Complications of Neuroform Stent in Endovascular Treatment of Intracranial Aneurysms

Background  The Neuroform stent can help in the treatment of difficult, wide-necked intracranial aneurysms. The objective of our study is to report some of the challenges associated with the Neuroform stent in the treatment of intracranial aneurysms. Methods  From January 2003 to August 2006, consecutive patients treated with Neuroform stent for intracranial aneurysms were prospectively enrolled. Information on patient demographics, cerebrovascular risk factors, aneurysm size and location were collected. Technical and clinical complications as well as clinical outcomes were measured. Data were analyzed retrospectively using SPSS software version 11.5. Results  Successful deployment of the stent, in the target artery, was achieved in 65/67 (97%) patients. Stent deployment failed in two cases and the migration of stent developed in one during coiling. Postoperative thromboembolic events developed in three patients. These three patients possessed hyperactive platelets, and were treated with intravenous eptifibatide. Intraoperative rupture of aneurysm developed in one patient, which was secured by subsequent coiling. Majority of the patients had good outcomes GOS (Glasgow Outcome Score) 1 or NIHSS (National Institute of Health Stroke Scale) 0 in 63/67 (94%), GOS 2 or NIHSS 2 in one patient and GOS 3 or NIHSS 4 was observed in three cases. Conclusion  Despite a low rate of intraoperative complications, post-procedural thromboembolic events were common in Neuroform stent-treated patients, which might be associated with hyperactive platelets. Further studies are warranted to identify any potential relationship between post-stent hyperactive platelets and thromboembolism.     

Neuroform支架在颅内宽颈动脉瘤栓塞治疗中的应用

目的评估Neuroform支架对颅内宽颈动脉瘤的栓塞治疗效果。方法11例颅内宽颈动脉瘤使用Neuroform自膨式颅内支架结合电解可脱弹簧圈进行栓塞治疗。将预装好的Neuroform支架系统引入载瘤动脉处,通过同轴导管释放支架覆盖动脉瘤颈;支架释放后,行可脱弹簧圈栓塞术;术后维持全身肝素化48h。结果动脉瘤100%栓塞8例,95%栓塞2例,1例后交通动脉瘤,在支架释放后,颈内动脉痉挛,放弃栓塞,改为二期栓塞治疗。4例术后6个月复查脑血管造影,动脉瘤消失,载瘤动脉通畅。结论Neuroform支架结合电解可脱弹簧圈栓塞颅内宽颈动脉瘤可克服目前血管内治疗的技术障碍,既可保护载瘤动脉通畅,又可改善宽颈动脉瘤栓塞效果。     

应用Neuroform颅内专用支架结合弹簧圈治疗颅内梭形和宽颈动脉瘤

目的探讨Neuroform颅内支架结合弹簧圈治疗颅内宽颈和梭形动脉瘤的应用价值.方法本组宽颈和梭形动脉瘤45例,采用微导管技术将支架两端跨越动脉瘤颈后释放.18例通过支架的网眼将微导管置入动脉瘤内;27例采用平行技术先将微导管置入动脉瘤,再释放支架,然后通过微导管填塞弹簧圈,术后随访3个月～4年.其中椎动脉巨大宽颈动脉瘤3例,基底动脉宽颈动脉瘤5例,后循环多发动脉瘤2例,眼动脉瘤5例,床突上段动脉瘤13例,后交通动脉瘤17例.结果45例动脉瘤致密填塞36例,9例大部填塞,术后患者均恢复良好,随访均无再出血及3例出现血栓栓塞症状.结论Neuroform颅内支架结合弹簧圈是治疗颅内宽颈和梭形动脉瘤安全有效的方法.     

Comparison of Long-Term Angiographic Results of Wide-Necked Intracranial Aneurysms : Endovascular Treatment with Single-Microcatheter Coiling,Double-Microcatheter Coiling,and Stent-Assisted Coiling

ObjectiveEndovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups. MethodsBetween January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with single-microcatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively. ResultsClinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01). ConclusionLong-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.     

Matrix弹簧圈栓塞治疗颅内破裂动脉瘤的并发症

目的评价Matrix弹簧圈栓塞颅内破裂动脉瘤的安全性。方法回顾性分析应用Matrix弹簧圈栓塞的102枚颅内破裂动脉瘤的临床表现、影像学资料、治疗过程、并发症和临床结果,分析与治疗相关并发症的发生、类型、频率、相关因素和后果。结果发生并发症的有16例,其中术中动脉瘤破裂9例,血栓形成3例,弹簧圈脱出1例,载瘤动脉闭塞3例,并发症发生率为15.69%。6例患者无神经功能异常,3例患者具有暂时性神经功能异常,6例患者具有持久性神经功能障碍,1例患者死亡。与治疗相关性持久性神经功能障碍发生率和死亡率分别为5.88%和0.98%。结论应用Matrix弹簧圈栓塞颅内破裂动脉瘤和应用裸金属圈栓塞一样安全,生物活性物质不增加血栓形成的风险,但应用Matix弹簧圈栓塞远段、较小动脉瘤应慎重。     

Endovascular Treatment of Aneurysms Associated with Fenestrated A1 Segment of Anterior Cerebral Artery: Report of Two Cases

Fenestration in A1 segment of anterior cerebral artery is a rare entity. Treatment of aneurysms derived from a fenestrated artery may be more challenging because the fenestrations provide specific difficulties. A thorough radiologic work‐up driven by high clinical suspicion is needed. Endovascular treatment, although it has been tried only once, ⁷ appears to be the treatment of choice. We successfully treated 2 cases using endovascular techniques and can conclude that endovascular treatment is a safe and effective treatment of aneurysms associated with this rare variation in the A1 segment of ACA.