aneurysm described here, but early results are encouraging. Alternatively, placement of telescoped stents or graft-stent devices offers promise for future endovascular therapy.     

Stentimplantation in die A. basilaris zur Unterstützung der endovaskulären Aneurysmabehandlung

In aneurysms with a neck:dome ratio of 1:2 or more or with a wide neck, endovascular treatment is less effective. In this situation, the rate of thrombotic and thromboembolic complications is increased. Recently available highly flexible balloon expandable coronary stents improved the technique of endovascular aneurysm treatment. Two patients with wide neck midbasilar aneurysms were successfully treated endovascularly using a combination of stent deployment into the basilar artery and coil occlusion of the aneurysm. The creation of an artificial boundary between a side wall aneurysm and the parent artery by stent deployment improves the conditions for subsequent coil occlusion of the aneurysm. If, after detachment, coils protrude from the lumen of a side wall aneurysm into the parent vessel, stenting of this vessel can prevent thrombotic and thromboembolic complications.     

支架辅助栓塞破裂性前交通宽颈动脉瘤

目的 探讨支架辅助栓塞前交通宽颈动脉瘤的术前评估、支架植入策略、治疗效果.方法 回顾分析采用支架结合弹簧圈治疗的21例前交通宽颈动脉瘤及载瘤动脉解剖形态,支架植入技术操作程序,临床和造影结果.结果 21例动脉瘤均成功植入支架,其中Neuroform支架19枚、LEO支架2枚.12例支架远端位于同侧A2段、5例支架远端越过前交通植入对侧A2段、4例位于动脉瘤内.术后即刻致密栓塞18例;大部分栓塞2例;部分栓塞1例.术中动脉瘤破裂1例,经继续栓塞后出血得到控制.平均8.7个月后DSA随访12例,MRA随访4例,显示1例动脉瘤再通.结论 术前应根据动脉瘤及前交通动脉的解剖形态和功能制定支架植入策略.支架辅助栓塞前交通宽颈动脉瘤技术安全可行,动脉瘤致密栓塞率高.支架的长期疗效需进一步随访观察.     

颅内破裂微小动脉瘤血管内治疗的安全性和有效性

目的探讨颅内破裂微小动脉瘤血管内治疗的安全性及有效性。方法回顾性分析2016年1月至2017年12月收治的53例颅内破裂微小动脉瘤的临床及随访资料,均采用血管内治疗。结果动脉瘤最大直径平均(2.19±0.55)mm。单纯弹簧圈栓塞27例,球囊辅助栓塞2例,支架辅助栓塞24例;术后即刻造影显示动脉瘤致密栓塞24例(45.3%),瘤颈残留16例(30.2%),瘤体显影13例(24.5%)。共3例(5.7%)发生围术期并发症,其中1例(1.9%)为术中破裂,1例(1.9%)为术中血栓形成,1例(1.9%)为术后早期再出血。39例影像学随访3·13个月,平均平均(6.1±2.4)个月,动脉瘤不显影32例(82.1%);稳定3例(7.7%);复发4例(10.3%),均再治疗。51例临床随访6~28个月,平均(14.9±6.6)个月,改良Rankin量表评分0~2分50例(98.0%),3分1例(2.0%)。结论对于颅内破裂微小动脉瘤,血管内治疗具有较高的围手术期安全性,以及较高的短期治愈率和临床预后良好率。