pipeline栓塞装置治疗大脑中动脉动脉瘤的疗效：一项回顾性多中心研究

目的 探讨pipeline栓塞装置（PED）治疗大脑中动脉（MCA）动脉瘤的临床效果。方法 回顾性分析2014年11月至2019年10月我国14个临床中心采用PED治疗的33例MCA动脉瘤的临床资料、影像学资料和随访资料。结果 33例共39个动脉瘤,使用37个PED。33例完成临床随访,30例（36个动脉瘤）完成影像随访;随访时间4～22个月,平均（10.6±6.3）个月;动脉瘤完全或近全闭塞30个（83.3%,30/36）;相对于单纯PED治疗组（71.4%）,PED辅助弹簧圈栓塞组动脉瘤闭塞率更高（100%;P=0.031）;预后不良（m RS评分>2分）3例（9.1%）,预后良好（mRS评分≤2分）30例（90.9%）;术后并发症发生率为24.2%(8/33),术前规律服用双抗药物3 d以上病人术后并发症发生率明显低于未规律服用双抗药物的病人（P=0.033）。结论 MCA动脉瘤可以采用PED治疗,疗效较满意。对于直径大、形态不规则的MCA动脉瘤,可使用PED结合弹簧圈栓塞治疗以获得更高的闭塞率。术前、术后应规范应用双抗药物以减少缺血、出血并发症。     

Treatment of unruptured intracranial aneurysms with the pipeline embolization device

The pipeline embolization device (PED; ev3 Endovascular, Plymouth, MN, USA) is a flow-diverter used in the endovascular treatment of intracranial aneurysms, particularly those with unfavorable configurations. It causes progressive flow redirection leading to aneurysm thrombosis. This study aimed to present a systematic review of the published literature on the clinical outcomes of PED. A Medline search of the English language literature was performed using the keywords “intracranial aneurysms” and “pipeline embolization device” or “flow diverters”. The inclusion criteria were: n > 10 patients; unruptured aneurysms; documentation of complications; and at least 3 months of follow-up. A total of 13 studies, with 905 patients and 1043 aneurysms, were included. The mean age was 53.8 years, with women comprising 76.3% of patients. The mean aneurysm diameter was 11.1 mm with 37% classed as large aneurysms and 10% classed as giant. The cumulative mortality rate was 2.3%. Seventeen patients had a stroke (1.9%), while 19 (2.0%) had a transient ischemic attack and 21 patients (2.3%) had an intracranial hemorrhage. The two outcome measures were the cumulative event rate (16.7%) and the 6 month aneurysm occlusion rate (79.7%). A funnel plot with study size plotted against the two outcome measures revealed publication bias. Data from recent studies suggest that complication and mortality rates associated with PED may be similar to other contemporary endovascular techniques, with a better 6 month aneurysm occlusion rate. More prospective clinical trials are warranted to further validate these results.     

血流导向装置和弹簧圈栓塞对颅内动脉瘤影响的Meta分析

目的通过meta分析的方法,比较血流导向装置(FDD)和弹簧圈栓塞治疗(CET)对颅内动脉瘤的临床疗效和安全性。方法系统检索Pub Med、Cochrane图书馆、Embase、中国知网和万方数据库,并手工查阅相关文献的引文目录。检索时间截至2017年3月,纳入符合入选标准的研究。疗效终点包括动脉瘤完全闭塞率和复发率,安全性终点为并发症发生率。结果最终纳入临床研究14项,包括观察性研究13项和随机对照试验1项。总样本量为1234例,其中FDD组449例,CET组785例。Meta分析结果提示,与CET相比,FDD能明显提高动脉瘤完全闭塞率(OR:3.40,95%CI:2.54~4.55;P0.01)并降低术后复发率(OR:0.12,95%CI:0.06~0.24;P0.01)。两组患者的总体并发症发生率并无显著差异(OR:1.11,95%CI:0.64~1.93;P=0.72)。结论相比于CET,FDD治疗颅内动脉瘤的效果更佳,且不增加并发症的发生率。     

大脑中动脉狭窄或闭塞显微手术治疗单中心经验并文献复习

目的 探讨颞浅动脉-大脑中动脉(STA-MCA)搭桥术治疗成人大脑中动脉狭窄或闭塞的疗效.方法 回顾性分析31例行STA-MCA搭桥术治疗的大脑中动脉狭窄或闭塞患者的临床资料,术前均行全脑血管造影(DSA)评价颈外动脉-颞浅动脉、颈内动脉、大脑中动脉的狭窄程度,CT灌注成像(CTP)评估脑血流灌注情况.手术采用经额颞入...     

Detachable coil embolisation of ruptured intracranial aneurysms: A single center study,a decade experience

Objective

The introduction of detachable coils revolutionised the management of patients with intracranial aneurysms and is now considered a first-line treatment in our institution. The purpose of this study was to review 10 years of experience with this method.

Methods

A retrospective review of prospectively collected data on 711 patients undergoing endovascular treatment of ruptured intracranial aneurysm between 1996 and 2005 with regard to technical feasibility, procedural complications, rebleeding, anatomical outcome, need for retreatment and overall clinical outcome.

Results

Endovascular treatment failed in 25 aneurysms from a total of 717 (4%). Aneurysm rupture complicated 37 procedures (4.7%) leaving 10 patients permanently disabled or dead (1.3%). Thromboembolic events complicated 35 procedures (4.5%) leaving 8 patients permanently disabled or dead (1%). One other patient died because of fatal parent vessel rupture. Further 6 procedures were complicated by arterial dissection and 18 by coil loop protrusion, however all of these patients achieved independent recovery. Overall morbidity–mortality was 2.9%. Further subarachnoid heamorrhage occurred in 16 patients (2.3%), 12 of which died. Altogether, 121 aneurysms from 511 (24%) were recanalized on follow up angiography, 52 required retreatment (7.1%). At 6 months follow up, 580 patients (82%) were independent, while 130 patients (18%) were disabled or dead.

Conclusion

Detachable coil embolisation of intracranial aneurysms is a very feasible treatment method associated with a small risk of permanent morbidity–mortality. Risk of further bleeding is small, but related with devastating outcome. Approximately 25% of aneurysms will recanalize and 7% will require retreatment. Despite these shortcomings, vast majority of patients will achieve independent recovery.     

Solitaire支架结合弹簧圈治疗颅内动脉瘤的初步使用经验

目的 评估应用新型颅内支架Solitaire结合弹簧圈治疗颅内动脉瘤的有效性和安全性,总结该支架的使用经验.方法 自2010年8月至2010年12月20例患者采用该支架辅助进行动脉瘤栓塞.通过手术前后影像学评价和患者出院时GOS评分,评估应用该支架的安全性和有效性.结果 所有支架均成功释放,手术成功率100%.总并发症发生率为15%,致死率为5%,手术相关并发症发生率5%.20例动脉瘤中,完全栓塞率65%,瘤颈残留率10%,不完全栓塞率25%.其中19例患者预后良好,GOS评分5分,1例患者死亡.结论 Solitaire支架在辅助治疗颅内动脉瘤方面是安全有效的.就其适用范围而言,该支架似乎更适合于直径2 mm以上的血管,其长期疗效仍需要进一步观察.

Abstract：

Objective To evaluate the safety and efficiency of Solitaire? AB neurovascular remodeling device - assisted coil embolization for patients with wide - necked or complex aneurysms. Method From August 2010 to December 2010, the consecutive data were collected from 20 patients with aneurysms treated with comined stenting. All patients underwent clinical and angiographic follow - up after the initial treatment. Results Successful position of the remodeling device was obtained in all cases. There were three complications ( 15% ), and only one complication (5% ) was attributed to the application of stent. One of the three patients was dead for hydrocephalus caused by cerebral hemorrhage during AVM embolization. One thromboembolic complication occurred after the stent was deployed. One ophthalmic artery occlusion occurred after coiling. The proportion of patients in whom Raymond class 1 occlusion was obtained was 65% ( n = 13). Raymond class 2 occlusion was achieved in 10% ( n = 2) and Raymond class 3 occlusion in 25% ( n =5). Nineteen patients left the hospital with a good clinical status. Conclusions The initial technical and clinical results of Solitaire? AB device - assisted coiling of aneurysm are encouraging. But we suggest that it may be applied in the vessel which diameter is more than 2 mm. In addition,the long - term outcome of patients and experiences of using this device need further study.     

Factors associated with rerupture of intracranial aneurysms after endovascular treatment: A retrospective review of 11 years experience at a single institution and review of the literature

Aneurysm rebleeding following initial endovascular management is uncommon, and the factors associated with its occurrence are poorly defined. We retrospectively analyzed a consecutive series of patients presenting with aneurysmal subarachnoid hemorrhage who underwent endovascular management to determine factors associated with rebleeding. Rebleeding occurred in 7/183 (3.8%) patients, 6 of which had an adjacent hematoma on initial neuroimaging. Aneurysms were located on the ACoA (n = 5), PCoA (n = 1), and MCA (n = 1). Sizes ranged from 3.5 to 13.0 mm (mean 8.0), with neck sizes ranging from 1.8 to 4.6 mm (mean 3.2). Time-to-rerupture ranged from hours to years, with 3/7 cases rebleeding within 30 days and 4/7 cases rebleeding later than 30 days. Initial incomplete angiographic occlusion occurred in 2/3 cases of early rebleeding. The presence of adjacent intracerebral hematoma (ɸ = 0.354, p < 0.005), increasing Fisher Grade (t(9.4) = 7.72, p < 0.005), and aneurysmal outpouching (ɸ = 0.265, p < 0.005) were found to be the only factors associated with rerupture status. Recurrent hemorrhage following endovascular management of ruptured intracranial aneurysms is an uncommon but important source of morbidity, particularly in the early post-embolization period. The presence of high-risk features, such as an adjacent intracerebral hematoma or aneurysm outpouching, warrant early and frequent angiographic follow up to document stability and mitigate rupture risk.     

Safety and long-term efficacy of endovascular treatment of small posterior communicating artery aneurysms by coiling with or without stent: A single center retrospective study

Objectives

Endovascular stents have been widely used in intracranial aneurysm embolization. In this work, we compared the safety and long-term efficacy of stent-assisted coiling with those of conventional coiling for small posterior communicating artery aneurysms, aiming at a better understanding of the related safety and efficacy profiles.

Methods

Between January 2008 and December 2011, 114 small PcomA aneurysms (defined as 3 mm ≤ maximum diameter < 10 mm in this study) in 108 patients were treated by endovascular treatment in our department. Patient demographics, aneurysm characteristics, angiographic results (initial and follow-up), and procedural complications were assessed.

Results

Embolization was successfully performed in all the patients. Complications occurred in 7.4% of patients in both groups. There was no associated mortality. Based on initial post-procedural angiography, the rate of complete aneurysm occlusion, neck remnant and residual sac in the stented group were 37.9%, 24.1%, and 37.9%, while in the conventional group the figures were 42.9%, 48.2%, and 8.9%, respectively. The initial angiographic results were significantly better in the conventional group, compared with the stented group (P = 0.038). The follow-up results showed that the rate of improvement in the stented group was significantly higher (53.3% vs. 14.0%; P < 0.001) and the recurrence rate was significantly lower than that in the conventional group (4.4% vs. 3.02%; P = 0.001).

Conclusion

Compared with conventional coiling, stent-assisted coiling of the small posterior communicating artery aneurysms does not increase the risk. Stents bear an advantage in reducing the recurrence rate, increasing progressive occlusion rate, and improving long-term prognosis in endovascular treatment of intracranial aneurysms.     

The angiographic and clinical outcomes of intracranial aneurysms following irradiation in patients with nasopharyngeal carcinoma: A 13-year experience and literature review

Background and purpose

Intracranial aneurysms are a known but rare complication of radiotherapy (RT). We reviewed the angiographic and clinical outcomes of intracranial aneurysms following RT in patients with nasopharyngeal carcinoma (NPC), a malignancy endemic in Hong Kong.