眼动脉段动脉瘤血管内栓塞治疗方法探讨

目的 探讨颈内动脉眼动脉段动脉瘤血管内栓塞治疗方法及技术要点.方法 回顾性分析2012年5月至2015年4月郑州大学第一附属医院采用血管内栓塞术治疗48例眼动脉段动脉瘤患者影像及临床资料、治疗效果及随访结果,探讨治疗方法及技术要点.结果 48例患者49枚动脉瘤均栓塞成功,其中单纯弹簧圈栓塞17枚(双微导管3枚),球囊辅助栓塞2枚,支架辅助栓塞28枚(Leo支架3枚,Lvis支架5枚,Enterprise支架14枚,Solatire AB支架6枚),Willis覆膜支架隔绝1枚,Pipeline密网支架植入1枚.术后即刻DSA造影显示,Raymond栓塞分级I级34枚(69％),Ⅱ级9枚(18％),Ⅲ级6枚(13％).术中发生支架内血栓形成2例.48例均达到临床治愈,出院时改良Rankin量表(mRS)评分0分44例,1分2例,4分2例(该2例治疗前≥4分);出院后3个月至1年mRS评分0分46例,2分1例,4分1例,均无新发神经功能障碍及出血.20例DSA随访1～21个月,18例痊愈,1例明显好转,1例明显复发,再次手术致密栓塞.结论 血管内栓塞治疗眼动脉段动脉瘤是一种微创、安全有效的方法,选择不同栓塞技巧是保证手术成功、减少术后并发症、提高治愈率的关键.     

颅内动脉瘤的栓塞治疗

1971年 ,苏联学者Ｓｅｒｂｉｎａｅｒｋｉｏ发明了可脱性球囊导管 ,经动脉途径栓塞治疗颅内动脉瘤逐渐得到应用。 1 983年Ｇｕｇｌｉｅｌｍｉ等报道了电解可脱性弹簧圈 (ＧＤＣ)在动脉瘤栓塞中的应用。ＧＤＣ以及稍后开始应用的ＭＤＳ在临床上广泛应用标志着颅内动脉瘤栓塞治疗技术的成熟。材料与方法1 998年 1 1月至 2 0 0 0年 7月 ,共经股动脉栓塞治疗颅内动脉瘤 2 3例 ,男 1 0例 ,女 1 3例 ,年龄为42～ 65岁 ,平均 56岁。 2 3例中 ,前交通动脉瘤 6例 ,后交通动脉瘤 1 7例。动脉瘤直径 3～ 7ｍｍ ,平均 4.7ｍｍ。动脉瘤颈宽 1～ 4ｍｍ ,平…     

Neuroform EZ支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤中远期安全性和有效性分析

【摘要】 目的 评价Neuroform EZ支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的中远期安全性和有效性。方法 回顾性分析2015年4月至2018年12月在南京医科大学第一附属医院接受Neuroform EZ支架辅助弹簧圈栓塞治疗的连续104例颈内动脉眼动脉段动脉瘤患者临床和影像学资料。重点分析动脉瘤特征、术后即刻和进展性闭塞率、围手术期并发症及临床随访结果。 结果 共104例患者116枚眼动脉段动脉瘤接受治疗,其中16例动脉瘤性蛛网膜下腔出血。根据眼动脉段动脉瘤Krisht分型,上侧型36枚,后侧型32枚,内侧型41枚,外侧型7枚。支架辅助弹簧圈填塞治疗均获成功。手术并发症发生率为2.9%,均为小血栓栓塞事件。术后即刻造影显示动脉瘤完全闭塞60枚（51.7%）,近全闭塞54枚（46.6%）,部分闭塞2枚（1.7%）。89例患者93枚动脉瘤接受平均（7.6±5.4）个月造影随访,首次随访造影显示完全闭塞率进展至92.5%（86枚）,未见迟发性支架内狭窄。动脉瘤复发3枚（3.2%）,均再次接受弹簧圈栓塞后达到完全闭塞。96例（92.3%）患者临床随访平均（18.5±11.2）个月,其中95例（99.0%）改良Rankin量表（mRS）评分为0～2分,远期预后良好。 结论 Neuroform EZ支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤安全有效,中远期随访中可提供更稳定闭塞率,且未见支架内再狭窄。     

电解可脱卸弹簧圈栓塞治疗颅内动脉瘤

目的　探讨电解可脱卸弹簧圈 (Guglielmidetachablecoil,GDC)栓塞治疗颅内动脉瘤的方法及效果。方法　颅内动脉瘤患者 11例 ,其中男 5例 ,女 6例 ,年龄 2 3～ 6 5岁。颈内动脉瘤 4例 ,后交通支动脉瘤 4例 ,前交通支动脉瘤 3例 ,动脉瘤直径最小为 4mm ,最大为 2 3mm ,所有患者均采用GDC材料进行栓塞。结果　 10 0 %栓塞 7例 ,90 %～ 99%栓塞 3例 ,70 %～ 90 %栓塞 1例 ,术后临床随访 1～ 12个月 ,无一例再出血。结论　血管内栓塞治疗动脉瘤是一种安全、微创、有效的治疗方法 ,使用GDC栓塞材料操作方便、手术并发症少。     

颅内动脉瘤栓塞后载瘤动脉缺血治疗的临床分析

目的：探讨颅内动脉瘤电解可脱卸弹簧圈(GDC)血管内栓塞术后载瘤动脉缺血的l临床治疗及相关影响因素。方法：选择颅内动脉瘤经血管内GDC栓塞治疗病例41例，术后7例出现载瘤动脉闭塞。就其相关因素，治疗方法、临床结果进行分析、探讨。结果：颅内动脉瘤Hunt-Hess分级1～3级41例病例中，经血管内GDC栓塞治疗后，7例出现载瘤动脉主干或其分支闭塞缺血所造成相应的临床神经症状，头疼、头昏、偏瘫、失语、偏盲及出血；经过三高(高血压、高血容量和高血稀释度)、抗痉挛、腰穿等综合治疗后，5例恢复良好，2例遗留偏瘫。结论：颅内动脉瘤栓塞后出现载瘤动脉主干狭窄或闭塞是其易发并发症之一，术中动态观察载瘤动脉血供情况，了解栓塞程度是预防其发生的手段之一，出现狭窄或闭塞时，要及时调整GDC和微导管，并给以抗痉挛、抗凝、扩血管以及三高治疗，当出现恶性颅高压症时手术配合治疗，往往会取得较好的临床效果。     

经动脉栓塞治疗右肾上极假性动脉瘤一例

肾脏假性动脉瘤较为少见 ,中山医院介入科最近收治 1例 ,报告如下。患者 ,男 ,19岁 ,右肾刀刺伤近半年入院。半年前 ,患者两侧腰背部刺伤 ,右侧较深 ,ＣＴ检查示 :右肾周血肿 ,后行“右肾周血肿清除术” ,术后恢复可。查体 :两侧腰背部见刀刺伤和手术切口瘢痕 ,余无特殊。ＭＲＩ检查 :ＭＲＡ重建图象示右肾上极见一肾动脉同时强化的高信号团影 ,其下基底部可见与一肾叶间动脉相连 (图 1)。横断位Ｔ1ＷＩ该肿块表现为血管流空 (图 2 )。Ｔ2 ＷＩ其中可见慢血流不均匀高信号影 ,病灶直径约 2 .2ｃｍ× 3 .2ｃｍ大小。　　ＤＳＡ检查 :右肾动脉…     

舌动脉瘤破裂出血动脉栓塞治疗一例

病例资料患者男,51岁。因吐出鲜血500 ml来急诊。曾因头面部及颈部皮疹,伴发热,双上肢肿胀、无力1个月,实验室检查肌酸激酶明显升高,肌电图提示皮肌炎。经激素冲击治疗后,持续口服激素治疗3个月,病情稳定。患者无明显诱因,突然吐出鲜血约500 ml,呈长条状血凝块,行喉镜、胃镜及胸部CT检查未发现异常。3 d后再次呕吐鲜血约1 000 ml,继之出现呼吸骤停、意识丧失,予气管插管、心肺复苏等抢救,心跳、呼吸恢复,为明确出血原因,心肺复苏后第2天行DSA检查,颈外动脉造影显示,右侧舌动脉咽段距起始部3 cm处见囊袋样对比剂充盈,约0.8 cm×1 cm,后缘见小尖刺状突起,     

髂内动脉巨大动脉瘤充填栓塞治疗一例

髂内动脉巨大动脉瘤充填栓塞治疗一例李选①吕旭②谢敬霞①发生于髂内动脉主干的动脉瘤较少见，本科诊断并行充填栓塞治疗１例，报告如下。患者男，６５岁。骶骨巨细胞瘤放疗后肿瘤增大，症状加重，拟行肿瘤切除。为减少术中出血，作术前髂内动脉栓塞。体检及实验室检查无...     

电解脱弹簧圈(GDC)在颅内动脉瘤腔栓塞治疗中的临床应用

目的：评价颅内动脉瘤GDC栓塞术的效果和并发症。材料和方法：应用GDC栓塞治疗颅内动脉瘤270例273枚.其中5例在载瘤动脉内支架置放后再行瘤腔内GDC栓塞。临床表现为动脉瘤性蛛网膜下腔出血236例，脑神经压迫症状18例，其他16例。131例在栓塞后3－15个月作了随访血管造影。结果：262例265枚动脉瘤栓塞成功，8例手术失败。动脉瘤完全闭塞或几近完全闭塞（闭塞范围＞95％）217枚，大部闭塞（闭塞范围70％－95％）31枚，部分闭塞（闭塞范围＜70％）17枚，与手术相关的死亡4例，与手术相关的并发症18例（其中13例经处理后无后遗症；4例轻残，1例重残）。随访脑血管造影显示动脉瘤复发9例,均为原部分栓塞患者.结论：颅内动脉瘤腔内GDC完全致密堵塞的效果肯定，与手术相关的并发症发生率与操作者经验有关。     

经导管动脉栓塞治疗8例脾动脉瘤

目的 探讨经导管动脉栓塞治疗脾动脉瘤的可行性和疗效.方法 对8例脾动脉瘤患者,经导管通过脾动脉使用弹簧圈栓塞瘤体远近端动脉而将瘤体隔绝,术后采用CT或血管彩色多普勒超声随访3～36个月.结果 8例脾动脉瘤均成功栓塞,无严重并发症.1例术后10个月因腹腔大出血死亡,其余7例随访3～36个月情况良好,未见血管再通.结论 经导管动脉栓塞治疗脾动脉瘤安全可行,术后定期影像随访非常重要.     

Endovascular treatment of the posterior inferior cerebellar artery aneurysms

Aneurysms may arise at various locations along the course of the posterior inferior cerebellar artery. Brainstem and cranial nerves manipulation make the surgical approach to proximal aneurysms difficult, while the occlusion of the parent vessel is sometimes unavoidable in peripheral aneurysms. Endovascular treatment can be a good alternative, but also with this approach the location of the aneurysm is critical. If occlusion of the parent vessel is planned, anatomical variations and vascular territories of the brainstem should be considered. We report our experience with 18 consecutive aneurysms (12 proximal, 6 peripheral) treated by coils. Complete occlusion was achieved in 14 patients and subtotal in 4. In three patients the parent vessel had to be sacrificed. During treatment two perforations occurred; aneurysms were completely occluded without clinical consequences. Two small asymptomatic cerebellar infarctions were seen on postoperative computed tomography. Clinical outcome was good in 16 patients     

Endovascular treatment of tiny ruptured anterior communicating artery aneurysms

INTRODUCTION: Because of its high complication rate, the endovascular treatment (EVT) of anterior communicating artery (ACoA) aneurysms less than 3 mm in maximum diameter remains controversial. We evaluated EVT of tiny ruptured ACoA aneurysms with Guglielmi detachable coils (GDCs). METHODS: We treated 19 ruptured ACoA aneurysms with a maximum diameter of 相似文献   

Endovascular treatment of renal aneurysms: A series of 18 cases

Purpose

To retrospectively analyze the results and complications of the endovascular treatment of 18 renal aneurysms.

Methods

From 2002 to 2011, 15 patients (aged 31–76), with 18 renal aneurysms, were admitted in our institution for treatment by embolization. Except one, all were wide-necked aneurysms. One aneurysm was treated by occluding the parent artery considering its distal location; a small-necked aneurysm was treated by simple coiling, and the remaining 16 were embolized utilizing adjunctive techniques to protect the parent artery. We analyzed the rates of technical success, complication and clinical consequence, post-operative occlusion and recurrence.

Results

There was a 100% technical success rate. 15 aneurysms showed a total occlusion on the post-treatment angiogram. 2 aneurysms demonstrated neck remnants, and one had an intrasaccular residual in-flow. Two minor post-operative complications were encountered but resolved over time. No delayed clinical complications were observed and the long-term angiographic follow-up demonstrated stability of the occlusion of the target renal aneurysm with no major recurrence.

Conclusion

Complications of the embolization of renal aneurysms are rare. Endovascular treatment should therefore be considered at first for the treatment of renal aneurysms.     

Endovascular treatment of proximal anterior cerebral artery aneurysms

Introduction  Aneurysms of the proximal segment of the anterior cerebral artery (A1A) are rare and challenging to treat. No information is available regarding their management by endovascular approach. The aim of this study was to report our experience with endovascular treatment (EVT) of A1As. Patients and methods  A retrospective review of our prospectively maintained database identified all A1As treated in our institution. The clinical charts, procedural data, and angiographic results were reviewed. Results  From April 2004 to August 2008, eight patients were identified and presented with an unruptured A1A. All aneurysms but one were <3 mm in diameter and two aneurysms had a perforator at the neck. Surgery was performed in two patients with an aneurysm <2 mm. Six patients were treated by selective embolization including five patients with balloon-assisted coiling (BAC) and/or via a retrograde approach from the contralateral side through the anterior communicating artery. These adjunctive techniques were used to safely catheterize the sac or to protect a branch at the neck. All patients showed an excellent clinical outcome. A complete aneurysm occlusion was obtained in all but one patient. Follow-up imaging in four patients showed stable results. Conclusion  EVT of A1As is feasible and associated with good clinical and anatomical results. Because of their location, small size, and close relationship with perforators, EVT frequently requires the use of BAC and/or a retrograde approach. Our results suggest that EVT is an alternative therapeutic option to surgical clipping if the aneurysm size is compatible with selective embolization.     

Endovascular treatment of unruptured intracranial aneurysms and circulating endothelial cells

Objectives

To evaluate the potential implication of circulating endothelial cells (CECs) in complications following endovascular treatment (EVT) of unruptured intracranial aneurysms. CECs characterized as CD146⁺/CD105⁺/CD45⁻/DAPI⁺ were considered to originate from an altered endothelial cell layer of the vessel wall.

Study design

In 15 patients, CECs were characterized and enumerated by the CellTracks^® System in blood samples from: (1) femoral artery (FA), (2) internal carotid artery (ICA) before (ICA₁) and after procedure (ICA₂), and (3) a peripheral vein before (PV₁) and after EVT (PV₂). Ischemic brain events were assessed using diffusion weighted imaging (DWI-MRI) before and 24 h after EVT.

Results

In ICA₁, the median number of single CECs and clusters of 2–5 CECs were higher than in FA, ICA₂, PV₁ and PV₂ samples (P < 0.001). Clusters >5 cells, sometimes >50 μm, were mainly observed in ICA₁ and never in PV₁, PV₂ or PV samples from ten healthy subjects. This distribution of CECs suggested femoral and ICA injury by the devices used, leading to endothelium shearing and desquamation of CECs. All patients discharged on day two (NIHSS score = 0), however silent ischemic brain lesions were observed in 9/15 (60%).

Conclusions

EVT detaches single and clusters of CECs from wall arteries that may be implicated in silent ischemic brain lesions genesis. Enumeration of CECs associated with DWI-MRI might represent an interesting strategy for monitoring and optimizing endovascular devices, and further limit EVT-related complications.     

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.     

Endovascular treatment of extracranial vertebral artery stenosis

Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.     

血管内支架治疗颅内动脉瘤

目的：探索使用血管内支架及血管内支架结合电解可脱卸弹簧圈（Guglielmi detachable coil,GDC)治疗颅内梭形及宽颈动脉瘤的可能性。方法：3例椎动脉颅内段梭形动脉瘤及6例宽颈动脉瘤,首先将冠脉支架跨动脉瘤颈放置,通过支架的网孔将微导管送入动脉瘤腔,填入GDC。结果：7例动脉瘤致密堵塞,2例大部堵塞,载瘤动脉通畅,临床效果优良。结论：联合使用支架及微弹簧圈是治疗颅内梭形及宽颈动脉瘤可选择的有效方法之一。     

破裂性前交通动脉瘤的电解可脱卸弹簧圈栓塞治疗

目的：总结45例破裂性前交通动脉瘤急症血管内栓塞的经验和体会,方法：采用电解可脱卸弹簧圈（Guglielmi detachable coil,GDC)作动脉瘤内填塞治疗。结果：动脉瘤完全闭塞25,90%以上闭塞14例, 90％闭塞6例;2次填塞2例,复发经手术治愈1例。术后并发脑梗死7例,术后死于肺部并发症1例,植物入状态生存1例,随访1－20个月,治疗结果稳定,颅内多动脉瘤5例,4例1次填塞成功,结论：GDC栓塞破裂性前交通动脉瘤效果好,虽然有较高的脑梗死发生率,但临床预后良好。