带膜支架治疗颅内动脉瘤的临床分析

目的 探讨Jostent冠状动脉带膜支架对于难治性颅内动脉瘤的血管内治疗效果.方法 自2006-03-2008-04应用Jostent冠状动脉带膜支架治疗颅内难治性动脉瘤8例,其中颈内动脉瘤6例和椎动脉瘤2例.结果 在7例患者中带膜支架被成功释放于靶动脉,动脉瘤完全消除并保持载瘤动脉畅通,临床效果满意.在1例患者中,因血管迂曲,带膜支架无法到达指定位置.无手术相关并发症发生.DSA随访3例,原动脉瘤未显示,载瘤动脉畅通.结论 对于难治性颅内动脉瘤,带膜支架是有用的血管内治疗手段.     

覆膜支架治疗外伤性颈内动脉海绵窦瘘及颅内动脉瘤的临床分析

目的 探讨Jostent冠状动脉覆膜支架对外伤性颈内动脉海绵窦瘘(TCCF)及难治性颅内动脉瘤的血管内治疗效果.方法 自2003年10月至2009年10月四川大学华西医院神经外科应用Jostent冠状动脉覆膜支架治疗TCCF及难治性颅内动脉瘤35例,其中TCCF 15例,颈内动脉瘤11例,椎动脉瘤9例.结果 35例中33例一次性于靶动脉置人覆膜支架成功,动脉瘤(瘘)完全消除并保持载瘤动脉畅通,临床效果满意.1例TCCF及1例椎动脉夹层动脉瘤患者因血管迂曲,覆膜支架无法到达指定位置.三维数字减影血管造影随访17例,原动脉瘤(瘘)未见显示,载瘤动脉畅通.结论 对于TCCF及难治性颅内动脉瘤,覆膜支架是有效的血管内治疗手段.     

经动脉入路血管内治疗142例创伤性颈内动脉海绵窦瘘临床分析

目的 验证经动脉入路血管内治疗对创伤性颈内动脉海绵瘘(CCF)的治疗效果.方法 142例经全脑血管造影确诊为颈内动脉海绵窦瘘,行常规可脱球囊栓塞术,其中7例行球囊栓塞失败,改为全麻下行Jostent覆膜支架成形术.结果 135例患者局麻下成功行可脱球囊栓塞术,7例行球囊栓塞失败后于全麻下成功行Jostent覆膜支架成形...     

特殊类型颈动脉海绵窦瘘的血管内栓塞治疗

目的　探讨特殊类型颈动脉海绵窦瘘的血管内栓塞治疗的可行性及其价值。方法 :2 8例有外伤史的患者 ,采用Seldinger技术送入导管行全脑血管造影 ,观察侧支循环情况后 ,进行血管内栓塞治疗。结果 :双侧颈动脉海绵窦瘘 6例 ;单侧者为小瘘口 4例、多发瘘口者 2例 ,瘘口部合并骨折片者 11例 ,合并创伤性动脉瘤者 3例 ;栓塞后出现NPPB者 2例。血管内栓塞治疗中 ,闭塞瘘口保持颈内动脉通畅者 9例 ,闭塞瘘口同时闭塞颈内动脉者 19例。结论 :对于特殊类型颈动脉海绵窦瘘行血管内栓塞治疗是安全、有效的 ,应为首选的方法。对于不同病例应采取特例特办的原则 ,方可取得良好的治疗效果。     

颅底动脉损伤的介入治疗

目的 探讨多种血管腔内手段治疗颅底动脉损伤的临床价值.方法 2004年10月至2007年5月间我院收治各类型颅底动脉损伤患者共53例,均有头颈部外伤史.主要症状为搏动性突眼和颅内血管杂音(39例)、声嘶或吞咽不适(9例)、鼻出血(5例)等;DSA检查证实颈动脉海绵窦瘘(carotid cavemous fistulae,CCF)39例,颈内动脉假性动脉瘤14例;针对上述53例患者不同的病变特点采用不同的血管腔内治疗,并通过电话或门诊随访.结果 对53例患者56支颈内动脉进行了腔内介入治疗,采用单纯可脱球囊栓塞治疗CCF'33例34支血管,可脱球囊联合弹簧圈栓塞3例,植入覆膜支架封堵CCF3例;采用单纯可脱球囊闭塞颈内动脉治疗假性动脉瘤8例,可脱球囊联合弹簧圈孤立假性动脉瘤2例,植入覆膜支架腔内隔绝治疗4例;平均随访时间9.5个月(2～25个月),85%(45/53)患者主诉症状于6个月内消失,12个月随访15%(8/53)患者遗留眼球运动受限或视力障碍.复查显示存在假性动脉瘤6例,残瘘3例,其中2例因海绵窦区的硬脑膜动静脉瘘而分别于术后第2、3个月行再次介入治疗.结论 对各型颅底动脉损伤,血管腔内介入治疗创伤小且安全有效.尽管存在缺陷,可脱球囊仍是治疗CCF和颈动脉假性动脉瘤的首选方法,在特殊情况下必需联合应用弹簧圈栓塞和覆膜支架植入等多种治疗手段.     

直接型颈动脉海绵窦瘘的血管内治疗

探讨血管内治疗对直接型颈动脉海绵窦瘘的价值。材料和方法：38例患者在治疗前均行脑血管造影检查，所有病例均采用经动脉途径，用可脱球囊导管进行栓塞治疗。结果：38例患者中有36例栓塞成功，其中34例患者瘘口完全闭塞。36例患者中有32例于栓塞后保留颈内动脉，4例行颈内动脉球囊闭塞术。术后36例患者的海绵窦综合症均有不同程度的好转。3例患者曾行经静脉途径可脱球囊栓塞治疗，但由于海绵窦内分隔的阻挡作用，球囊不能进入海绵窦及其瘘口附近而告失败。2例患者由于球囊早脱并移位于大脑中动脉分支血管内，导致患者发生失语和一侧肢体偏瘫。结论：血管内可脱球囊栓塞治疗直接型颈脉海绵窦瘘，其瘘口闭塞率高，死亡率低，是直接型颈动脉海绵窦瘘的首选治疗手段。     

16层CT在颈动脉海绵窦瘘分型诊断中的临床意义

目的:探讨16层CT在颈动脉海绵窦瘘分型诊断中的临床意义。方法:回顾性分析17例经临床或DSA检查证实的颈动脉海绵窦瘘16层CTA检查结果,同时对本组病例进行分型。结果:①直接型瘘12例,其中5例瘘口位于海绵窦Ⅱ段,2例瘘口位于海绵窦Ⅲ段,4例瘘口位于海绵窦Ⅳ段,1例瘘口位于海绵窦Ⅴ段,瘘口呈线条状8例,呈非线条状4例。②间接型瘘5例,均未能清晰显示颈内、外动脉的硬脑膜支。结论:16层CT血管成像是一种无创的颈动脉海绵窦瘘的首选诊断方法,能清楚显示颈动脉海绵窦瘘瘘口的位置和大小,对其在治疗方案的选择有重要的临床意义。     

覆膜支架在颅颈动脉疾病中的临床应用

颅颈动脉应用覆膜支架主要用于治疗巨大或宽颈动脉瘤、各种原因所致的颅颈动脉假性动脉瘤、椎基底动脉梭形动脉瘤、海绵窦动静脉瘘、椎动脉-颈静脉瘘和溃疡性粥样斑块动脉狭窄等.这类病变是目前手术及血管内治疗材料和技术难以解决的.对颅颈动脉病变应用覆膜支架治疗的状况进行综述.     

颈动脉海绵窦瘘的DSA评价及其分类

探讨数字减影血管造影对颈动脉海绵窦瘘评价的价值，并通过对其血管造影表现的分析，提出新的颈动脉海绵窦瘘的分类方法。材料和方法：56例颈动脉海绵窦瘘患者均行DSA检查，每例患者均行患侧超选择性颈内、外动脉造影，同时对本组病例进行分类。结果：56例颈动脉海绵窦瘘患者中，A型瘘38例，B型瘘4例，C型瘘10例，D型瘘2例，E型瘘2例。38例直接瘘患者中，1例瘘口位于海绵窦Ⅰ段，10例瘘口位于海绵窦Ⅱ段，4例瘘口位于海绵窦Ⅲ段，18例瘘口位于海绵窦Ⅳ段，5例瘘口位于海绵窦Ⅴ段。前交通代偿良好者33例，后交通代偿良好者39例，31例患者的前、后交通动脉均有代偿。56例颈动脉海绵窦瘘患者中，50例向眼静脉引流，47例向岩下窦引流，18例经皮层静脉引流，8例向后颅窝区引流。结论：1．数字减影血管造影可较好地显示颈动脉海绵窦瘘的位置和大小，同时可以有效地评价Willis环的功能，为颈动脉海绵窦瘘的治疗提供有价值的信息。2．颈动脉海绵窦瘘可分为5型，即A，B，C，D，E型瘘，其中E型瘘文献中未见类似报道。     

微弹簧圈栓塞难治性外伤性颈动脉海绵窦瘘的疗效观察

目的 探讨和研究微弹簧圈血管内栓塞难治性外伤性颈动脉海绵窦瘘的疗效.方法 回顾13例用微弹簧圈栓塞治疗的难治性外伤性颈动脉海绵窦瘘患者.所有患者均有持续性颅内血管杂音、搏动性突眼及球结膜充血水肿.均采用微弹簧圈栓塞治疗,其中经动脉入路9例,经眼上静脉入路4例.结果 12例术后造影瘘El消失且颈内动脉通畅.1例填人5枚微...     

可脱球囊治疗外伤性颈内动脉海绵窦瘘

目的：研究外伤性颈内动脉海绵窦瘘的栓塞治疗。材料与方法：本文对5例外伤性颈内动脉海绵窦瘘患者施行了血管内介入栓塞术。所有患者均于手术前行Matas试验。结果：4例患者经可脱球囊栓塞术治疗，颈内动脉海绵瘘消失，颈内动脉保持通畅，颈内动脉海绵窦瘘的临床综合征于治疗后消失。1例由于瘘口较大，球囊不能完整闭塞瘘口，因该患者健侧颈内动脉代偿供应患侧的能力差，故无法栓塞患侧颈内动脉，栓塞术后该患者临床症状及体征有所改善但未能完全消除。结论：栓塞治疗对于外伤性预内动脉海绵窦瘘是一种有效治疗方法。     

创伤性颈内动脉假性动脉瘤的血管内治疗

目的 探讨载瘤动脉闭塞、弹簧圈栓塞以及支架技术治疗颅内创伤性颈内动脉假性动脉瘤(pseudoaneurysm,PSA)的适应证及其疗效.方法 本组6例患者,3例海绵窦段PSA合并颈内动脉海绵窦痿(carotid-cavernous fistula,CCF),2例单纯颈内动脉PSA,1例CCF球囊栓塞后复查显示PSA.球囊闭塞CCF及创伤性颈内动脉PSA 1例,弹簧圈栓塞3例,颈内动脉球囊闭塞2例.根据6例患者的临床表现、影像学资料、治疗方法选择、临床疗效、随访资料以及文献,分析三种治疗方式的适应证.结果 本组患者无手术相关并发症发生,无脑缺血并发症.术后无鼻出血发生,3例眼球突出回复,1例随访半年视力改善,3例颅内杂音消失,3例瞳孔缩小,复查数字减影血管造影(DSA)未见PSA复发.结论 血管内治疗是治疗颈内动脉PSA的首选,合并CCF时可行球囊闭塞或载瘤动脉闭塞.对单纯窄颈者予以弹簧圈栓塞,对宽颈的采用支架技术结合弹簧圈栓塞,而位于颈内动脉岩段可选择带膜支架.

Abstract：

Objective To investigate the indication and result of parental artery occlusion, embolization with coils, stents in treatment of the traumatic carotid artery pseudoaneurysm. Methods There were six patients with traumatic carotid artery pseudoaneurysm including three patients of cavernous pseudoaneurysm combined with carotid-cavernous fistula (CCF), two with simple traumatic carotid artery pseudoaneurysm and one with traumatic carotid artery pseudoaneurysm that was found after CCF embolization with detachable balloon. The treatment included balloon occlusion for CCF and traumatic carotid pseudoaneurysm in one patient, coil embolization in three and intenal carotid artery balloon occlusion in two. The Clinical manifestations, imaging data, choice of treatment, clinical efficacy, follow-up data and literatures were analyzed to discuss the indications for three treatments. Results There was no cerebral ischemia or surgically-related complication. No epistaxis occurred. The eyeball protrusion restoration was found in three patients and intracranial bruit vanishing in three. Vision was improved one patient after half a year follow-up. The pupils shrank in three patients during follow - up. Digital subtraction angiography (DSA) showed no recurrence of pseudoaneurysm. Conclusions Endovascular treatment is the preferred choice of treatment for traumatic carotid artery pseudoaneurysm. The occlusion or parent artery balloon occlusion can be used when the pseudoaneurysm is combined with CCF. Coil embolization can be used for shoes with narrow neck, stent technology combined with coil embolization for those with wide neck and the covered stent for the rock section of the internal carotid artery.     

Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results

BACKGROUND AND PURPOSE: We present our preliminary experience, including mid-term angiographic and clinical follow-up results, with an alternative technique for the endovascular treatment of intracranial aneurysms in a series of patients. This new method, previously described in anecdotal case reports, consists of endovascular deployment of an artificial vessel graft (stent graft or covered stent) in the parent vessel to exclude the intracranial aneurysm sac from circulation. METHODS: Twenty-five internal carotid artery (ICA) aneurysms in 24 patients were successfully treated by using a Jostent coronary stent graft deployed in the parent artery across the aneurysm neck. All except four aneurysms were extradural, located in the petrous or cavernous portion of the ICA. The four intradural aneurysms were located in the carotico-ophthalmic region. Seventeen aneurysms in 16 patients occurred posttraumatically, secondary to motor vehicle accidents or surgical injury. RESULTS: Twenty-three aneurysms were immediately excluded from circulation after stent graft placement. In two aneurysms, a slow contrast material filling (endoleak) into the aneurysm cavity was observed immediately after treatment. One was thrombosed, as shown by late control angiography; in the other one, a second larger bare stent was used to appose the stent graft's distal end to the ICA wall, thus sealing the endoleak into the distal graft. No technical adverse event, including vessel dissection, vessel perforation, or thromboembolism, occurred with or without clinical consequence. No mortality or morbidity developed during or after the procedure, including the follow-up period. Two-year control angiography in one patient, 1.5-year control angiography in two patients, 1-year control angiography in six patients, and 6-month control angiography in 12 patients were performed, revealing reconstruction of the ICA with no aneurysm recanalization. All symptoms resolved after treatment in the patients who had initially presented with mass effect. CONCLUSION: Initial anatomic, clinical and mid-term follow-up results in this small series of patients are encouraging. This technique has been proved to have potential in the reconstructive treatment of intracranial aneurysms. Further research and development are needed to optimize the stent graft technology for the cerebrovascular system.     

以突眼为表现的眼部血管病——颈动脉海绵窦瘘的介入治疗

目的探讨颈动脉海绵窦瘘眼部表现特点、影像学检查及介入治疗方法。 方法回顾分析5年中18例首诊于我院眼科的颈动脉海绵窦瘘者的眼部症状及体征、影像学检查、治疗方法等。18例患者均行介入手术治疗,其中应用可解脱球囊封堵瘘口12例,应用弹簧圈+Onyx胶封堵瘘口3例,覆膜支架隔绝瘘口3例。 结果所有病例中最常见的眼部表现为搏动性眼球突出、球结膜充血水肿、眼球运动障碍等。头颅或眼部CT平扫检查所有病例均显示患侧眼球突出,眼上静脉增粗;全部患者均行数字减影血管造影检查明确诊断。本组18例（20眼）均行介入手术治疗,其中应用可解脱球囊封堵瘘口12例（14眼）,结果10例（12眼）瘘口完全闭塞,发生并发症2例,无严重并发症或死亡病例。应用弹簧圈+Onyx胶封堵瘘口3例（3眼）、覆膜支架隔绝瘘口3例（3眼）,瘘口均完全闭塞,无并发症或死亡病例。全部手术患者眼部症状和体征均得到明显改善。随访时间（12±3.4）个月,无复发病例,颈动脉覆膜支架内未发生狭窄及闭塞。 结论对于以突眼及其他相关症状就诊于眼科的患者,应考虑颈动脉海绵窦瘘的可能,血管造影是该病诊断的金标准,介入手术治疗对颈动脉海绵窦瘘是安全有效的。     

Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.     

Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.     

Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement

BACKGROUND AND PURPOSE: Endovascular techniques are the methods of choice for the treatment of patients with carotid cavernous fistulas. We report our experience using stent-assisted coil placement for treatment of patients with high-flow fistulas that are associated with severe laceration of the internal carotid artery. METHODS: In a retrospective review of an internal endovascular therapy database covering the interval between October 2001 and October 2003, we identified a total of 5 patients presenting with 6 high-flow type A carotid cavernous fistulas (one had a bilateral fistula) that were associated with severe laceration of the internal carotid artery. All were treated first with stenting of the injured segment of the internal carotid artery followed by transarterial (3/6) and/or transvenous (4/6) obliteration of the fistula with detachable platinum coils. In 2 cases, a liquid adhesive was also used. In all instances, a compliant balloon was inflated within the stented arterial segment during coil deposition to avoid extension of coils into the parent artery. RESULTS: All 6 fistulas were obliterated, and each internal carotid artery was successfully reconstructed. Except for posttraumatic cranial nerve dysfunction in 1 patient, clinical outcome was very good. Follow-up angiograms in 3 of the 6 patients obtained at intervals between 3 and 6 months (mean, 4.5 months) revealed no fistula recurrence and no evidence of intimal hyperplasia within the stent. CONCLUSION: In this series of patients with high-flow carotid cavernous fistula associated with severe injury to the internal carotid artery, stent-assisted coil placement offered a safe and effective treatment. Stent-assisted coil placement may increase the ability to successfully treat fistulas with severe injury to the internal carotid artery with preservation of the parent artery.     

创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤的诊断和治疗

目的 探讨创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤的诊疗方法.方法 介入方法诊断和治疗6例创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤患者.结果 5例出现反复鼻腔大出血;所有患者均行瘘口和假性动脉瘤球囊闭塞,2例颈内动脉保留,1例合并对侧间接型颈动脉海绵窦瘘行经面静脉-眼上静脉瘘口弹簧圈栓塞术.术后颅内杂音均即刻消失,结膜充血水肿2周～3个月内消退.无介入相关并发症.所有患者均行随访,无临床症状复发,均恢复工作.结论 车祸是致颈动脉海绵窦瘘合并蝶窦假性动脉瘤的主要原因;受力部位多集中在患侧眶额部到眶颧部的眶前外侧区;头颅MRI结合临床表现对于术前确诊该病非常有帮助;可脱球囊闭塞瘘口和假性动脉瘤或闭塞颈内动脉是安全、有效的治疗方法.     

Transarterial balloon-assisted n-butyl-2-cyanoacrylate embolization of direct carotid cavernous fistulas

BACKGROUND AND PURPOSE: Transarterial detachable balloon embolization of direct carotid cavernous fistulas (DCCFs) has become an optimal treatment. In a few cases, the parent artery has to be sacrificed to achieve morphologic cure. We present our experience with transarterial balloon-assisted n-butyl-2-cyanoacrylate (n-BCA) embolization of DCCFs in which there was failure to achieve angiographic cure and preservation of parent arteries. METHODS: Of 141 patients with traumatic DCCFs who had been treated by transarterial embolization with occlusion of the fistula and parent artery preservation, 18 received transarterial balloon-assisted n-BCA embolization-6 for residual fistula after the balloons detached, 7 for recurrent fistula because of premature balloon deflation or migration, and 5 for repeated puncture of the detachable balloon by the bony fragment at the cavernous sinus. A total of 27 procedures were performed with an average 1.5 attempts per patient, and the volume of the n-BCA mixture varied from 0.5 to 2.3 mL with a mean of 0.83 mL. RESULTS: All DCCFs were successfully occluded by the n-BCA mixture with preservation of parent arteries. One patient with a giant cavernous sinus varix had a fatal subarachnoid hemorrhage. One had a recurrence and was treated by internal carotid artery (ICA) occlusion. Five had asymptomatic pseudoaneurysms at the parent artery. There was no adhesion of the n-BCA mixture to the protective balloon or the microcatheter or n-BCA reflux into the parent arteries. CONCLUSION: Transarterial balloon-assisted n-BCA embolization is a feasible, efficient, and safe treatment for DCCFs when angiographic cure and ICA preservation are not achieved by transarterial detachable balloon embolization.