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1.
颈内动脉前壁动脉瘤支架结合弹簧圈栓塞术后再出血:病例报道 总被引:2,自引:2,他引:0
目的 报道1例应用支架结合弹簧圈栓塞治疗颈内动脉前壁宽颈动脉瘤后发生早期再出血的病例.方法 将球囊膨胀型血管内支架跨动脉瘤颈部位置并准确释放后,微导管超选进入动脉瘤内填塞弹簧圈.结果 支架成功置人,完全覆盖瘤颈,动脉瘤得到人部栓塞(90%以上),载瘤动脉及毗邻的侧支血管保持通畅,患者术后恢复良好,但是术后16 d因动脉瘤再次破裂出血导致死亡.结论 血管内支架结合弹簧圈栓塞治疗颈内动脉前肇宽颈动脉瘤是可行的,但应充分认识动脉瘤早期再次破裂出血的风险,短期随访及再治疗非常必要. 相似文献
2.
目的评价Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效。方法2007年至2011年应用Neuroform3支架辅助弹簧圈栓塞118例脑动脉瘤,其中86例为破裂出血性动脉瘤,32例为未破裂动脉瘤,76例在出血72 h内实施了治疗。术后对患者进行脑血管造影和临床随访。结果支架准确释放115例(97.5%),因为血管扭曲和痉挛失败植入支架1例,支架移位2例。实施单纯支架植入2例,采用微导管经支架网眼技术66例,支架后释放技术49例。术后即刻造影示动脉瘤完全栓塞87例(74.4%),次全栓塞30例(25.6%)。术中无动脉瘤破裂出血事件发生,术后症状性脑梗死3例,无症状性脑梗死5例。术后随访6~60个月,平均26.8个月,共随访到105例,复查1~5次脑血管造影,完全栓塞99例(84.6%),次全栓塞病例中11例(36.7%)存在血栓形成;9例(7.7%)瘤体复发,其中5例进行了再次治疗达到完全栓塞,术后所有患者均无再出血,除3例外,所有患者支架内无明显狭窄。结论 Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤安全、有效,仍需更长期的随访和多中心研究。 相似文献
3.
Chinmay Bhimaji Kulkarni Srikanth Moorthy Sreekumar Karumathil Pullara Rajesh Ramaih Kannan 《Korean journal of radiology》2013,14(6):931-934
We report a rare case of aneurysm of splenic artery arising anomalously from the superior mesenteric artery (SMA). The aneurysm was treated successfully by coil embolization of the splenic artery distal to aneurysm and then deploying a stent graft in the SMA. A combination of stent graft and coil embolization for the treatment of aberrant splenic artery aneurysm has been reported only once. We describe the imaging findings and the endovascular procedure in this patient. 相似文献
4.
Luo CB Chang FC Teng MM Guo WY Chang CY 《AJNR. American journal of neuroradiology》2008,29(10):1951-1955
BACKGROUND AND PURPOSE: Coil herniation into the parent artery after detachment is an uncommon complication of embolization of the intracranial aneurysm. We report our experience with stent reconstruction of the lumen and flow of the internal carotid artery (ICA) after coil herniation during embolization for intracranial ICA aneurysms and the possible mechanisms of coil herniation.MATERIALS AND METHODS: A series of 216 consecutive patients was treated by endovascular coil embolizations for intracranial aneurysms. Of these patients, there were 9 (4 men, 5 women; 32–68 years of age) complicating with coil herniation into the ICA and undergoing stent deployment to reconstruct the ICA lumen (n = 8) or both lumen and flow (n = 1). Wide-neck aneurysms were found in 8 and narrow-neck, in 1. Aneurysms were in the posterior communicating artery (n = 5) and the paraophthalmic (n = 3) and cavernous portions (n = 1) of the ICA. Self-expandable stents were deployed in the ICA in 6; balloon-mounted stents were selected in 3.RESULTS: The causes of coil herniation appeared to be coil instability after detachment (n = 6), excessive embolization (n = 1), microcatheter-related problems (n = 1), or being pushed by subsequent coil embolization (n = 1). Endovascular stent placement to reconstruct the lumen and/or flow of the ICA was technically successful in all 9 patients; 1 needed a second stent due to further coil migration. No significant procedure-related complications were found. Clinical follow-up was 8–35 months.CONCLUSION: Coil herniation occasionally occurs during endovascular embolization of ICA aneurysms because of coil instability after detachment, excessive embolization, microcatheter-related problems, or pushing by subsequent coil embolization. In this small series, stent placement was safe and effective in the reconstruction of the arterial lumen and/or restoration of flow past a herniated coil mass.Endovascular detachable coil embolization of intracranial aneurysms has increasingly become an alternative treatment technique to neurosurgical aneurysm clipping.1 Despite increasing clinical experience and technologic improvements, endovascular treatment still has inherent risks of morbidity and mortality. The most common complication of endovascular embolization of the aneurysm is thromboembolic events, which may result from poor technique, endovascular devices, and/or poor flushing of the catheter systems. These complications may occur in 2.5%–28% of patients treated.2-4 Stent-assisted aneurysm embolization is a well-known tool in the management of intracranial wide-neck aneurysms to prevent coil protrusion into the parent vessel and may allow safer and denser packing of the aneurysm sac.5-8 However, to our knowledge, stent as a salvage procedure to reconstruct the lumen and/or blood flow of the parent artery during the procedure has not been well evaluated.The purpose of our study was to report our experience using stents to reconstruct the lumen and/or blood flow of the parent artery after coil herniation in the internal carotid artery (ICA) during embolization of intracranial ICA aneurysms and to report possible mechanisms of coil herniation. 相似文献
5.
Manninen HI Berg M Vanninen RL 《Journal of vascular and interventional radiology : JVIR》2008,19(4):487-492
PURPOSE: To report preliminary results of stent-assisted coil embolization in the treatment of wide-necked renal artery bifurcation aneurysms. MATERIALS AND METHODS: Four patients (three women, one man; mean age, 54 years; range, 49-67 y) with wide-necked renal artery aneurysms were treated with dedicated neurointerventional self-expanding nitinol stent-assisted coil embolization during a 2-year period. The stent was delivered over the neck of the aneurysm, after which the aneurysm was filled with detachable coils through a microcatheter placed into the aneurysm through the stent mesh. RESULTS: Stent delivery and coil embolization was successfully completed in all cases. Complete aneurysm occlusion without coil protrusion or arterial flow compromise was obtained in all patients. A small peripheral subsegmental renal infarction necessitating no therapy was registered in one patient on postembolization computed tomography. At follow-up angiography 1 year after embolization, no aneurysm recanalization or arterial obstruction was registered. CONCLUSIONS: Our preliminary experience indicates that stent-assisted coil embolization is technically feasible and effective for the exclusion of challenging renal artery bifurcation aneurysms without the sacrifice of any branch arteries. 相似文献
6.
Emergent management of ruptured pericallosal-callosomarginal artery aneurysm using stent-assisted coil embolization 总被引:1,自引:0,他引:1
We present a case of a ruptured bilobed pericallosal aneurysm successfully treated with coil embolization through a Neuroform stent. A 48-year-old male presented with subarachnoid hemorrhage (SAH) following rupture of a previously clipped aneurysm at the bifurcation of the pericallosal and callosomarginal arteries, primarily along the pericallosal artery, Hunt and Hess grade 5. After an initial unsuccessful attempt to embolize the wide-neck aneurysm with a detachable coil, a 4×15 Neuroform stent was uneventfully deployed across the aneurysm neck followed by successful coil embolization using detachable coils. We believe this case describes the first successful use of the Neuroform stent to assist in coiling of a wide-neck pericallosal-callosomarginal aneurysm. This case highlights the expanding role of emergency endovascular therapies to manage severe SAH. 相似文献
7.
Stephen L. Ferrara Thomas B. Kinney Lee D. Hall 《Journal of vascular and interventional radiology : JVIR》2012,23(10):1330-1334
Congenital aortic aneurysms are a rare, life-threatening disorder that present complex treatment challenges. The authors describe a congenital thoracic aortic aneurysm treated by endovascular means with stent-assisted coil deployment. Because of rapid in utero aneurysm growth and cardiac dysfunction, a 2.6-kg male was delivered expeditiously by Cesarean section at 352/7 weeks' gestation. On day of life 1, bilateral femoral arterial access was used to deliver a balloon-expandable stent across the wide-necked aneurysm. Microcoil embolization of the aneurysm via a prepositioned microcatheter was then performed. The child had an uncomplicated hospital course and is asymptomatic 5 months later, with complete aneurysm thrombosis. 相似文献
8.
Jenssen GL Wirsching J Pedersen G Amundsen SR Aune S Dregelid E Jonung T Daryapeyma A Laxdal E 《Cardiovascular and interventional radiology》2007,30(3):523-525
Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization.
Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old
man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm. 相似文献
9.
Treatment of intracranial broad-neck aneurysms with a new self-expanding stent and coil embolization 总被引:10,自引:0,他引:10
Alfke K Straube T Dörner L Mehdorn HM Jansen O 《AJNR. American journal of neuroradiology》2004,25(4):584-591
BACKGROUND AND PURPOSE: Endovascular treatment of broad-neck intracranial aneurysms with detachable coils requires special techniques. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows attenuated packing of the coils. However, access for the stent-delivery system can be technically limited in tortuous anatomy. We present six cases of broad-neck aneurysms treated with a new self-expanding stent and coil embolization. METHODS: Three aneurysms of the supraophthalmic internal carotid artery and three aneurysms of the basilar tip with extension to the origin of a posterior cerebral artery were treated. The stent was a new self-expanding stent with a 3F over-the-wire microcatheter delivery system. Coil embolization was performed with electrolytically detachable coils. Time-of-flight MR angiography was performed after treatment in five cases. Three other patients could not be treated with the stent because deployment was not possible after correct positioning of the delivery system. RESULTS: Access with the stent-delivery system was easy, and the aneurysm neck was covered sufficiently. After stent placement, total coil embolization was achieved in four and subtotal coil embolization was achieved in two. Parent arteries remained open, and no secondary coil migration was seen. On follow-up MR imaging, the stent was clearly visible and patency of the parent vessel and emerging branches was assessable. CONCLUSION: This new stent is a safe and efficient tool for the endovascular treatment of intracranial broad-neck aneurysms. Access to smaller vessels was easy, but the mechanism of deployment had to be improved. Follow-up MR imaging was sufficient. 相似文献
10.
支架结合弹簧圈在栓塞颅内复杂动脉瘤中的应用 总被引:1,自引:0,他引:1
目的 探讨支架结合弹簧圈在栓塞颅内复杂动脉瘤中的应用价值以及急性期使用支架的安全性.资料与方法 29例患者,32个动脉瘤.采用Neuroform支架,弹簧圈主要采用Matrix、Orbit圈,分析栓塞效果.急性期支架辅助栓塞宽颈动脉瘤20例.择期栓塞患者术前3天予以强抗血小板聚集药物,所有患者术后予强抗血小板聚集药物及5天抗凝治疗.术后复查21例.结果 所有病例栓塞操作均顺利完成,无手术并发症;除1例巨大动脉瘤为次全栓塞外,其他均致密栓塞.其中1枚支架覆盖2个动脉瘤并栓塞3例,支架辅助栓塞巨大宽颈动脉瘤3例,支架置入行二期动脉瘤颈残留弹簧圈再栓塞2例,动脉瘤常规弹簧圈栓塞后3年复发再以支架辅助栓塞1例.急症支架辅助微弹簧圈栓塞动脉瘤未发现支架内血栓形成或狭窄堵塞.复查21例中,除1例次全栓塞的巨大动脉瘤出现动脉瘤腔部分显影外,其余20例均未见动脉瘤显影.结论 支架结合不同型号弹簧圈栓塞有助于提高颅内复杂动脉瘤的治疗成功率;急性期可以使用支架,但在未行抗血小板聚集药物准备的前提下,其安全性有待进一步研究. 相似文献
11.
Hideki Ishimaru Kazuaki Nakashima Hideaki Takahata Yohjiro Matsuoka 《Neuroradiology》2013,55(2):207-211
Introduction
Although stenting for stenotic vertebral artery dissection (VAD) improves compromised blood flow, subsequent peri-stent aneurysm (PSA) formation is not well-known. We report two cases with PSA successfully treated with coil embolization.Methods
Three patients with stenotic intracranial VAD underwent endovascular angioplasty at our institution because they had acute infarction in posterior circulation territory and clinical evidence of hemodynamic insufficiency. In two of three patients balloon angioplasty at first session failed to relieve the stenosis, and a coronary stent was implanted. Angiography immediately after stenting showed no abnormality in case 1 and minimal slit-like projection at proximal portion of the stent in case 2.Results
Angiography obtained 16 months after the stenting revealed PSA in case 1. In case 2, angiography performed 3 months later showed that the projection at proximal portion enlarged and formed an aneurysm outside the stent. Because follow-up angiographies showed growth of the aneurysm in both cases, endovascular aneurysmal embolization was performed. We advanced a microcatheter into the aneurysm through the strut of existing stent and delivered detachable coils into the aneurysm lumen successfully in both cases. The post-procedural course was uneventful, and complete obliteration of aneurysm was confirmed on angiography in both cases.Conclusion
Stenting for stenotic intracranial VAD may result in delayed PSA; therefore, follow-up angiographies would be necessary after stenting for stenotic intracranial arterial dissection. Coil embolization through the stent strut would be a solution for enlarging PSA. 相似文献12.
双微导管技术在宽颈颅内动脉瘤栓塞中的初步应用经验 总被引:6,自引:0,他引:6
目的 评估采用双微导管技术在宽颈颅内动脉瘤栓塞中的初步经验。方法 6例宽颈动脉瘤在常规方法应用无效后采用双侧股动脉入路 ,把 2支微导管置入动脉瘤腔内 ,由微导管内同时或先后送入弹簧圈 ,待弹簧圈稳定后解脱 ,随后再送入更多的弹簧圈以达到致密填塞。结果 6例AN成功地栓塞 ,10 0 %闭塞 2个、闭塞 >90 %的 4个。缺血性并发症 1例 ,导致中残。术后 3月时GOS优良 5例、中残 1例。有 5例进行了造影随访 ,无AN复发和再破裂。结论 双微导管技术对于某些复杂的宽颈动脉瘤是一种可供选择的方法。 相似文献
13.
14.
The endovascular treatment of wide-necked aneurysms remains challenging. The “Y”-stenting technique has been used for stent-assisted
coil embolization of wide-necked bifurcation aneurysms. So far, this technique has been described for aneurysms of the basilar
apex or the middle cerebral artery bifurcation and only for open stent systems using the Neuroform stent. We report a 52-year-old
woman with recurrence of a wide-necked aneurysm of the anterior cerebral artery that was successfully retreated by stent-assisted
coiling using the “Y”-stenting technique with the Enterprise stent system. 相似文献
15.
Matrix可脱弹簧圈栓塞治疗颅内动脉瘤的临床应用 总被引:1,自引:1,他引:1
目的探讨Matrix可脱弹簧圈血管内栓塞治疗颅内动脉瘤的临床价值。方法对56例共61个颅内动脉瘤施行血管内Matrix可脱弹簧圈栓塞治疗,4例宽颈动脉瘤和2例梭形动脉瘤采用Neuroform支架结合Matrix可脱弹簧圈栓塞治疗。结果应用Matrix可脱弹簧圈栓塞成功53例58个动脉瘤,占95.1%;3例因严重血管痉挛导致微导管无法到位而实施动脉瘤夹闭术;2例弹簧圈尾端残留于载瘤动脉,但未导致临床后果;无死亡及严重并发症;53例随访3~12个月无再次出血和并发症。结论Matrix可脱弹簧圈可有效栓塞颅内各部位动脉瘤,术中有明显的促进动脉瘤腔内形成血栓的作用,可以防止再次破裂出血。 相似文献
16.
Georg Mühlenbruch Omid Nikoubashman Björn Steffen Mete Dadak Moritz Palmowski Martin Wiesmann 《Cardiovascular and interventional radiology》2013,36(1):239-244
Purpose
Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model.Materials and Methods
Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug.Results
With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization.Conclusion
The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms. 相似文献17.
Pyun HW Lee DH Yoo HM Lee JH Choi CG Kim SJ Suh DC 《AJNR. American journal of neuroradiology》2007,28(8):1594-1598
BACKGROUND AND PURPOSE: Placement of a covered stent to control carotid blowout (CB) in malignant tumors of the head and neck has been reported to be an effective treatment. However, it is not uncommon to encounter recurrent hemorrhage. The purpose of this study was to evaluate the follow-up results of patients treated with covered stents. MATERIALS AND METHODS: We retrospectively reviewed the results of 7 consecutive patients who underwent placement of a covered stent to control CB. Most of them had poor wound healing because of previous irradiation, surgery, or both. The initial procedures were successful in all patients. Their clinical course was reviewed for rebleeding, additional endovascular treatments in recurrent cases, and outcomes. RESULTS: Recurrence developed in 6 of 7 patients. The interval between the first procedure and the hemorrhagic event was from 3 to 44 days. In 6 patients who had a recurrent CB, 4 had rebleeding from the previous site of the stent, whereas 2 other patients experienced recurrent bleeding in a different area from the site of the stent. Additional endovascular treatments were carried out in all affected patients by another insertion of a covered stent (n = 3), coil embolization (n = 2), or insertion of a covered stent followed by permanent arterial occlusion (n = 1). CONCLUSION: Placement of a covered stent in patients with head and neck cancer who sustain CB showed frequent rebleeding despite favorable initial rescue results. Recurrent CB at the previous stent site developed frequently in patients with uncontrolled wound infection. Concomitant or short-interval arterial trapping should be considered selectively in those conditions. 相似文献
18.
Li MH Li YD Fang C Gu BX Cheng YS Wang YL Gao BL Zhao JG Wang J Li M 《Neuroradiology》2007,49(10):819-828
Introduction The aim of this retrospective study was to evaluate the clinical efficacy and limitations of different endovascular modalities
in the treatment of very large and giant intracranial aneurysms.
Methods A group of 20 patients with very large and giant intracranial aneurysms treated by endovascular approaches were retrospectively
analyzed. Of the 20 patients, 9 had been treated by parent artery occlusion, 8 by coil embolization, and 3 with an intracranial
covered stent. Two recurrent aneurysms initially treated with coil embolization were retreated with an intracranial covered
stent. Patients were followed for 9–83 months after the procedure.
Results Endovascular treatment was technically feasible in all 20 patients. One patient died 7 days after the procedure from rebleeding
caused by incomplete aneurysmal occlusion. Immediate postprocedural angiograms showed that complete occlusion was achieved
in 11 aneurysms, subtotal occlusion in 7, and incomplete occlusion in 2. The final angiographic results in the other 19 surviving
patients confirmed complete occlusion of 15 aneurysms, subtotal occlusion in 3, and incomplete occlusion in 1. Clinical evaluations
performed at the final follow-up visit showed an excellent outcome in 11 patients and a good outcome in 8.
Conclusion Endovascular treatment of giant intracranial aneurysms with coil embolization is often associated with a low complete occlusion
rate and a high recanalization rate, and parent artery occlusion remains a practical option in selected patients. Based on
our limited experience, the use of an intracranial covered stent appears to be a relatively simple and safe procedure for
occluding very large and giant aneurysms while still maintaining the patency of the parent artery. 相似文献
19.
Endovascular neurointervention for cerebral aneurysm 总被引:6,自引:0,他引:6
Embolization would have an advantage in the treatment of cerebral aneurysms by eliminating the need for craniotomy. The recent protocol of endovascular treatment for cerebral aneurysm is classified into two main categories; is parent artery occlusion and intra-aneurysmal embolization. For aneurysms with a broad neck and large sac, it is recommended to consider proximal arterial occlusion if tolerance is confirmed by cerebral blood flow study at the time of balloon Matas' test. Parent artery occlusion is a classical technique, but still mandatory and effective clinically. In patients who have aneurysms with a has well-defined neck and who are not good candidates for craniotomy, intra-aneurysmal embolization would be recommended as an alternative means of treatment. Care should be taken to prevent problems and complications, including careful catheter and guidewire manipulation. Careful selection of cases and appropriate pre-, intra-, and post-procedure patient management is essential. Since the clinical application of Gugliemi's detachable coil (GDC) started, the potential of endovascular treatment for cerebral aneurysm has changed considerably. Preliminary results of embolization using GDC suggest that endovascular treatment would offer marked improvement in the management of patients harboring cerebral aneurysms. 相似文献
20.
Xianli LvYouxiang Li Chuhan JiangXinjian Yang Zhongxue Wu 《European journal of radiology》2011,79(2):317-322