国产Tubridge血流导向装置治疗中小型颅内动脉瘤的短期疗效及安全性分析

目的 评估国产Tubridge治疗中小型颅内动脉瘤的短期疗效和安全性。方法 回顾性分析2020年8月至2021年12月在复旦大学附属华山医院静安分院介入科接受Tubridge治疗的23例颅内未破裂中小型（≤10mm）动脉瘤患者的临床资料,共计31个动脉瘤;术后采用改良Rankin量表（mRS）评分评估患者临床预后（0～2分为预后良好,3～5分为预后不良）,术后采用Raymond分级评估动脉瘤栓塞情况。结果 支架置入成功率100%。末次平均随访时间6.6个月,17例患者行数字减影血管造影（digital subtraction angiography,DSA）造影随访,其中RaymondⅠ级19个,RaymondⅡ级1个,RaymondⅢ级5个,末次造影随访动脉瘤完全栓塞率76%;术后发生1例出血并发症（4.4%）,2例缺血并发症（8.7%）,4例无症状性支架内膜增生伴轻度狭窄,症状性并发症发生率8.7%。全部患者获得临床随访结果,mRS≤2分22例,mRS>2分1例。结论 国产Tubridge治疗颅内中小型动脉瘤具有良好的效果,但是术后出血或缺血性并发症不容忽视。     

支架辅助弹簧圈栓塞颅内破裂动脉瘤临床分析

【摘要】 目的 探讨支架辅助弹簧圈栓塞治疗颅内破裂动脉瘤的有效性和安全性。方法 回顾性分析2011年1月1日至2017年12月31日南方医科大学珠江医院采用支架辅助弹簧圈栓塞治疗的230例颅内动脉瘤患者临床资料，观察终止期为2018年6月30日。观察术中和术后并发症，采用改良Rankin量表（mRS）评分评估临床预后。 结果 颅内动脉瘤未破裂组166例患者血栓、出血事件发生率分别为7.2%（10/166）、0，破裂组64例患者血栓、出血事件发生率分别为7.8%（5/64）、4.7%（3/64）。动脉瘤复发率在破裂组、未破裂组分别为26.6%（17/64）、16.3%（27/166）。两组并发症和复发率差异均无统计学意义（P＞0.05）。通过广义评估方程分析重复测量数据，破裂组患者最终随访mRS评分与术前相比显著降低（P＜0.001），未破裂组mRS评分变化无显著差异（P＞0.05）。 结论 支架辅助弹簧圈栓塞治疗颅内破裂动脉瘤安全有效。     

支架技术在颅内复杂动脉瘤治疗中的应用

目的探讨支架在颅内复杂动脉瘤中的治疗技术及应用价值。方法回顾性分析应用支架技术辅助栓塞治疗的31例颅内动脉瘤患者（宽颈动脉瘤28例,梭形动脉瘤3例）的临床资料。术中将支架引至动脉瘤处释放支架覆盖动脉瘤颈,并结合弹簧圈栓塞术。结果 31例共置入支架32枚,其中Enterprise支架24枚,LEO支架5枚,Solitaire AB支架3枚。采用单纯支架置入技术2例,此2例微小动脉瘤术后见瘤腔内造影剂滞留。支架结合弹簧圈治疗29例,其中支架先释放技术7例,支架后释放技术22例,支架结合弹簧圈治疗组取得满意疗效。术后即刻栓塞结果按改良的Raymond分级：动脉瘤体完全栓塞20例（Ⅰ级）,瘤颈残留7例（Ⅱ级）,瘤体显影2例（Ⅲ级）。随访1～6个月未发生再出血及缺血并发症。结论支架辅助栓塞技术是治疗颅内动脉瘤安全有效的方法,可提高动脉瘤栓塞的致密程度,采用支架后释放技术使绝大多数颅内复杂动脉瘤的介入治疗成为可能。     

球囊联合支架辅助弹簧圈栓塞颅内分叉部宽颈动脉瘤

目的：分析球囊联合支架辅助弹簧圈栓塞术治疗颅内分叉部宽颈动脉瘤的优势。方法回顾性分析2014年1月至4月昆明医科大学第一附属医院采用球囊联合支架辅助弹簧圈栓塞术治疗20例共25枚颅内分叉部宽颈动脉瘤患者的临床资料。20例患者中曾患蛛网膜下腔出血12例,无出血史8例;25枚颅内分叉部宽颈动脉瘤中位于基部动脉未端分叉部14枚,大脑中动脉分叉部8枚,颈内动脉末端分叉部3枚。根据Raymond分级评价介入治疗术后即刻和3个月后三维DSA检查结果,根据改良Rankin 量表（mRS）评分评价术后3个月临床疗效。结果球囊联合支架辅助弹簧圈栓塞术后即刻三维DSA检查显示25枚颅内分叉部宽颈动脉瘤中RaymondⅠ级21枚,Ⅱ级2枚,Ⅲ级2枚;术后3个月DSA随访显示RaymondⅠ级20枚,Ⅱ级3枚,Ⅲ级2枚。术后3个月mRS评分显示17例患者0分,1例患者1分,均预后良好;2例患者4～6分,预后不良。结论球囊联合支架辅助弹簧圈栓塞术在颅内分叉部宽颈动脉瘤介入治疗术中具有明显优势。     

短期加用替罗非班在支架辅助弹簧圈栓塞梭形动脉瘤中的安全性与有效性研究

目的评估支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内,在标准双抗血小板治疗的基础上,短期应用小剂量替罗非班在降低缺血并发症方面的安全性及有效性。 方法回顾分析我中心2015年1月至2020年12月颅内未破裂梭形动脉瘤接受支架辅助弹簧圈栓塞治疗,并在手术过程中及术后24 h内静脉接受替罗非班（0.1 μg/kg/min）预防血小板聚集的患者资料。记录并分析围手术期并发症,动脉瘤栓塞程度及术后3个月随访时的mRS评分。 结果本研究共纳入38例患者,39枚动脉瘤,动脉瘤平均直径（6.4±2.1）mm。其中,26枚动脉瘤接受了单支架辅助弹簧圈栓塞治疗,13枚动脉瘤接受了双支架辅助弹簧圈栓塞治疗。术后即刻78.9%（30/38）的动脉瘤实现完全栓塞;在26例接受脑血管造影复查的患者中,92.3%（24/26）的患者动脉瘤实现完全闭塞。围手术期缺血并发症发生率为7.9%（3/38）;无出血并发症发生。3个月随访的良好预后率为97.4%（37/38） （mRS评分为0~1分）。 结论支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内,静脉加用小剂量替罗非班未增加出血并发症。但是,由于样本量偏少,缺少对比,在降低缺血并发症方面的有效性尚需进一步证实。     

支架治疗颅内远端动脉瘤安全性和有效性分析

【摘要】 目的 探讨血管内支架治疗颅内远端动脉瘤的安全性和有效性。方法 回顾性分析2018年1月至2021年12月在河南省人民医院接受血管内支架治疗的40例颅内远端动脉瘤患者临床资料,动脉瘤共43枚。动脉瘤辅助支架栓塞治疗32例（34枚）,血流导向装置治疗8例（9枚）。颅内远端动脉瘤定义为位于前循环中A2/M2段、后循环中P2段及其远端动脉瘤。随访期采用Raymond分级评分评估动脉瘤栓塞情况,改良Rankin量表（mRS）评分评估临床预后。结果 34枚动脉瘤成功完成支架辅助弹簧圈栓塞治疗,末次影像随访结果显示31枚（91.2%）动脉瘤Raymond评分Ⅰ级,3枚Ⅱ级。4例（12.5%）患者发生手术相关缺血性并发症。中位随访6.5个月,31例（96.9%）患者mRS评分为0～2分,获得良好预后。9枚动脉瘤成功完成血流导向装置治疗,末次影像随访结果显示5枚动脉瘤Raymond分级Ⅰ级,3枚Ⅱ级,1枚失访。1例患者发生缺血性并发症。中位随访9个月,6例患者mRS评分为0～2分,获得良好预后。结论 血管内支架辅助栓塞颅内远端动脉瘤是一种安全有效的治疗策略。小口径支架应用提高了颅内远端动脉瘤治疗闭塞率,血流导向装置是用传统方法治疗具有挑战性的远端动脉瘤的有效替代方法。     

新型自膨式颅内支架Enterprise在西藏高原治疗宽颈破裂颅内动脉瘤中的应用

目的总结在西藏高原地区利用新型颅内专用支架Enterprise经血管内介入治疗破裂出血的宽颈颅内动脉瘤的疗效及围手术期的处理。方法 6例破裂出血的颅内宽颈动脉瘤患者均行数字减影血管造影（DSA）检查确诊,并根据动脉瘤的特点实施个性化血管内介入治疗,其中5例行支架辅助铂金弹簧圈栓塞术,1例行单纯支架贴敷术。结果 6例中完全栓塞4例,次全栓塞1例,单纯支架贴敷1例。术中复查DSA显示：动脉瘤显影消失5例,单纯支架置入后瘤腔内对比剂滞留1例。1例术后出现对侧肢体偏瘫（肌力0级）,经治疗后,肌力恢复（上肢V-级、下肢V级）。除术前Hunt＆HessⅣ级、Glasgow4分的1例因继发肺部感染、脑积水恢复至Hunt＆HessⅢ级、Glasgow 7分继续留院治疗外,其余5例均恢复正常。门诊随访1～5个月,无再出血或缺血事件发生。结论高原地区利用Enterprise经血管内介入治疗破裂出血的宽颈颅内动脉瘤是安全、有效、可行的,但围手术期的抗凝及抗血小板聚集治疗需注意高原低氧因素的影响。     

Solitaire AB支架辅助栓塞颅内动脉瘤临床随访研究

目的观察Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤初中期效果。方法回顾性分析2009年至2012年期间采用Solitaire AB支架辅助弹簧圈栓塞治疗的49例颅内宽颈动脉瘤患者49个动脉瘤,其中41例患者41个动脉瘤（26个破裂出血,15个未破裂）术后随访12～48个月,根据改良Rankin评分、DSA、CTA或MRA检查评价颅内动脉瘤影像学及临床结果。结果栓塞术后有2例动脉瘤再次破裂出血,3例脑梗死,1例载瘤动脉闭塞,死亡1例,并发症发生率为14.2%。栓塞术后12个月DSA、MRA或CTA检查显示,32个动脉瘤（32/41,78.0%）完全栓塞,明显高于术后即刻（21个,42.9%）（P＝0.02）;瘤颈残留7个（17.1%）,部分栓塞2个（4.9%）,均较术后即刻有改善。24个动脉瘤（58.5%）稳定而无变化,复发4个（9.7%）。末次随访时改良Rankin评分显示0分18例（43.9%）,1分10例（24.4%）,2分5例（12.2%）,3分4例（9.8%）,4分2例（4.85%）,5分2例（4.85%）。患者日常活动能力自理率为80.5%,预后良好。结论 Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤安全有效,有助于提高完全栓塞率,降低操作相关并发症。     

颅内多发动脉瘤的介入诊治分析

目的：探讨血管内介入诊治颅内多发动脉瘤的临床效果。 方法：选取我院神经外科2016年1月至2018年6月收治的29例颅内多发动脉瘤患者,均行脑血管造影后确诊接受血管内单纯或支架辅助的弹簧圈填塞治疗。采用Raymond分级评价患者动脉瘤填塞的程度,格拉斯哥预后评分（GOS）评价治疗效果。 结果：对29例患者的40枚动脉瘤实施了介入治疗,按照Raymond分级,Ⅰ级（完全填塞）30枚,Ⅱ级（近全栓塞）4枚,Ⅲ级（部分栓塞）2枚,Pipeline密网支架覆盖瘤颈4枚。术后患者的GOS评分为5分18例,4分8例,3分2例,2分1例。 结论：采用血管内介入方式治疗颅内多发动脉瘤可以取得较高的动脉瘤填塞程度及较好的临床效果和预后。     

颅内动脉瘤内支架辅助治疗的并发症分析

目的分析内支架辅助治疗颅内动脉瘤的并发症,探讨降低并发症的方法。方法 2009年6月至2012年3月收治38例颅内动脉瘤患者,其中曾有蛛网膜下腔出血17例,无出血史21例;颅内单发动脉瘤26例,多发动脉瘤12例,总计50枚动脉瘤中,位于前交通动脉11枚,后交通动脉17枚,大脑中动脉8枚,椎动脉5枚,颈内动脉床突段9枚。在对38例50枚动脉瘤的介入治疗中,采用单纯弹簧圈栓塞4枚,单纯支架覆盖12枚,支架辅助弹簧圈栓塞34枚,其中使用LEO支架27枚,Neuroform支架16枚,Solitaire支架3枚。结果 38例患者的50枚动脉瘤中,对46枚行支架治疗,动脉瘤内支架辅助治疗的总并发症率为19.6%(9/46),包括术中动脉瘤破裂出血3例,支架诱发血栓形成5例(均为LEO支架),致支架移位1例,术后发生脑梗死致偏瘫2例,因并发肺部感染死亡1例;术中支架打开不良1例。结论颅内动脉瘤的内支架辅助治疗有较高的脑血管并发症,需要加强内支架辅助治疗的围手术期管理,以减低并发症发生率和改善并发症患者的预后。     

LVIS支架辅助栓塞颅内动脉瘤安全性及有效性分析

目的 评价低剖面编织型设计的自膨式LVIS支架辅助弹簧圈栓塞治疗颅内动脉瘤的安全性及有效性.方法 回顾性分析2014年4月至2016年6月收治的127例LVIS支架辅助弹簧圈栓塞治疗颅内动脉瘤患者临床资料,分析手术安全性、术后即刻效果、复发率及临床、影像学随访结果.结果 127例颅内动脉瘤患者介入栓塞术中成功植入130枚LVIS支架,1例植入失败,技术成功率99.2％.7例术中或术后出现支架内血栓事件(7/127,5.5％),无围手术期出血、死亡.术后即刻动脉瘤完全闭塞112枚(88.1％),瘤颈残余15枚(11.9％).术后平均随访8个月,37例影像学复查显示33例(89.1％)动脉瘤完全闭塞,4例(10.9％)瘤体仍显影,其中3例为术后即刻有瘤体显影,1例为动脉瘤复发,无死亡.结论 LVIS支架辅助栓塞颅内动脉瘤安全有效,但远期疗效有待进一步随访观察.     

A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms

Introduction We report the results of a prospective clinical study using a new self-expanding nitinol stent (Enterprise) designed for the treatment of wide-necked intracranial aneurysms. Methods We treated 31 saccular, wide-necked intracranial aneurysms in 30 patients. Ten aneurysms had recanalized after prior endovascular treatment without a stent, and 21 aneurysms had not been treated before. Results Stent deployment was successful in all procedures. Additional coil embolization was performed in all aneurysms. Initial complete angiographic occlusion was achieved in 6 aneurysms, a neck remnant was left in 18 aneurysms and there were 7 residual aneurysms. Angiographic follow-up examinations of 30 lesions after 6 months demonstrated 15 complete occlusions, 8 neck remnants and 7 residual aneurysms. One patient refused the 6-month angiographic follow-up. Spontaneous occlusion of the aneurysm had occurred in 14 patients, and 6 aneurysms showed recanalization. Four of these residual aneurysms were retreated. At the 6-month follow-up, 29 parent arteries were unaffected, whereas two parent vessels demonstrated minor asymptomatic narrowing at the stent site. Two patients experienced one or more possible or probable device-related serious adverse events during the 6-month follow-up period. There was no procedural morbidity or mortality at 6 months after the procedure. Conclusion The reported results demonstrated the safety and feasibility of the Cordis Neurovascular Enterprise stent in the treatment of wide-necked intracranial aneurysms. Initial clinical and angiographic results are favorable. Werner Weber and Martin Bendszus contributed equally to this work.     

Coil embolization of intracranial saccular aneurysms using the Low-profile Visualized Intraluminal Support (LVIS™) device

Introduction

The novel Low-profile Visualized Intraluminal Support (LVIS?, LVIS and LVIS Jr.) device was recently introduced for stent-supported coil embolization of intracranial aneurysms. Periprocedural and midterm follow-up results for its use in stent-supported coil embolization of unruptured aneurysms are presented herein.

Methods

In this prospective multicenter study, clinical and radiologic outcomes were analyzed for 55 patients with saccular aneurysms undergoing LVIS-assisted coil embolization between October 2012 and February 2013. Magnetic resonance angiography or digital subtraction angiography was performed to evaluate midterm follow-up results.

Results

The standard LVIS device, deployed in 27 patients, was more often used in internal carotid artery (ICA) aneurysms (n?=?19), whereas the LVIS Jr. (a lower profile stent, n?=?28) was generally reserved for anterior communicating artery (n?=?14) and middle cerebral artery (n?=?8) aneurysms. With LVIS-assisted coil embolization, successful occlusion was achieved in 45 aneurysms (81.8 %). Although no instances of navigation failure or stent malposition occurred, segmentally incomplete stent expansion was seen in five patients where the higher profile LVIS was applied to ICA including carotid siphon. Procedural morbidity was low (2/55, 3.6 %), limited to symptomatic thromboembolism. In the imaging of lesions (54/55, 98.2 %) at 6-month follow-up, only a single instances of major recanalization (1.9 %) occurred. Follow-up angiography of 30 aneurysms (54.5 %) demonstrated in-stent stenosis in 26 (86.7 %), with no instances of stent migration. Only one patient suffered late delayed infarction (modified Rankin Scale 1).

Conclusion

The LVIS device performed acceptably in stent-assisted coil embolization of non-ruptured aneurysms due to easy navigation and precise placement, although segmentally incomplete stent expansion and delayed in-stent stenosis were issues.     

Preliminary Experience with Stent-Assisted Coiling of Aneurysms Arising from Small (<2.5 mm) Cerebral Vessels Using The Low-Profile Visualized Intraluminal Support Device

BACKGROUND AND PURPOSE:The Low-Profile Visualized Intraluminal Support (LVIS) stent is a new device recently introduced for the treatment of wide-neck intracranial aneurysms. This single-center study presents the authors'' preliminary experience using the LVIS stent to treat saccular aneurysms with parent arteries smaller than 2.5 mm.MATERIALS AND METHODS:Aneurysms with a LVIS stent used in a small parent vessel (<2.5 mm in diameter) between October 2014 and April 2016 were included. Procedure-related complications, angiographic results, clinical outcomes, and midterm follow-up data were analyzed retrospectively.RESULTS:A total of 22 patients was studied, including 5 ruptured and 17 unruptured aneurysms. Most of the aneurysms were located in the anterior circulation (90.9%). Stent placement in the parent arteries measuring 1.7–2.4 mm in diameter (mean, 2.1 mm) was successful in 100% of cases. Procedure-related complication developed in 1 patient (4.5%) who presented with aneurysm rupture. No permanent morbidity and mortality occurred. Immediate angiographic outcome showed complete occlusion in 8 aneurysms (36.4%), neck residual in 8 (36.4%), and residual aneurysm in 6 (27.3%). All patients underwent angiographic follow-up at a mean of 8.3 months, which revealed complete occlusion in 18 (81.8%) patients, neck remnant in 3 (13.6%), and residual sac in 1 (4.5%). No recanalization of the target aneurysm was observed. There was 1 case with asymptomatic in-stent stenosis.CONCLUSIONS:Our preliminary results show that the deployment of LVIS stents in small vessels is feasible, safe, and effective in the midterm. Larger studies with long-term follow-up are needed to validate our promising results.

The introduction of stent devices has greatly advanced the endovascular treatment options of intracranial aneurysms. Many aneurysms that had been previously considered untreatable because of their morphology, including those with unfavorable dome-to-neck ratios and/or location, are now amenable to coiling with the use of stents.^1,2 However, the use of stents for treating wide-neck distal intracranial aneurysms with small parent vessels remains challenging. Several previous studies reported relatively high rates of periprocedural thromboembolic events and in-stent stenosis.^3–11The Low-Profile Visualized Intraluminal Support (LVIS) device (MicroVention, Tustin, California), a new device offering an option between conventional stents and flow diverters, is designed for the stent-assisted coil embolization of wide-neck intracranial aneurysms. There is an increasing number of publications on the use of the LVIS device.^12–16 However, to our knowledge, no studies to date have specifically investigated the placement of the LVIS device in small vessels. Hence, we conducted this retrospective study to examine the LVIS device in terms of its safety, deployment feasibility, and treatment effectiveness in intracranial aneurysms with parent vessels measuring <2.5 mm in diameter.     

Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: a single center experience

Objective

The aim of the present retrospective study is to compare outcome of the endovascular treatment using the Enterprise stent in intracranial wide-necked saccular and dissecting aneurysms.

Methods

Forty-six patients with 50 complex intracranial aneurysms admitted between June 2009 and November 2010 were treated using Enterprise stents. Thirty-one aneurysms were wide-necked saccular, 19 aneurysms dissecting. In 48 cases, aneurysms were occluded by stent-assisted coiling; in 2 cases, by stent alone.

Results

Among the aneurysms treated with the Enterprise stent, patient sex, aneurysm location, hypertension history and the immediate angiographic results differed significantly between the saccular and dissecting aneurysm groups. However, recurrence rate, clinical follow-up outcomes did not differ significantly between the saccular and dissecting groups. There was 1 (2%) procedure-related complication, which caused death in the saccular group. At mean 9.1-month follow-up, the result was good in all dissecting cases and good in 30 saccular cases. There was 1 recurrence in each group.

Conclusions

Enterprise stent is very useful for endovascular embolization of intracranial wide-necked saccular and dissecting aneurysms because it is easy to navigate and place precisely. The overall morbidity and mortality rates were low.     

Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience

BACKGROUND AND PURPOSE: Endovascular treatment of wide-necked aneurysms remains a therapeutic challenge. We conducted this study to evaluate the angiographic results and clinical outcome of patients treated with stent-assisted coiling by using a recently available self-expandable intracranial stent. METHODS: A retrospective review of all patients treated with self-expandable stent-assisted coiling between September 2002 and December 2003 was done. Treatment was attempted in 32 patients with 35 aneurysms. Four of the aneurysms were ruptured. All had either a dome-to-neck ratio less than 2 and/or a neck diameter of 5 mm or larger. Following stent placement, coiling was attempted in 33 of 34 aneurysms. The technical success of the procedure, procedure related complications, and the angiographic results were documented. RESULTS: In 34 of 35 aneurysms, stent deployment across the neck of the aneurysm was successful. Coiling was performed successfully in 30 of 33 aneurysms. In 20 aneurysms, immediate posttreatment angiography showed either total (17%) or satisfactory (50%) occlusion. Procedure-related mortality occurred in one patient (3.1%). Adverse events occurred in eight patients (25%); in three of them permanent neurologic deficit resulted (9.3%). In six patients, thrombus formation occurred within the stented segments during the procedure and reopro infusion was used. Follow-up angiography was available in 12 (40%) of 30 treated aneurysms. CONCLUSION: In our practice use of the self-expandable stent seemed to facilitate endovascular treatment of wide-necked intracranial aneurysms. Difficulty of deployment and stent thrombogenicity are the main drawbacks of the system.     

血管内支架结合弹簧圈治疗颅内宽颈动脉瘤的影像学随访结果

目的 总结血管内支架结合弹簧圈治疗颅内宽颈动脉瘤的影像学随访结果，了解支架技术在脑动脉瘤治疗中的作用。方法 62例颅内宽颈动脉瘤患者接受血管内支架结合弹簧圈栓塞治疗，并在术后行脑血管造影及临床随访。结果 所有患者均成功植入支架，47例动脉瘤达到致密填塞，15例大部填塞，载瘤动脉通畅。1～6个月造影随访56例动脉瘤内无造影剂显影，4例仍有瘤颈残留，1例复发而再次治疗；12～37个月随访43例中，2例瘤颈残余，1例动脉瘤复发，其余完全闭塞，弹簧圈形态无改变。结论 血管内支架植入后明显改变瘤内血流动力学并促进血栓形成，通过促进瘤颈内膜形成达到影像学治愈。     

One-Year Angiographic Follow-Up after WEB-SL Endovascular Treatment of Wide-Neck Bifurcation Intracranial Aneurysms

BACKGROUND AND PURPOSE:Endovascular coiling of wide-neck intracranial aneurysms is associated with low rates of initial angiographic occlusion and high rates of recurrence. The WEB intrasaccular device has been developed specifically for this indication. To date, there has been no report of the long-term follow-up of a series of patients with aneurysms treated with this type of device, to our knowledge. Our aim was to evaluate a 1-year follow-up of angiographic results in a prospective single-center series of patients treated with the WEB-Single-Layer (SL) device.MATERIALS AND METHODS:All patients treated with the WEB-SL device in our center between August 2013 and May 2014 were prospectively included. One-year angiographic outcomes were assessed. Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm.RESULTS:Eight patients with 8 unruptured wide-neck aneurysms were enrolled in this study. Average dome width was 7.5 mm (range, 5.4–10.7 mm), and average neck size was 4.9 mm (range, 2.6–6.5 mm). One-year angiographic follow-up obtained in all aneurysms included 1 complete aneurysm occlusion (12.5%), 6 neck remnants (75%), and 1 aneurysm remnant (12.5%). Of 8 aneurysms, worsening of aneurysm occlusion was observed in 2 (25%) by compression of the WEB device. There was no angiographic recurrence of initially totally occluded aneurysms. No bleeding was observed during the follow-up period.CONCLUSIONS:Endovascular therapy of intracranial aneurysms with the WEB-SL device allows treatment of wide-neck aneurysms with a high rate of neck remnant at 1 year, at least partially explained by WEB compression. Initial size selection and technologic improvements could be an option for optimization of aneurysm occlusion in WEB-SL treatment.

The WEB aneurysm embolization system (Sequent Medical, Aliso Viejo, California) is an intrasaccular braided device specifically developed for endovascular treatment of wide-neck intracranial aneurysms with the goal of disrupting flow at the aneurysm neck and promoting aneurysmal thrombosis without the need for reconstruction of the entire parent artery segment with a stent. Several types of WEB devices are currently available¹: the WEB-Dual-Layer (DL), which is made of 2 layers held together and creating 2 compartments, and the WEB-Single-Layer (SL), which is a single-layer device creating only 1 compartment. Only a few studies on the treatment of intracranial aneurysms by using the WEB-DL have been published,^2–5 and to date, only a single published article on aneurysms treated with WEB-SL reported a series including any anatomic follow-up.⁶ We recently published the 6-month clinical and anatomic outcomes of WEB-SL endovascular treatment.⁷The purpose of this study was to evaluate the 1-year angiographic results of patients managed with the WEB-SL device in a prospective single-center series.     

Neuroform颅内支架辅助栓塞宽颈颅内动脉瘤的初步经验

目的　报道我科使用Neuroform支架辅助可脱式弹簧圈栓塞宽颈脑动脉瘤的初步经验。方法　 2 2例 2 4枚宽颈颅内动脉瘤采用Neuroform支架和弹簧圈进行栓塞 ,其中急性破裂动脉瘤 19枚、未破裂动脉瘤 5枚。结果　支架均成功地释放 ,支架置入后的造影未发现有瘤内造影剂滞留的血流动力学改变。 10 0 %闭塞动脉瘤 18枚 ,90 %以上闭塞 5枚 ,1枚伴发的未破裂小型宽颈动脉瘤在支架置入后微导管无法超选 ,载瘤动脉均通畅。有 2枚动脉瘤虽有支架阻挡 ,但仍有部分弹簧圈畔进入载瘤动脉。所有患者没有出现与支架置入有关的症状性缺血性并发症。 17例造影随访中 ,有 1例在 3个月复查时发现再通 ,进行 2次栓塞完全闭塞动脉瘤 ,其余未见复发 ,结论　Neuroform颅内支架使用安全有效 ,适合于宽颈颅内动脉瘤的支架辅助弹簧圈栓塞 ,特别适合于迂曲的脑血管 ;其径向支撑力较差 ,在输送微导管时应防止其移位 ;其支架网眼较大 ,对血流动力学改变不明显 ,致密填塞是重要的 ,在输送弹簧圈时仍应防止弹簧圈畔进入载瘤动脉 ;术前、术后抗血小板药物的应用以及术后严格的系列造影随访是必要的。     

Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability

INTRODUCTION: The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up. MATERIALS AND METHODS: Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with (<10 mm) small neck (<4 mm) (SASN); 55 were small with wide neck (>/=4 mm) (SAWN); six were large (10-25 mm) (L); and one was giant (G) (>25 mm). The embolization technique was the same with that in standard bare coiling. RESULTS: Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively. CONCLUSIONS: Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial.