NeuroformⅡ支架联合MatrixⅡ弹簧圈治疗颅内宽颈动脉瘤的初步经验

目的探讨NeuroformⅡ支架植入联合MatrixⅡ弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效、技术要点、安全性及并发症防治。方法诊断为颅内宽颈动脉瘤的病人11例,其中大脑前动脉瘤2例,后交通动脉瘤4例,眼动脉瘤1例,大脑中动脉瘤2例,椎基底动脉瘤2例。7例先行NeuroformⅡ支架瘤颈成形,将微导管通过支架网眼置入动脉瘤内,填塞弹簧圈;4例先置入微导管于动脉瘤内,再释放支架后栓塞,术后3~6个月随访。结果所有病例栓塞操作均顺利完成,无手术并发症;其中致密填塞8例,部分致密填塞3例,术后病人均恢复良好,4例短期随访无再出血及血栓栓塞症状发生。结论NeuroformⅡ支架联合MatrixⅡ弹簧圈治疗颅内宽颈动脉瘤安全、有效。     

Neuroform Atlas支架在颅内动脉分叉处宽颈动脉瘤栓塞中的应用体会

目的 探讨Neuroform Atlas支架在颅内动脉分叉处宽颈动脉瘤栓塞中的价值。方法 回顾性分析2021年1～9月16例采用Neuroform Atlas支架辅助弹簧圈栓塞治疗颅内动脉分叉处宽颈动脉瘤的临床和影像学资料。动脉瘤位于大脑中动脉分叉处8例，大脑前动脉分叉处4例，大脑前、中动脉分叉处2例，大脑前动脉A2远端分叉处1例，大脑后动脉P2分叉处1例。破裂动脉瘤10例(术前Hunt-Hess分级Ⅰ级6例，Ⅱ级2例，Ⅲ级2例),未破裂动脉瘤6例。结果 均在单一Neuroform Atlas支架辅助下完成栓塞，技术成功率100%。术后即刻造影显示动脉瘤完全闭塞13例，瘤颈残留2例，瘤体残留1例。术中及围手术期未观察到介入操作相关并发症。出院前改良Rankin量表(mRS)0～1分11例，2分3例，3分2例。16例随访时间3～14个月，(7.8±3.2)月。mRS评分0～1分14例，2分1例，3分1例。9例术后3～6个月行DSA,动脉瘤完全闭塞8例，瘤颈残留1例，9例均未见载瘤动脉狭窄或支架内闭塞。结论 Neuroform Atlas支架辅助弹簧圈栓塞治疗颅内动脉分叉处宽颈动脉瘤安全，...     

LVIS支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤预后影响因素分析

目的 探讨LVIS支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的疗效,分析预后影响因素。方法 回顾性分析2015年2月至2020年2月行LVIS支架辅助弹簧圈栓塞治疗的60例急性期颅内破裂宽颈动脉瘤患者的临床资料,术后根据mRs评分评估预后,分析预后影响因素。结果 60例急性期颅内破裂宽颈动脉瘤患者手术均获成功,支架手术成功率为100%;术中出现动脉瘤破裂1例(1.67%),载瘤动脉血栓形成3例(5%)。术后造影检查显示动脉瘤完全栓塞52例(86.67%),近全栓塞6例(10%),部分栓塞2例(3.33%),栓塞率为96.67%(58/60)。单因素分析显示,年龄、原发性高血压史、入院时Hunt-Hess分级以及动脉瘤分型可能是影响急性颅内破裂宽颈动脉瘤预后的危险因素(P<0.05);二元Logistic回归分析显示入院时Hunt-Hess分级为Ⅲ～Ⅳ级是影响预后的独立危险因素(P<0.05)。结论 LVIS支架辅助弹簧圈栓塞治疗急性期颅内破裂颈动脉瘤效果显著,安全性高;对于入院时Hunt-Hess分级为Ⅲ～Ⅳ级者应提高警惕,在病情允许下尽快实施手术治疗,以改善预后。     

弹簧圈栓塞治疗颅内微小动脉瘤及中长期随访

目的评价弹簧圈栓塞治疗颅内微小动脉瘤（VSCAs）的有效性及稳定性。方法 19例患者（20枚VSCAs）接受血管内弹簧圈栓塞治疗。对其中9枚动脉瘤使用单纯弹簧圈栓塞,9枚使用支架辅助弹簧圈栓塞,2枚使用球囊辅助弹簧圈栓塞。根据DSA表现,将栓塞程度分为完全栓塞、次全栓塞和部分栓塞。术后进行中长期随访并收集DSA及临床结果。结果所有VSCAs均获成功栓塞。术后即刻DSA显示,20枚VSCAs中5枚为完全栓塞,9枚为次全栓塞,6枚为部分栓塞。1~2年随访DSA示20枚VSCAs均完全栓塞,未发现动脉瘤复发及弹簧圈脱出、移位。临床随访显示所有患者均未出现动脉瘤再次破裂出血及神经系统缺血症状。结论血管内弹簧圈栓塞治疗VSCAs有效、稳定;中长期随访证实次全及部分栓塞的患者可发展为完全栓塞。     

支架或球囊辅助弹簧圈栓塞技术对颈内动脉宽颈后交通动脉瘤的疗效

目的评估支架或球囊辅助弹簧圈栓塞技术对颈内动脉宽颈后交通动脉瘤的治疗效果和安全性。方法回顾性分析接受支架或球囊辅助弹簧圈栓塞的47例颈内动脉宽颈后交通动脉瘤患者,其中31例采用支架辅助治疗,16例采用球囊辅助治疗。治疗后随访6~36个月,分析患者的术后造影、并发症及临床情况。结果 47例中,采用支架或球囊两种辅助治疗方法相关并发症发生率分别为9.68%(3/31)和6.25%(1/16);手术后即刻造影显示完全栓塞率分别为58.06%(18/31)和68.75%(11/16)。31例支架辅助弹簧圈栓塞病例中随访造影18例,均无动脉瘤复发;16例球囊辅助弹簧圈栓塞病例中随访造影10例,其中3例复发。结论支架辅助弹簧圈栓塞技术和球囊辅助弹簧圈栓塞技术是颈内动脉宽颈后交通动脉瘤安全有效的治疗方法。支架辅助弹簧圈栓塞技术能够显著降低颈内动脉宽颈后交通动脉瘤的复发率,但有增加缺血事件的风险。球囊辅助弹簧圈栓塞技术的手术操作相关并发症低,术后完全栓塞率高,但复发率也相对较高。     

支架辅助弹簧圈栓塞治疗大脑中动脉分叉部宽颈动脉瘤

目的 观察支架辅助弹簧圈栓塞治疗大脑中动脉分叉部宽颈动脉瘤的安全性和有效性。方法 分析60例接受支架辅助弹簧圈栓塞治疗的大脑中动脉分叉部宽颈动脉瘤患者共65个动脉瘤,观察术后即刻及随访动脉瘤栓塞程度,评估术后并发症、疗效及安全性。结果 术中2例(2/60,3.33%)动脉瘤破裂出血,4例(4/60,6.67%)支架内血栓形成;术后即刻栓塞程度为RaymondⅠ级50个(50/65,76.92%)、Ⅱ级12个(12/65,18.46%)、Ⅲ级3个(3/65,4.62%)。术后1个月内3例(3/60,5.00%)动脉瘤再出血,2例致死;1例(1/60,1.67%)死于肺栓塞;4例(4/60,6.67%)并发脑梗死。1例术后6个月瘤颈复发,1例术后25个月出现无症状性血管闭塞;末次复查数字减影血管造影显示43个(43/51,84.31%)RaymondⅠ级、8个(8/51,15.69%)Ⅱ级。末次随访,49例(49/57,85.96%)改良Rankin量表评分为0～2分,8例(8/57,14.04%)为3～4分。结论 支架辅助弹簧圈栓塞技术治疗大脑中动脉宽颈动脉瘤安全、有效。     

Enterprise支架在颅内动脉瘤治疗中的应用

目的评价Enterprise支架在颅内动脉瘤治疗中的应用价值及安全性。方法 2008年12月～2011年3月应用Enterprise支架(美国Codman公司)治疗颅内动脉瘤21例,其中宽颈动脉瘤19例,梭形动脉瘤2例。在微导丝引导下,将支架输送导管送至动脉瘤颈以远,通过输送导管将支架引至动脉瘤处释放支架覆盖动脉瘤颈,行弹簧圈栓塞术。结果采用单纯支架置入技术2例,支架先释放技术5例,支架后释放技术14例。21例22枚支架置入顺利,全部成功释放,位置良好。术后即刻血管造影显示动脉瘤致密性栓塞13例,大部栓塞6例,单纯支架置入的2例微小动脉瘤见瘤腔内造影剂滞留。除1例驼背病人术后1周并发肺部感染死亡外,余20例随访1～6个月无临床症状加重,未发生脑再出血或新发梗死;11例术后6～12个月行DSA,2例动脉瘤瘤颈有残留,未见支架移位和支架内狭窄。结论 Enterprise支架操作简便,易通过血管弯曲处并准确释放,为颅内动脉瘤提供了较为安全有效的治疗方法。     

血管内微弹簧圈栓塞术治疗颅内动脉瘤的临床分析

目的探讨血管内微弹簧圈栓塞术治疗颅内动脉瘤的临床价值。方法对92例动脉瘤患者实行血管内微弹簧圈栓塞术,其中单纯微弹簧圈栓塞80例,Solitaire支架辅助弹簧圈栓塞12例。结果 92例动脉瘤均成功栓塞,其中完全栓塞67例,大部分栓塞17例,部分栓塞8例,术后死亡2例,皆为术前Hunt-Hess分级Ⅳ级,术中动脉瘤破裂出血,1例为广泛蛛网膜下腔出血,1例为大量额叶脑内血肿。应用Logistic回归分析显示患者年龄、高血压及Hunt-Hess分级是影响动脉瘤预后的危险因素。结论血管内微弹簧圈栓塞术治疗颅内动脉瘤可有效防止动脉瘤破裂出血,有很好的临床应用价值。     

颅内动脉瘤破裂弹簧圈介入栓塞术围术期护理体会

目的总结颅内动脉瘤破裂弹簧圈介入栓塞术的围术期护理体会。方法对36例接受弹簧圈介入栓塞治疗的颅内动脉瘤破裂患者给予围术期综合护理措施,回顾性分析患者的临床资料。结果本组患者术后出现脑积水5例,经侧脑室置管引流1周后拔除引流管痊愈。发生甲状腺功能减退3例,经口服甲状腺素片,甲状腺功能恢复正常。其余28例患者均顺利康复出院。随访6~16个月,全部患者均未遗留神经功能障碍,未发生再次出血,生活可以完全自理。结论弹簧圈介入栓塞治疗动脉瘤破裂,微创、治愈率高。护理人员应熟悉其临床特征、了解手术的方法及意义,做好围术期综合护理措施,以改善治疗效果,使患者早日康复出院。     

支架植入术联合弹簧圈栓塞治疗颅内复杂动脉瘤

目的探讨应用新型颅内支架植入联合弹簧圈栓塞术治疗颅内复杂动脉瘤的疗效。方法对26例30个颅内复杂动脉瘤行支架植入术弹簧圈栓塞术,术后6～24个月进行随访。结果术后即刻疗效：24个复杂动脉瘤完全栓塞,4个次全栓塞（栓塞95%以上）,2个不完全栓塞;所有支架位置满意,载瘤动脉通畅。随访2例动脉瘤复发,未见支架移位、塌陷、狭窄,载瘤动脉通畅、光滑。结论颅内支架植入联合弹簧圈栓塞术治疗颅内复杂动脉瘤安全有效;应根据动脉瘤的具体情况来选择具体技术。     

Transluminal stent-assisted coil embolization of a vertebral confluence aneurysm: technique report

BACKGROUND: Recent advances in stent technology have allowed for negotiation of often tortuous posterior circulation intracranial vasculature. Stent-assisted coil embolization is a novel treatment for complex wide-necked aneurysms, as stents provide a buttress that allows for coil deposition while preventing coil herniation into the parent vessel lumen. We describe a case of stent-assisted coil embolization of a complex wide-necked vertebral confluence aneurysm. CASE DESCRIPTION: A 61-year-old woman presented with a Hunt-Hess III, Fisher Grade III subarachnoid hemorrhage secondary to a ruptured vertebral confluence aneurysm demonstrated on angiography. The patient underwent emergent angiography and attempted coiling of a vertebral confluence aneurysm. Because of the aneurysm's complex wide neck and the presence of subclavian steal syndrome, the coils repeatedly herniated into the left vertebral and basilar artery lumina. A flexible coronary stent was deployed across the aneurysm neck, preventing coil herniation and allowing for greater coil deposition. The patient tolerated the procedure and underwent repeat coiling 2 months postoperatively because of mild coil compaction. This resulted in 100% occlusion and the patient is neurologically normal except for a sixth nerve palsy which had been present after the hemorrhage. CONCLUSION: Recent advances in stent technology allow negotiation of the tortuous posterior circulation vasculature. Stent-assisted coil embolization of complex, wide-necked vertebral confluence aneurysms may be an alternative intervention for these surgically challenging lesions.     

Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.

In a multicenter study, 120 patients with intracranial aneurysms presenting a high surgical risk were treated using electrolytically detachable coils and electrothrombosis via an endovascular approach. The results of treatment in patients with posterior fossa aneurysms (42 patients with 43 aneurysms) are presented. The most frequent clinical presentation was subarachnoid hemorrhage (24 cases). The clinical follow-up periods ranged from 1 week to 18 months. Complete aneurysm occlusion was obtained in 13 of 16 aneurysms with a small neck and in four of 26 wide-necked aneurysms. A 70% to 98% thrombosis of the aneurysm was achieved in 22 of 26 aneurysms with a wide neck and in three of 16 small-necked aneurysms. One aneurysm could not be treated due to a technical complication. Two cases required postprocedural surgical clipping of a residual aneurysm. One patient (originally in Hunt and Hess Grade V) experienced procedural rupture of the aneurysm requiring an emergency parent artery occlusion. He eventually died 5 days later. Another patient (originally in Grade IV) had coil migration and posterior cerebral artery territory ischemia. A third patient developed a permanent neurological deficit (hemianopsia) after complete occlusion of a wide-necked basilar bifurcation aneurysm. One patient, harboring an inoperable giant basilar bifurcation aneurysm, died from aneurysm bleeding 18 months after partial occlusion. Overall morbidity and mortality rates related to treatment were 4.8% (two cases) and 2.4% (one case), respectively (2.6% and 0% if considering only patients in Hunt and Hess Grades I, II, and III). It is suggested that this technique is a viable alternative in the management of patients with posterior fossa aneurysms associated with high surgical risk. Longer angiographic and clinical follow-up study is necessary to determine the long-term efficacy of this recently developed endovascular occlusion technique. Close postoperative angiographic and clinical monitoring of patients with wide-necked subtotally occluded aneurysms is mandatory to check for potential aneurysmal recanalization, regrowth, and rupture.     

Application of the Willis covered stent in the treatment of internal carotid artery blood blister-like aneurysms

The optimal treatment for blood blister-like aneurysm (BBA) has not yet been determined, and BBA has a high recurrence rate after stent-assisted embolization. The purpose of the present study was to evaluate the safety and feasibility of patients with BBA rupture in the acute phase or patients with BBA who have recurrence after stent-assisted coil embolization. Eight patients (8 women, mean age 50.3?±?3.7 years) who presented with ruptured BBA or recurrence BBA that had been treated by stent-assisted embolization (5 patients after primary treatment of stent-assisted embolization) were retrospectively reviewed. Clinical follow-up was performed at 1 year after endovascular treatment. All patients were successfully treated with the WCS, and immediate postoperative angiography showed that the aneurysms were completely isolated. The ophthalmic artery was covered by WCS in one patient; however, this patient did not show any clinical visual field or vision symptoms. Procedure-related complications such as aneurysm rupture, vasospasm, acute thrombosis, or thromboembolism did not occur in any case. All patients were followed up for 1 year after endovascular treatment, and they were in good condition without recurrence. One patient developed delayed bleeding at the right temporal lobe. All patients had good clinical prognosis (modified Rankin Scale score?≤?2). WCS implantation may be a safe and feasible strategy for patients with BBA rupture in the acute phase and patients with BBA who have recurrence after stent-assisted coil embolization and is a promising option worth exploring.

     

Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding

OBJECT: During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding. METHODS: Patients were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annual questionnaires. Stable angiographic occlusion was evident in 86.4% of small and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients (between 11 and 35 months posttreatment) and by rupture of a coincidental untreated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embolization, with no rebleeding in subsequent years. Rebleeding occurred in three (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms that appeared stable on angiography. CONCLUSIONS: Periodic follow-up angiography after coil embolization is recommended to identify aneurysm recurrence and those patients at a high risk of late rebleeding.     

血管内治疗大脑前动脉远端动脉瘤

目的观察血管内治疗大脑前动脉远端(DACA)动脉瘤的效果。方法回顾性分析14例接受血管内治疗的DACA动脉瘤患者(共15个动脉瘤),对10个动脉瘤行单纯弹簧圈栓塞、4个动脉瘤行支架辅助下弹簧圈栓塞,1个以Onyx胶栓塞。之后复查DSA,根据Raymond分级评价即刻疗效。术后6个月复查DSA,以改良Rankin量表(mRS)评估预后,mRS评分0~2分为结局良好。结果术后即刻12个动脉瘤Ⅰ级栓塞,3个Ⅱ级栓塞。术中、术后均未发生缺血等并发症。1例术后12 h死于动脉瘤再次破裂出血。术后6个月随访显示1例复发,10例结局良好(mRS评分0~2分),另2例mRS评分分别为3分、4分。结论个体化血管内治疗DACA动脉瘤安全、有效。     

Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils

OBJECTIVE: The long-term durability of the endovascular occlusion of cerebral aneurysms is one of the major factors limiting the more widespread use of this technique. Long-term occlusion of wide-necked aneurysms has improved with new assistive devices that seem to improve aneurysm occlusion while protecting the parent vessel. We report the use of a new intracranial stent--the Neuroform microstent--in the treatment of patients with wide-necked cerebral aneurysms. METHODS: Patients identified as harboring wide-necked intracranial aneurysms were evaluated for stent-assisted coiling. After appropriate anticoagulation was performed, depending on whether the aneurysm was ruptured or unruptured, the Neuroform stent was delivered across the neck of the aneurysm and deployed with a coil pusher. After stent placement, standard coil occlusion of the aneurysm was achieved in the majority of cases. RESULTS: Fifty-six patients were identified as having wide-necked intracranial aneurysms suitable for stent-assisted coiling. A total of 49 aneurysms in 48 patients were treated with this procedure. In eight cases, stent deployment failed. Forty-one of the aneurysms were initially stented, followed by coil placement. Six aneurysms were stented only, and one aneurysm was initially coiled, followed by stent placement. There were five deaths (8.9%), one of which occurred secondary to a stroke after the procedure (1.8%). Four patients (7%) experienced thromboembolic events, three of which were considered to have been secondary to the procedure (5.3%). In addition, there were two femoral pseudoaneurysms. The overall complication rate was 10.7%. Five patients were available for follow-up angiographic evaluation, and their cases are discussed. CONCLUSION: Intracranial stenting may overcome important technical limitations in current endovascular therapy by improving the occlusion of wide-necked aneurysms while protecting the parent vessel.     

Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note

The authors present two cases of patients with small, acutely ruptured, wide-necked aneurysms of the distal vertebral artery that were not amenable to conventional coil embolization and were instead treated by means of a double-stent method in which one stent was placed inside another. Angiography performed immediately after the procedure revealed a significant reduction in aneurysm filling; total occlusion of the lesion was observed after 7 days and confirmed 6 months later in both aneurysms. By placing one stent inside the other, stent permeability can be reduced, which may result in significant hemodynamic changes with accelerated aneurysm thrombosis. This double-stent method may represent a therapeutic alternative, especially in cases of small, wide-necked aneurysms in which conventional endovascular techniques or stent-supported coil embolization is not considered feasible or is believed to be too dangerous, and surgical treatment is contra-indicated.     

Stent-assisted Gugliemi detachable coil repair of wide-necked renal artery aneurysm using 3-D angiography

PURPOSE: To report a wide-necked renal artery aneurysm treated successfully with stent-assisted Gugliemi detachable coil occlusion, assisted by three-dimensional (3-D) angiography. CASE REPORT: A 56-year-old woman with history of hypertension presented with a 2.5-cm wide-necked saccular aneurysm involving her distal right renal artery. A balloon-expandable stent was positioned across the neck of the aneurysm and multiple Gugliemi detachable coils were deployed through a microcatheter inserted through the interstices of the stent into the aneurysm sac, guided by 3-D angiography. Follow-up 3-D angiography at 6 months revealed a patent renal artery with continued exclusion of the aneurysm and preservation of renal blood flow. CONCLUSION: Stent-assisted coil occlusion assisted by 3-D angiography is a potential renal-sparing endovascular approach to treating wide-necked renal artery aneurysms with complex vascular anatomy.