球囊或支架辅助下栓塞治疗颅内宽颈动脉瘤的效果观察

目的 探讨应用球囊或支架辅助栓塞技术治疗颅内宽颈动脉瘤的效果.方法 颅内宽颈动脉瘤患者24例,介入治疗术前经影像学检查或术中数字减影血管造影明确诊断.采用全身麻醉,经股动脉穿刺入路,在数字减影血管造影下,根据动脉瘤的形状、大小,采用相应辅助技术,选用合适的弹簧圈,逐步将瘤腔满意填塞.结果 24例患者共计24个瘤体,使用球囊辅助弹簧圈技术栓塞8个,使用支架辅助栓塞技术16个,其中100％栓塞21例,95％栓塞2例,死亡1例.23例患者电话随访1个月后恢复良好,无再出血发生.结论 联合使用支架和微弹簧圈治疗颅内宽颈动脉瘤安全、有效.     

Neuroform支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的长期疗效分析

目的:评价使用Neuroform支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤术后的长期疗效。方法:18例Neuroform支架辅助弹簧圈栓塞颅内宽颈动脉瘤患者均在术后3年以上接受数字减影血管造影下全颈脑血管造影检查。结果:除2例出现支架内血栓形成伴轻度狭窄形成外,其余16例患者均未发现支架内狭窄迹象;14例动脉瘤体完全无显影,4例患者有动脉瘤颈轻度复发迹象。结论:Neuroform支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤术式有效、可行,长期效果良好,长期术后并发症发生率低。     

浅析Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效观察

目的:探究Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效.方法:选取本院自2009年9月至2015年12月收治29例颅内宽颈动脉瘤患者,全部患者都实施Solitaire AB支架与弹簧圈栓塞联合治疗.并对术后90天通过脑血管造影的复查,对患者栓塞效果进行评价.结果:对29例患者中有25例患者100％填塞,3例超过91％填塞,1例85～90％填塞.同时,进行0.5～1年的随访,根据改良后的Rankin评分进行评价,其中有24例0分,3例1分,2例2分.有1例患者由于蛛网膜下腔出血,导致出现严重的脑血管痉挛,引发弥漫性脑肿胀,经过抢救无效后死亡.其余患者没有出现栓塞术中动脉瘤破裂的现象,也没有手术支架移位以及出血等并发症的发生.结论:Solitaire AB支架辅助弹簧圈介入治疗颅内宽颈动脉瘤效果显著,是一种较为有效的、安全可行的手术方式,不会增加再次出血和血栓栓塞的发生几率,且对患者预后无影响.支架辅助弹簧圈栓塞对颅内宽颈动脉瘤的治疗效果显著,安全性较高.     

Neuroform3自膨式支架在弹簧圈介入栓塞宽颈前交通动脉瘤中的作用

背景：近年来,采用支架辅助弹簧圈栓塞保持载瘤动脉通畅,防止弹簧圈脱入载瘤动脉,可显著提高疗效和安全性。目的：探讨Neuroform3自膨式支架在弹簧圈介入栓塞治疗宽颈前交通动脉瘤中的应用。方法：回顾性分析在Neuroform3自膨式支架辅助下,采用弹簧圈介入栓塞32例宽颈前交通动脉瘤患者的临床资料,其中男15例,女17例,年龄41-71岁,随访观察治疗效果及不良反应情况。结果与结论：32例患者技术操作顺利,宽颈前交通动脉共置入32枚Neuroform3支架,弹簧圈置入顺利,释放位置满意,技术成功率达到100%。在Neuroform3支架辅助水解脱弹簧圈栓塞完成后造影显示,32枚动脉瘤完全栓塞30枚,占94%;部分栓塞2枚,占6%。术后患者恢复良好,平均住院6.3 d。32例患者术后随访3-6个月,再行全脑血管造影未见再次脑出血、脑血管栓塞或动脉瘤复发。表明在Neuroform3自膨式支架辅助下采用弹簧圈介入栓塞治宽颈前交通动脉瘤,材料与宿主生物相容性好且安全有效。     

支架和球囊辅助技术在颅内宽颈动脉瘤栓塞中的应用

目的 探讨支架和球囊辅助瘤颈重塑技术治疗颅内宽颈动脉瘤栓塞的疗效.方法 将26例颅内宽颈动脉瘤患者按手术方法分为支架辅助组(19例)和球囊辅助组(7例).对于体/颈比＜2而＞1的动脉瘤,选择球囊辅助瘤颈重塑技术进行动脉瘤弹簧圈栓塞术;对于体/颈比＜1或瘤颈过于宽大的动脉瘤,选择支架辅助瘤颈重塑技术进行动脉瘤弹簧圈栓塞术.术后3个月对2组患者的预后进行改良Rankin量表评分,术后6个月复查数字减影血管造影技术(DSA),观察预后良好率和复发率.结果 支架辅助组19例患者,动脉瘤完全栓塞12例,次全栓塞7例;球囊辅助组7例患者,动脉瘤完全栓塞4例,次全栓塞2例,部分栓塞1例.所有病例手术均成功,无动脉瘤破裂出血.2组患者均进行3～6个月的随访,术后3个月改良Rankin量表评分,支架辅助组0分16例,1分2例,2分1例,预后良好率为84.2％;球囊辅助组0分6例,1分1例,预后良好率为85.7％.术后6个月支架辅助组13例患者复查DSA,11例影像学稳定,2例次全栓塞转为完全栓塞,载瘤动脉均通畅,支架未见移位;球囊辅助组5例患者复查DSA,4例影像学稳定,1例有瘤颈残留.2组均无死亡病例,无再出血发生.结论 支架和球囊辅助瘤颈重塑结合弹簧圈栓塞均是治疗颅内宽颈动脉瘤安全、有效的方法.     

支架在治疗颅内宽颈动脉瘤中的应用

目的分析颅内支架在治疗颅内宽颈动脉瘤中的临床疗效及应用体会。方法回顾性分析12例颅内宽颈动脉瘤患者的治疗过程,其中3例动脉瘤位于颈内动脉海绵窦段,2例位于颈内动脉眼动脉段,2例位于颈内动脉后交通段,1例位于前交通动脉,2例位于大脑中动脉分叉部,1例位于椎动脉,1例位于基底动脉;绝对宽颈（瘤颈〉4mm）动脉瘤9例,相对宽颈3例,瘤颈/瘤体均〉0.7。术中将颅内支架引至动脉瘤处并释放支架覆盖动脉瘤颈,然后行弹簧圈栓塞术。结果7例采用Neuroform自膨式支架,5例采用Leo支架,12枚支架全部成功释放。其中100%栓塞8例,95%栓塞3例,1例支架释放后动脉瘤不显影未行弹簧圈栓塞。1例术中出血经迅速填塞弹簧圈及支持对症治疗后患者治愈。本组患者无死亡。10例术后3个月随访造影,9例动脉瘤腔完全闭塞,1例达95%栓塞,载瘤动脉无狭窄。结论颅内自膨式支架辅助弹簧圈闭塞颅内宽颈动脉瘤,既可保护载瘤动脉通畅,又可提高宽颈动脉瘤栓塞的致密程度,效果较好,并且可降低穿支血管阻塞的发生率。     

Solitaire AB 支架辅助栓塞颅内宽颈动脉瘤86例疗效观察

【目的】评估 Solitaire AB 支架在辅助栓塞颅内宽颈动脉瘤中的临床应用价值。【方法】回顾性分析中国人民武装警察总医院2010年1月至2013年10月应用 Solitaire AB 支架治疗的86例(91枚)颅内宽颈动脉瘤患者的临床资料。患者术后随访6个月到2年,根据 Raymond 分级、改良 Rankin 评分、DSA 检查评价颅内动脉瘤影像学及临床结果。【结果】86例患者91枚动脉瘤中致密栓塞49枚(53.8%),瘤颈残余27枚(29.7%),部分栓塞15枚(16.4%)。栓塞术后复查 DSA、MRA 或 CTA 检查显示,48枚(55.1%)动脉瘤栓塞情况稳定,32枚(36.7%)动脉瘤内有进一步血栓形成,7枚(8.0%)动脉瘤可见动脉瘤内再通。3例患者发生术中动脉瘤破裂出血,1例患者发生脑血管痉挛。术后3个月改良 Rankin 评分0~2分恢复良好者为77例(93.9%),3~6分者5例(6.1%),4例失访。【结论】Solitaire AB 支架辅助栓塞颅内宽颈动脉瘤安全有效,可提高致密栓塞率,患者并发症发生率低,其具有较高的临床使用价值。     

Solitaire AB支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤

目的：探讨Solitaire AB支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤的有效性和安全性。方法对2011年1月～2013年10月33例患者34个前循环宽颈动脉瘤采用Solitaire AB支架辅助弹簧圈栓塞,回顾性分析其临床资料和疗效。结果所有患者均采用支架半释放技术,33例患者共应用Solitaire AB支架34个,均成功到位并准确释放。1个支架内血栓形成,其余无手术相关并发症。动脉瘤完全栓塞26个,瘤颈残留6个,部分栓塞2个。载瘤动脉通畅。除1例后交通动脉瘤病人术后3 d并发颅内出血死亡外,余32例临床随访6～12个月无临床症状加重,未发生再出血及缺血并发症。22例术后6～12个月行DSA随访,2个动脉瘤瘤颈有残留,未见支架内狭窄和闭塞。结论 Solitaire AB支架操作简便,采用支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤是安全的和有效的。     

血管内支架在颅内宽颈动脉瘤介入治疗中的应用

目的:评价使用血管内支架介入治疗颅内宽颈动脉瘤的临床效果,选择有效的手术方式。方法:回顾性分析使用血管内支架介入治疗的14例颅内宽颈动脉瘤(瘤颈∶体平均0.96)手术方式及效果。11例采用支架辅助弹簧圈栓塞,其中应用Neuroform支架6例,LEO支架5例。1个Neuroform支架覆盖瘤颈2例,2个LEO支架重叠覆盖瘤颈1例。结果:10例在术后3个月~12个月复查造影。①11例支架辅助弹簧圈栓塞,应用Neuroform支架6例,LEO支架5例;术中5例100%栓塞,3例复查瘤腔均不显影;术中6例75%~90%填塞,但均有造影剂严重滞留,4例复查,3例瘤腔完全闭塞,1例瘤腔扩大。②2例采用1个neuroform支架覆盖瘤颈,术中均有造影剂严重滞留,复查瘤腔均不显影。③1例采用2个neuroform支架重叠覆盖瘤颈,术中有造影剂严重滞留,10个月后瘤腔消失。结论:对颅内宽颈动脉瘤采取单纯血管内支架或血管内支架结合弹簧圈栓塞是安全、有效的治疗方法,治疗关键是血管内支架的选择和操作技术。     

LVIS支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的效果观察

目的观察LVIS支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的效果。方法将130例颅内宽颈动脉瘤患者分为对照组与观察组,每组65例。对照组接受弹簧圈栓塞手术治疗,观察组接受LVIS支架辅助弹簧圈栓塞治疗。比较2组临床疗效以及随访6个月时的再发责任血管卒中事件发生率、复发率。结果观察组栓塞有效率为98. 46%,显著高于对照组92. 30%(P 0. 05)。术后随访6个月,观察组预后良好率、复发率均显著优于对照组(P 0. 05)。对照组有3例出现再发责任血管卒中事件,而观察组未发生此类事件,2组比较有显著差异(P 0. 05)。结论 LVIS支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤疗效确切,可以提高栓塞成功率,降低复发率。     

颅内支架辅助栓塞宽颈动脉瘤初步经验

目的 探讨颅内宽颈动脉瘤新的血管内治疗技术,初步评价该技术和新栓塞材料的安全性和有效性.方法 回顾我们治疗中心近9个月内收治的11例宽颈动脉瘤病人的临床资料.对颅内Neuroform 支架辅助生物活性Matrix弹簧圈栓塞宽颈动脉瘤技术特点进行探讨,并通过对部分获得血管造影随访病人的疗效观察,评价该技术的临床应用价值.结果 联合颅内Neuroform支架和生物活性Matrix弹簧圈血管内治疗的11例宽颈动脉瘤病人中,除1例死于并发症外,其余病人均得到满意疗效,其中6例病人术后半年行数字减影血管成像(DSA)随访,未见动脉瘤复发,但仍需长期观察.结论 联合颅内支架和生物活性弹簧圈是一有效的血管内治疗颅内宽颈动脉瘤技术,颅内支架理想的大小选择和恰当的植入位置是成功治疗的重要一环,生物活性Matrix弹簧圈栓入瘤腔后可有效促进血栓和结体组织形成.     

应用支架治疗颅内宽颈动脉瘤的探讨

目的总结应用支架结合弹簧圈和单纯应用覆膜支架治疗颅内宽颈动脉瘤的初步经验.方法回顾分析12例颅内宽颈动脉瘤,10例应用支架结合弹簧圈技术治疗,2例颈动脉海绵窦段动脉瘤应用覆膜支架治疗.结果应用支架结合弹簧圈技术治疗10例,8例完全栓塞,2例大部分（＞95%）栓塞.应用覆膜支架治疗2例动脉瘤完全闭塞.影像随访10例3～12月,动脉瘤完全消失.临床随访12例,死亡1例.结论在栓塞宽颈颅内动脉瘤时选择应用支架结合弹簧圈技术或单纯应用覆膜支架可取得满意疗效.     

Neuroform自膨式支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效分析

目的:探究Neuroform自膨式支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤的临床疗效。方法:接受介入治疗的颅内宽颈动脉瘤患者152例纳入研究,根据治疗方法不同分为非支架辅助弹簧圈栓塞组(单纯弹簧圈组)56例和支架辅助弹簧圈栓塞组(支架辅助组)96例。回顾性分析患者的临床资料,比较2组治疗一般情况、并发症发生率、术前及出院时美国国立卫生院脑卒中量表(NIHSS)评分及格拉斯哥昏迷量表(GCS)评分、复发率及预后。结果:2组手术时间、术后住院时间及随访时间差异无统计学意义(P>0.05)。出院时支架辅助组NIHSS评分低于单纯弹簧圈组,GCS分数高于单纯弹簧圈组(P<0.05)。2组并发症发生率差异无统计学意义(P>0.05)。随访期间,支架辅助组复发率及mRS评分低于单纯弹簧圈组(P<0.05)。结论:对于蛛网膜下腔出血颅内宽颈动脉瘤患者,在弹簧圈栓塞的基础上联合Neuroform自膨式支架可明显提高疗效,同时降低动脉瘤的复发率,安全性高。     

Stent-assisted coiling for the treatment of ruptured micro-intracranial wide-necked aneurysms

The stent-assisted coil embolization technique has been increasingly used in the clinic, but its efficacy and safety have yet to be assessed. This study aimed to evaluate the efficacy and safety of stent-assisted coiling in the treatment of micro-intracranial wide-necked aneurysms.Between May 2007 and November 2011, a total of 35 micro-intracranial wide-necked ruptured aneurysms were occluded with Enterprise stent-assisted coils. The patients were followed up for two years.Stent-assisted coiling was performed successfully in all cases, and stent placement was satisfactory without any complications. Of 35 aneurysms, 13 (37.1%) were completely occluded, ten (28.5%) had residual necks, and 12 (34.2%) had residual aneurysms. In the two-year follow-up, no aneurysm rupture occurred and no patients had nerve dysfunction. All patients were reviewed by digital subtraction angiography or computed tomography angiography. One patient had a residual neck (2.8%), and no patients experienced stent restenosis or thromboembolic events.In general, stent-assisted coiling is effective and safe for the treatment of micro-intracranial wide-necked aneurysms.     

Y-stent-assisted coil embolization of anterior circulation aneurysms using two Solitaire AB devices: a single center experience

Wide-neck intracranial aneurysms remain a challenge to endovascular treatment. We describe our experience in repairing wide-neck aneurysms of the anterior circulation located at arterial branch points using coil embolization assisted by Y-stenting using two Solitaire(?) stents.Six wide-neck intracranial aneurysms located on the middle cerebral artery bifurcation( 3), pericallosal artery( 1), and anterior communicating artery( 2) were repaired by Y-stent-assisted coil embolization using two Solitaire(?) stents. Four cases were incidental findings of aneurysm and two cases were previously treated ruptured aneurysms that had undergone recanalization. All the cases were successfully treated without complications. Follow-up by digital subtraction angiography and magnetic resonance angiography at six months showed the stents to be patent with no recanalization of the aneurysm sacs. Repairing wide-neck aneurysms of the anterior circulation by Y-stent-assisted coil embolization using two Solitaire(?) stents is a simple and safe method of treating complex aneurysms. While the results are promising, larger series with longer term follow-ups are needed to corroborate that this treatment method is superior to other techniques.     

Hybrid,Y-configured,dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms

In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms.We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts.In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one.Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.     

血管内支架结合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理

目的探讨血管内支架结合电解可脱卸弹簧圈（GDC）治疗颅内宽颈动脉瘤的护理要点、并发症的防治及疗效。方法对10例宽颈动脉瘤病人围术期做好心理护理，术后加强病情观察，精心护理，预防并发症发生。结果10例病人全部治愈出院。9例致密栓塞，1例大部填塞。血管造影检查，动脉瘤不显影，载瘤动脉及邻近主要血管分支通畅，均无再出血或血栓栓塞等相关并发症。结论血管内支架结合弹簧圈是治疗颅内宽颈动脉瘤安全、有效的方法，短期治疗效果肯定，正确的护理，可以提高手术的成功率，减少并发症。