介入法制作犬颈动脉狭窄模型

目的　运用介入法建立适合神经介入治疗新材料、新技术的犬颈动脉狭窄模型。方法　12条犬全麻后 ,采用血管内介入方法 ,用自制弯头导丝机械损伤一侧颈总动脉中段内膜及中膜 ,制作成12条颈动脉狭窄模型 ,分别于术后即刻与术后 2、4、8、10周行DSA检查 ,观察颈动脉狭窄模型的动态变化 ,并与病理对照。结果　 12条犬成功获得 2 4条颈动脉狭窄模型 ,颈动脉狭窄的平均程度为 (6 3.5±2 5 .3) %。结论　本方法可成功制作成犬颈动脉狭窄模型 ,再现了人颈动脉狭窄模型的病理演变过程及颅内血流动力学改变 ,可用于介入治疗新材料、新技术的实验研究。本颈动脉狭窄模型的建立简单、稳定、可重复性强     

脑动脉瘤的血管内球囊栓塞治疗

本介绍了脑动脉瘤球囊栓塞疗法所使用器械，包括可脱性球囊、导管以及球囊内充填剂，评价了保留载瘤动脉法及闭塞载瘤动脉法的适应证、并发症，叙述了血管内球囊栓塞疗法的具体操作过程及其术后处理。     

颅内动脉瘤的介入放射治疗

目的：分析２０例颅内囊状动脉瘤微弹簧圈和可脱球囊栓塞治疗方法、结果、技术特点、弹簧圈理化特性和并发症处理等。材料和方法：１７例囊状动脉瘤采用微弹簧圈栓塞，３例采用球囊栓塞。１５例颈动脉穿刺入路，途径短，成功率高。５例股动脉穿刺入路。结果：栓塞后动脉瘤完全闭塞，载瘤动脉通畅１４例；动脉瘤栓塞９０％，载瘤动脉通畅３例；动脉瘤同时与载瘤动脉完全闭塞３例。２０例颅内囊状动脉瘤栓塞后３个月随诊无一例死亡和发生栓塞并发症；动脉瘤闭塞９０％的３例，ＤＳＡ证实动脉瘤完全消失。结论：介入放射治疗颅内动脉瘤效果良好，能保持载瘤动脉通畅而达到不开颅治愈病人的目的。     

血管内治疗颅内动脉瘤

Hisiuk(1960年)最早提出用可脱性球囊血管内阻塞颅内动脉瘤,但未能应用于临床。Fogarty(1963年)用不可脱性球囊导管血管内闭塞动脉瘤及载瘤动脉。自从Serbinenko(1974年)首次报告用可脱性球囊导管血管内栓塞治疗颅内动脉瘤及其它脑血管疾病以后,由Deb-run,Taki,Berenstein,Hieshima等对球囊、球囊内充     

115例颅内动脉瘤血管内栓塞的疗效分析

目的　对 115例颅内动脉瘤血管内栓塞治疗进行总结、分析 ,旨在提高治愈率 ,减少并发症。材料与方法　男 66例 ,女 49例 ,全部病例均经股动脉穿刺插管选择性全脑血管造影确诊。 40例用可脱球囊栓塞 ,75例用钨丝螺旋圈栓塞。结果　 115例经选择性全脑血管造影发现 116个动脉瘤 ,瘤体最小为 5mm× 5mm ,最大为 65mm× 46mm。 40例用可脱球囊栓塞中 ,18例栓塞成功 ,成功率 45 % ;75例用钨丝螺旋圈栓塞中 ,61例栓塞成功 ,成功率 81.3 %。结论　合理选用栓塞材料 ,严格掌握适应证是提高动脉瘤栓塞的成功率、减少并发症的关键     

血管内介入治疗颅内动脉瘤的现状及进展

颅内动脉瘤是神经外科常见疾病，死亡的主要原因为出血及早期并发症。随着血管内介入治疗的日趋成熟，越来越多的医师开始选择这种微创、有效的方法。     

血管内介入栓塞治疗颅内微小动脉瘤8例分析

目的探讨颅内微小动脉瘤(直径≤3.0 mm)血管内介入栓塞治疗的疗效及安全性。方法回顾性分析我科2011年3月～2012年1月接受介入栓塞治疗的8例颅内动脉瘤患者临床资料。共11个动脉瘤,采取单纯弹簧圈栓塞9个,采用颅内支架结合弹簧圈栓塞2个。结果 11个动脉瘤均100%栓塞成功,6例患者随访3～12个月无复发,另外2例因未定时返院复查而失访。结论采用单纯弹簧圈或结合颅内支架栓塞是目前治疗颅内微小动脉瘤的较好方法,具有创伤小、疗效好、并发症少的优点,值得广泛应用。     

颅内动脉瘤血管内栓塞治疗分析

目的探讨颅内动脉瘤血管内栓塞治疗的手术时机、治疗方法、并发症及其预防措施。方法回顾性分析2009年7月~2012年7月在我院行颅内动脉瘤血管内栓塞治疗患者40例临床资料。另选同期进行开颅夹闭手术患者40例进行比较。结果经数字减影血管造影（DSA）检测结果显示,观察组与对照组在动脉瘤栓塞程度、术后并发症和随访结果上比较,差异均有统计学意义。结论血管内栓塞治疗颅内动脉瘤疗效切实可靠,安全、有效、微创,预后好,早期手术和及时术后处理是降低致残率、致死率的重要方法。     

Dacron graft aneurysm treated by endovascular stent-graft

A 72-year old man who underwent aorto-bifemoral bypass with insertion of a Dacron graft 18 years previously presented with an aneurysm in the left limb of his graft. Angiography also demonstrated a bilateral occlusion of the popliteal arteries. Computed tomography (CT) angiography was performed and showed a localized dilation of 3 cm in the left limb of the graft, which had a diameter of 14 mm throughout. In view of the technical difficulties of a surgical procedure, an endovascular stent was considered. Through a left femoral arteriotomy, a stent graft was inserted and deployed in the left limb of the graft. This resulted in total exclusion of the Dacron graft aneurysm. To the best of our knowledge, this is the first report of such a procedure.     

Aortoiliac aneurysm with arteriocaval fistula treated by a bifurcated endovascular stent-graft

A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient’s cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knolwedge such a case has not been previously reported.     

Abciximab for thrombolysis during intracranial aneurysm coiling

Introduction  Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients’ outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. Materials and methods  All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, ±12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. Results  No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. Conclusions  Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke.     

颅内动脉瘤破裂早期的血管内栓塞治疗

目的探讨颅内动脉瘤破裂早期血管内栓塞治疗的效果。方法２０例破裂的颅内动脉瘤采取早期血管内治疗技术，用自制的多形钨丝弹簧圈栓塞动脉瘤囊。动脉瘤的位置：前交通动脉（ＡＣｏＡ）７例，后交通动脉（ＰＣｏＡ）６例，中动脉（ＭＣＡ）２例，眼动脉１例，后循环４例。病人分级：ＨｕｎｔＨｅｓＩＩ级３例，ＩＩ级及ＩＶ级各７例，Ｖ级３例。１６例于３天内治疗，其余４例于６天内治疗。结果１８例闭塞９０％以上，其中８例动脉瘤完全闭塞（４０％），２例死亡。术后观察３个月～２年，１５例效果良好，３例残留轻～中度瘫痪，术后随访无一例发生蛛网膜下腔出血（ＳＡＨ）。结论血管内栓塞是治疗颅内动脉瘤急性期破裂的较好方法。     

电解可脱式弹簧圈栓塞治疗颅内动脉瘤破裂

目的　探讨血管内电解可脱式铂金微弹簧圈 (GDC)早期栓塞治疗破裂后颅内动脉瘤的临床价值。方法　对 15例破裂后颅内动脉瘤施行血管内GDC早期栓塞治疗 ,15例患者按Hunt Hess分级 :I级 8例、II级 6例、IV级 1例 ,所有病例均经DSA造影和CT扫描诊断。结果　GDC栓塞手术成功13例 ,占 86 .7% (13/ 15 ) ;13例随访 3～ 2 5个月无再次出血和并发症 ,其中 2例 6个月后复查DSA未见复发 ,全部病例头颅正侧位片显示GDC形态、位置无改变 ;栓塞手术失败的 2例患者分别于术后第 4天和 4个月死亡。结论　早期GDC血管内栓塞治疗破裂后颅内动脉瘤为有效方法 ,可以防止再次破裂出血。     

Postoperative aneurysm remnants: endovascular treatment as an alternative to further surgery

Because further surgery on postoperative aneurysm remnants can be difficult and lead to significant morbidity and mortality, endovascular treatment, using controlled detachable coils, was performed in three patients with such remnants. The endovascular approach was technically more difficult in these cases than in previously untreated patients. In one case, the “remodelling” technique was necessary. Given the successful outcome in these patients, endovascular treatment can be proposed as an alternative to another operation, when further surgery appears too risky or is refused by the patient. Received: 16 December 1997 Accepted: 25 September 1998     

腹主动脉瘤腔内隔绝术中内漏动物模型的建立

目的：建立近似人体的腹主动脉瘤（AAA）腔内隔绝术（EVE）后内漏的实验动物模型。方法：采用6只犬 ，以牛颈静脉间置法或前壁补片的方法形成保留腰动脉的肾下型AAA，经髂动脉行AAA EVE，术中采用修剪人造血管和改变支架附着点的方法形成内漏。结果：血管造影示6只犬动脉瘤形态良好，5只犬形成了即时性内漏，内漏来自近端返流，也有近端返流。结论：通过移植物释放位置的变化可以模拟出与人体EVE后相似的即时性内漏，以供血流动力学和治疗研究。     

介入法犬股骨头坏死模型制作

目的 应用介入方法建立犬股骨头坏死模型.方法 9只成年杂种犬全麻后,分别通过股动脉Seldinger法穿刺插管,超选一侧股骨头供血动脉行平阳霉素灌注及明胶海绵栓塞处理,建立股骨头缺血坏死模型,对侧股骨头作对照.模型犬随机分为3组,每组3只,分别于栓塞术后2、4、6周处死.所有犬均于栓塞术前及术后每周行双侧髋关节MRI扫描,栓塞术前、术后即刻、处死前行双侧股骨头供血动脉DSA造影检查,最后一次造影结束处死动物,取双侧股骨头标本送病理学观察.结果 9只犬均造模成功,术后所有栓塞动脉造影复查均未见再通.造模侧股骨头在术后2周出现早期病理学改变.术后4周MRI显示股骨头坏死异常信号,病理切片出现不同程度骨细胞及骨小梁坏死,术后6周病理切片可见坏死后增生及修复反应.结论 本法能成功制作出犬股骨头坏死模型,具有创伤小、造模方法简单、成模时间短、动物死亡率低等优点,是一种比较理想的造模方式.     

颅内动脉瘤介入治疗与显微手术治疗对比研究

目的 :对比分析颅内动脉瘤介入治疗与显微手术治疗的时机及术中、术后处理及疗效。方法 :回顾性分析颅内动脉瘤介入治疗 36例与应用显微手术治疗 132例的疗效。结果 :介入治疗 36例 4 1枚动脉瘤中 34枚动脉瘤行GDC栓塞、1枚行单纯支架置入、6枚行支架置入 GDC栓塞 ;术后恢复良好者 2 7例 ,轻残 5例 ,重残 3例 ,死亡 1例。显微手术组132例中 ,术后恢复良好 86例 ,轻残 2 5例 ,重残 14例 ,死亡 7例。结论 :在颅内动脉瘤治疗中 ,介入治疗较显微手术治疗简单易行 ,恢复快、预后好