带膜支架治疗6例颅内动脉瘤的临床分析

目的探讨应用带膜支架治疗颅内动脉瘤的效果。方法根据靶血管的直径和病变的长度,选择合适带膜支架行病变隔绝术,共治疗椎动脉颅内段动脉瘤3例、颈内动脉动脉瘤3例。结果在6例患者带膜支架被成功释放于靶动脉,动脉瘤消失,并保持载瘤动脉畅通,临床效果满意。支架放置后6个月造影随访病例载瘤动脉畅通。结论带膜支架是采用血管内治疗技术处理部分颅内动脉瘤的有效手段。     

颈内动脉、椎动脉医源性假性动脉瘤及其处理

目的 探讨颈内动脉、椎动脉医源性假性动脉瘤的形成原因、预防及其处理.方法 总结2004年4月至2009年2月浙江大学医学院附属第二医院神经外科4例颈内动脉、椎动脉医源性假性动脉瘤,其中1例为鼻咽癌放射治疗后,其余3例均为手术创伤所致.2例用球囊闭塞假性动脉瘤和载瘤动脉,另2例采用带膜支架闭塞假性动脉瘤并保持载瘤动脉通畅.结果 1例颈内动脉假性动脉瘤患者球囊闭塞载瘤血管后出现失代偿,经开颅去骨瓣减压术后遗留长期肢体偏瘫,1例椎动脉假性动脉瘤球囊闭塞后效果良好,2例颈内动脉假性动脉瘤采用带膜支架闭塞了假性动脉瘤并保持载瘤动脉通畅.随访15个月至6年,效果满意.结论 对颈内动脉、椎动脉医源性假性动脉瘤应引起足够的重视,对邻近特别是包绕这些动脉时,应仔细操作.对疑似假性动脉瘤患者应及时行脑血管造影,以明确诊断.带膜支架是颈内动脉、椎动脉假性动脉瘤的首选治疗方法.     

Neuroform微型自膨支架辅助可脱弹簧圈闭塞颅内宽颈动脉瘤的临床探讨

目的:探讨Neuroform微型自膨支架在闭塞颅内宽颈动脉瘤中的应用效果.方法:9例颅内宽颈动脉瘤患者,经适当的抗凝后,将Neuroform微型自膨支架引入载瘤动脉处,通过同轴导管释放支架覆盖动脉瘤颈,支架释放后,行标准可脱弹簧圈填塞术.结果:9例患者中,达到100%栓塞7例,95%栓塞2例.栓塞后造影证实载瘤动脉通畅,无狭窄.1例基底动脉顶端动脉瘤放置支架后左侧大脑后动脉发生痉挛,但病人无症状.无术后死亡.4例术后6个月随访造影,除1例基底顶端巨大动脉瘤不全栓塞(95%栓塞)无改变外,3例动脉瘤腔完全闭塞,载瘤动脉无狭窄.结论:Neuroform微型支架辅助可脱弹簧圈闭塞颅内宽颈动脉瘤效果好,既可保护载瘤动脉通畅又可改善宽颈动脉瘤栓塞的效果.     

血管内支架治疗颅内、外动脉狭窄和颅内宽颈动脉瘤

目的 探讨血管内支架治疗颅内、颅外动脉狭窄以及颅内宽颈动脉瘤的安全性和有效性. 方法应用血管内支架成形治疗14例颅内、颅外动脉狭窄;支架结合弹簧圈栓塞治疗颅内宽颈动脉瘤5例,单纯支架置入治疗颅内宽颈动脉瘤1例.结果 14例颅内、外动脉狭窄,经支架成形治疗后10例血管直径恢复正常,4例血管直径恢复85%～90%.6例颅内宽颈动脉瘤,4例获得致密栓塞,1例疏松栓塞,1例单纯支架置入后动脉瘤腔内血流滞留.术中发生支架移位1例.随访1～36月,无发生缺血或出血性事件,10例定期血管造影检查未发现支架再狭窄或闭塞,动脉瘤无复发.结论 应用血管内支架治疗颅内、颅外动脉狭窄以及辅助弹簧圈治疗颅内宽颈动脉瘤是安全、可行、有效的.     

血管内支架结合电解可脱卸弹簧圈治疗颅内椎动脉宽颈动脉瘤

目的：总结血管内支架结合电解可脱卸弹簧圈治疗颅内椎动脉宽颈动脉瘤的初步经验。方法：通过股动脉途径，采用将血管内支架跨动脉瘤颈放置，通过其网孔将微导管送入动脉瘤腔后填塞GDC的技术治疗6例椎动脉颅内段宽颈动脉瘤。结果：1例支架置入术失败，其余5例支架均准确到位。4动脉瘤达到致密填塞，1例大部填塞，载瘤动脉通畅。1例采用弹簧圈同时闭塞动脉瘤及载瘤动脉，无手术并发症，患均恢复良好。结论：血管内支架联合微弹簧圈是治疗颅内宽颈动脉瘤的有效方法，但仍需要远期随访。     

血管内治疗颅内多发性动脉瘤

目的探讨血管腔内治疗颅内多发动脉瘤的疗效、技术要点,安全性及并发症防治。方法回顾分析16例颅内多发动脉瘤患者（共34个动脉瘤）,全部选择血管内治疗,其中裸支架载瘤动脉成形弹簧圈栓塞7个动脉瘤,成篮弹簧圈栓塞23个,4个有穿支血管的动脉瘤未进行治疗。结果裸支架载瘤动脉成形弹簧圈栓塞技术栓塞7个宽颈动脉瘤,致密栓塞6个,部分栓塞1个,支架被弹簧圈压塌陷1例,无支架内血栓形成、支架移位及动脉内膜撕裂,无载瘤动脉以及分支闭塞;成篮弹簧圈栓塞技术治疗23个动脉瘤,致密栓塞16个,部分栓塞7个。除4例有穿支动脉动脉瘤未行栓塞治疗外均一次性栓塞治疗。2例术前腰椎穿刺引流患者1例在治疗前再次蛛网膜下隙出血。结论血管内介入栓塞治疗颅内多发动脉瘤具有安全、有效、创伤小、并发症少的优点、且不受部位及动脉瘤个数的影响,可一次性治疗所有动脉瘤,应首选。     

血管内支架治疗颅内动脉瘤和动脉狭窄的安全性和有效性

目的：探讨血管内支架成形术在颅内动脉瘤和动脉狭窄治疗中的安全性和有效性。方法：7例椎动脉颅内段梭形动脉瘤及45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，填入电解可脱卸弹簧圈（GDC）。39例颅内动脉狭窄采用球囊扩张型支架成形术治疗。结果：血管内支架均成功植入。42例动脉瘤致密填塞，7例大部填塞，3例疏松填塞；39例颅内狭窄患中36例血管直径恢复80％以上，3例残余狭窄20％以上，无1例发生严重的并发症。所有患临床恢复良好，影像学随访无动脉瘤复发，载瘤动脉通畅；无支架内狭窄和血栓形成。结论：联合使用支架及微弹簧圈可能成为治疗颅内梭形及宽颈动脉瘤的有效方法，支架成形术治疗颅内动脉狭窄是安全、可行的。     

支架结合可脱性弹簧圈治疗颅内宽颈动脉瘤的临床分析

目的分析颅内支架结合弹簧圈治疗颅内宽殒动脉瘸的临床疗效及应用体会。方法回顾性分析12例颅内宽颈动脉瘤患者,其中3例动脉瘤位于颈内动脉海绵寞段,2例位于颈内动脉眼动脉段,2例位于殒内动脉后交通段,1例位于前交通动脉,2例位于大脑中动脉分叉部,1例位于椎动脉,1例位于基底动脉,绝对宽颈（瘤颈〉4mm）动脉瘸9例,相对宽颈3例,瘤颈／瘸体均〉0．7。术中将颅内支架引至动脉瘸处并释放支架虔互动脉瘤颈,然后行弹簧圈栓塞术。结果7例采用Neuroform自膨式支架,5例采用Leo支架,12枚支架全部成功释放。其中100％栓塞8例,95％栓塞3例,1例支架释放后动脉瘤不显影未行弹簧圈栓塞。1例术中出血经迅速填塞弹簧圈及支持对症治疗后患者治愈。本妞病人无死亡。5例术后3个月随访造影,动脉瘸腔完全闭塞,载瘤动脉无狭窄。结论颅内自膨式支架辅助弹簧圈闭塞颅内宽颈动脉瘤既可保护载瘤动脉通畅又可提高宽颈动脉瘤拴塞的致密程度,效果较好,并且可降低穿支血管阻塞的发生率。     

破裂椎基底动脉夹层动脉瘤介入治疗(附9例报告)

目的:总结颅内破裂椎基底动脉夹层动脉瘤的诊断和介入治疗经验。方法:分析9例颅内破裂椎基底动脉夹层动脉瘤的症状和影像检查结果,就其介入治疗策略作回顾总结。结果:临床表现为自发性蛛网膜下腔出血,积血以脑干前方脑池最为明显,DSA显示为血管的扩张和狭窄。采取支架植入辅助弹簧圈栓塞4例、单纯支架治疗2例,其余3例采用闭塞载瘤血管远近端治疗。8例恢复良好,Rankin评分小于3分者7例,4分者1例,死亡1例;6个月后随访未见动脉瘤显影。结论:积极采取保留或闭塞载瘤动脉的介入方法治疗破裂椎基底动脉夹层动脉瘤,可防止再出血。     

Enterprise支架后释放结合微弹簧圈栓塞治疗颅内宽颈动脉瘤

目的探讨Enterprise支架后释放技术结合辅助微弹簧圈栓塞治疗颅内宽颈动脉瘤的安全性和疗效。方法回顾性分析2009年6月—2012年12月间采用Enterprise支架后释放结合微弹簧圈栓塞治疗22例25枚颅内宽颈动脉瘤患者的动脉瘤及载瘤动脉解剖形态、支架植入技术及栓塞情况。出院前及术后3～6个月进行DSA复查。结果 22例均成功置入支架,支架到位情况满意,载瘤动脉通畅。18枚动脉瘤完全栓塞(100%),5枚近完全栓塞(95%～99%),2枚不完全栓塞(95%以下)。出院前及术后3～6个月DSA复查,24枚动脉瘤未再显影,1枚动脉瘤瘤颈部分残留,形态规则,术后两次造影无明显变化,载瘤动脉均通畅无狭窄,所有患者未再发出血。结论 Enterprise支架后释放结合微弹簧圈栓塞治疗颅内宽颈动脉瘤安全可靠,动脉瘤栓塞致密,载瘤动脉通畅。     

Very late stent thrombosis due to multiple stent fracture and stent malapposition

Coronary stent fracture (SF) is a rare but potentially serious complication of coronary artery stenting.Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to multiple steut fractures at 8 sites and multiple stent malapposition formation four years after a sirolimus-eluting stent implantation (Firebird,Microport,Shanghai,China). A 43-year-old man with hyperlipidemia and a smoking history was referred for coronary angiography (CAG)following repeated exertion associated chest pain in January 2007.CAG revealed a diffused tortuous stenosis at the proximal segment and a total occlusion at the mid-segment of the left anterior descending (LAD) artery,a 90％ stenosis at the proximal segnent of the left circumflex artery (LCX),and a diffused lesion with a maximal 60％ stenosis of the right coronary artery (RCA).     

Forgotten urological stent

"Forgotten" Ureteral stent DJ stent related complication is not uncommon even in the era of modern urology in the developed world. In this context we have undertaken a retro-prospective study in relation to its various causes, complications, management and prevention of forgotten stents in a single teaching institute. The study period was from January'04 to December'09. The sample size was 60. The effect of "forgotten stent" in our study reflects mild UTI to various complications including severe renal failure. We had approached all of our cases judiciously using various modalities of minimal access endourological techniques either alone or in combinations with successful outcome. The study concluded that it is vary easy to prevent "forgotten stent" and so its complications. However if we confront such unwanted complications that could be managed successfully with the use of endourological techniques. We did not use other techniques like laparoscopy and open surgery in this study.     

Incidence and predictors of definite stent thrombosis after coronary stent implantation

Background  Coronary stents are widely used in percutaneous coronary intervention (PCI) procedures. We aimed to explore the incidence, predictors and characteristics of stent thrombosis (ST) after coronary stent implantation in routine clinical practice.

Methods  From data of 18 063 consecutive patients who underwent successful stent implantation in Shenyang Northern Hospital from 2004 to 2010, we identified patients with definite ST (n=140) and control patients (n=280) matched on age, diagnosis, sex, current antiplatelet medication and stent type. The incidence, predictors and characteristics of ST after coronary stent implantation were investigated.

Results  The incidence of angiographically confirmed ST was 0.78% (140/18 063). The time distribution of ST was acute in 43 (30.7%), subacute in 50 (35.7%), and late in 47 (33.6%) patients. Binary Logistic regression analysis identified the angiotensin-converting enzyme inhibitor (ACEI) (odds ratio (OR)=0.472, 95% CI: 0.276–0.807, P=0.006) and heparin (OR=0.477, 95% CI: 0.278–0.819, P=0.007) were associated with an reduced risk of cumulative ST. Stent length (OR=1.042, 95% CI: 1.026–1.058, P <0.001), serum creatinine total (OR=1.020, 95% CI: 1.004–1.035, P=0.04), cholesterol (OR=1.267, 95% CI: 1.021–1.573, P=0.032), glucose (OR=1.086, 95% CI: 1.002–1.176, P=0.044), and platelet aggregation (OR=1.113, 95% CI: 1.075–1.154, P <0.001) were associated with an increased risk of cumulative ST.

Conclusion ST is associated with longer stent length and higher level of total cholesterol, glucose and platelet aggregation.

     

Meta-analysis of stent thrombosis after drug-eluting stent implantation: 4-year follow-up

Background Drug-eluting stents （DES） are the most common device used in percutaneous treatment of coronary artery disease. Recently, there has been an increased concern regarding their safety profile, in particular the late and very late stent thrombosis rate compared to bare metal stents （BMS）. The aim of the study was to compare the reported incidence of late and very late stent thrombosis of DES and BMS in patients from published clinical studies with an extended follow-up period to four years.Methods A search strategy was developed to identify publications reporting on late or very late thrombosis of BMS and DES available through MEDLINE and Cochrane Library databases. Two independent reviewers appraised eligible studies and extracted data. Odds ratios （OR） were calculated for each outcome and presented with 95% confidence intervals （CI）.Results Fourteen randomized controlled trials, which were at least single blinded, were identified. There was no difference in the incidence of late and very late stent thrombosis in patients treated with DES compared with patients treated with BMS （late OR 0.55, 95%Cl 0.23-1.31 and late/very late OR=1.08, 95%CI 0.61-1.91）.Conclusions The safety profile of DES was similar to BMS in terms of stent thrombosis. We found no evidence of increased risk of late and very late thrombosis for DES.     

Late stent thrombosis: a not negligible issue after drug-eluting stent implantation

Drug-eluting stent （DES） has markedly reduced restenosis and the need for target lesion revascularization （TLR）. The safety profile of DES does not seem to differ from that of bare metal stent in the acute and subacute phases following coronary intervention. However, at World Congress of Cardiology 2006 a meta-analysis of randomized trials suggested that there was a small but significant increase in risk of death or Q-wave myocardial infarction throughout a period of 3 years after implantation of a Cypher stent possible due to late stent thrombosis） The study received wide attention and since then the long-term safety of DES has been questioned by the physicians, patients and societies.     

Subclavian artery stent fracture

We report a case of a 52 year-old dentist who had stent implantation for a left subclavian artery stenosis. However, this was later complicated by a stent fracture within one week of stent placement. A chest radiograph showed two pieces of the fractured stent, which was confirmed by computed tomographic angiogram (CTA) of the affected artery. We then discuss the occurrence of stent fractures, which are not uncommon but serious complications of endovascular therapy.     

涂层支架的研究进展

经皮冠状动脉内气囊血管成形术后常产生支架内再狭窄的问题，目前采用不同涂层技术研制各种涂层支架以对抗支架内再狭窄。     

Coronary aneurysm and very late stent thrombosis formation associated with sirolimus-eluting stent implantation

Since drug-eluting stents （DES） can significantly reduce the risk of instant restenosis compared with bare-metal stents, they have been widely used in interventional therapy for coronary heart disease. With bare-metal stents being rapidly replaced by DES there is a great concern about the safety of DES due to stent thrombosis.Very late stent thrombosis （VLST） has been categorized as occurring beyond 1 year.3 Coronary aneurysm formation induced stent malapposition is a rare but potentially fatal cause of VLST. We report a case of coronary aneurysm with VLST formation 35 months after sirolimus-eluting stent （SES） implantation.