颈动脉支架成形术在高手术风险颈动脉狭窄治疗中的应用

目的：探讨应用Onyx胶栓塞颅内动静脉畸形（CAVM）的治疗效果.方法：2008年1月～2009年12月,经股动脉穿刺,采用血管介入Onyx胶栓塞治疗CAVM 50例,其中畸形血管团直径＜3.0 cm者10例,3.0～6.0 cm者29例,＞6.0 cm者11例.结果：50例CAVM患者,一次栓塞治疗后畸形血管团栓塞达90%以上者12例,栓塞在90%以下者38例均行多次栓塞或联合手术、放射治疗.并发颅内出血症2例,其中1例术后24h死亡.44例术后随访3～18个月,无一例CAVM复发.结论：Onyx胶是治疗CAVM较为理想的栓塞材料,血管内栓塞治疗CAVM有良好的疗效.     

血管内介入治疗脑动静脉畸形

目的探讨血管内栓塞治疗脑动静脉畸形(AVM)的临床效果和安全性. 方法应用血管内栓塞治疗脑AVM 11例,栓塞剂为NBCA,栓塞后3例行手术切除,3例行γ-刀治疗.结果 1例完全栓塞,5例栓塞70%～90%,3例栓塞50%～70%,2例栓塞小于50%.生活、工作完全正常治愈5例,症状明显改善4例,症状无改善2例.结论血管内栓塞治疗脑AVM的方法是相对安全的,可治愈部分脑AVM,对于大型、重要功能区的脑AVM,血管内栓塞联合手术或放疗可提高治愈率,降低致残率和死亡率.     

血管内介入治疗脑动静脉畸形

目的 探讨血管内栓塞治疗脑动静脉畸形(AVM)的临床效果和安全性．方法 应用血管内栓塞治疗脑AVMll例，栓塞剂为NBCA，栓塞后3例行手术切除，3例行γ-刀治疗．结果 1例完全栓塞，5例栓塞70％—90％，3例栓塞50％—70％，2例栓塞小于50％．生活、工作完全正常治愈5例，症状明显改善4例，症状无改善2例．结论 血管内栓塞治疗脑AVM的方法是相对安全的，可治愈部分脑AVM，对于大型、重要功能区的脑AVM，血管内栓塞联合手术或放疗可提高治愈率，降低致残率和死亡率．     

105例脑动静脉畸形并出血的外科治疗

目的探讨脑动静脉畸形及合并出血后外科治疗方法的选择。方法105例病人根据脑动静脉畸形的分级、出血的部位、出血量的大小及病人的状况等选择手术、栓塞或栓塞后手术等方法治疗。结果手术组60例,全切除55例,占92%;部分切除5例,占8%。血管内治疗40例,一次全部栓塞的15例,占37%;分次全部栓塞的18例,占45%;部分栓塞的7例,占18%。血管内治疗后手术5例,全切除3例,占60%;部分切除2例,占40%。治愈91例,治愈率为86%;好转6例,占6%;死亡8例,占8%。结论手术治疗和血管内治疗是目前治疗脑动静脉畸形并出血的有效方法。     

腔内注射Onyx胶治疗小脑上动脉动脉瘤1例

远端动脉瘤指位于主干血管末梢或其远处小分支的动脉瘤，相对少见。小脑上动脉（the Superior Cerebellar artery，SCA）远端动脉瘤更为罕见，其处理较为棘手。Onyx是一种新型栓塞材料，主要用来栓塞颅内动静脉畸形，也有报道用来治疗颅内动脉瘤及其载瘤动脉。现将采用腔内注射Onyx胶治疗左侧SCA远端动脉瘤1例报道如下。     

体感诱发电位监护下脑动静脉畸形的栓塞治疗

目的:评价在短潜伏期体感诱发电位(SSEP)监护下脑动静脉畸形(AVM)的血管内栓塞治疗(EVET)的效果。方法:回顾性分析我院收治进行EVET的31例患者的资料,其中男17例,女14例,年龄9～67岁,平均37.6岁。结果:①影像学结果:31例AVM病例中,17例(55%)行一期EVET,畸形血管团完全消失;3例行二期栓塞治疗有2例(7%)畸形血管团完全消失;2例行三期栓塞治疗,畸形血管团完全消失;9例行一期EVET时出现SEEP的明显变化,未作进一步的EVET。以最后一期栓塞后的数字减影式血管造影(DSA)资料进行栓塞程度统计:畸形血管团完全消失(100%栓塞)19例,占61%;70%～99%的栓塞7例,占23%;30%～69%的栓塞4例,占13%;≤29%的栓塞1例,占3%;②SSEP结果:术中N20波潜伏期及波幅无变化17例,5例SSEP有变化者治疗好转后作了二、三期EVET。8例出现中枢传导并N20波幅的降低,1例出现N20波消失,此9例未作进一步的EVET;③并发症:共4例,其中2例术中出现血管痉挛,1例术后出现偏瘫等神经功能损害,1例术后出现正常灌注压突破并死亡;④随访结果:良好28例,占90%...     

颅内动脉瘤的介入治疗分析

目的探讨血管内介入治疗颅内动脉瘤的可行性与安全性。方法回顾性分析行血管内介入治疗的19例动脉瘤患者的临床资料。结果 19例动脉瘤患者经血管内介入治疗后,15例患者达到完全闭塞,3例患者95%以上闭塞,1例患者90%~95%闭塞,所有患者均治愈出院,术后载瘤动脉均显影正常,无异位栓塞及永久并发症发生。随访6~24个月,未再发生蛛网膜下腔出血,生活均正常。结论介入栓塞治疗颅内动脉瘤是安全有效。     

介入栓塞联合显微手术一站式切除高级别脑动静脉畸形疗效分析

目的探讨介入栓塞联合显微手术一站式切除高级别脑动静脉畸形的手术要点和临床价值。方法回顾性分析使用介入栓塞联合显微手术一站式切除的33例高级别脑动静脉畸形患者的临床资料,包括临床表现、影像学特征、治疗指征和结果,并用改良的Rankin量表(mRS)评估结果。结果 19例(57. 6%)患者存在出血,7例(21. 2%)存在癫痫发作,6例(18. 2%)存在头痛,1例(3. 0%)出现进行性神经功能缺损。根据Spetzler-Martin分级(SMG):Ⅲ级7例(21. 2%)、Ⅳ级22例(66. 7%)、Ⅴ级4例(12. 1%)。切除术后共7例(21. 2%)患者出现治疗相关并发症。32例(97. 0%)患者术后造影显示畸形团完全闭塞。无死亡患者。随访3～36个月,平均9. 6个月,31例(93. 9%)患者mRS为0分,1例(3. 05%)患者mRS为1分,1例(3. 05%)患者mRS为4分。结论介入栓塞联合显微手术一站式切除高级别脑动静脉畸形弥补单了一治疗方案的缺陷,获得了较高的即时闭塞率和相对较低的致残率和病死率。     

可脱性弹簧圈血管内栓塞颅内动脉瘤(附126例分析)

<正> 目的:探讨可脱性弹簧圈血管内栓塞治疗颅内动脉瘤的效果及技术要点.方法:对126例颅内动脉瘤应用微导管技术,在数字减影血管造影(DSA)监视下行血管内栓塞治疗,其中85例90个动脉瘤用机械式可脱性弹簧圈(Machenical detachable spiral,MDS),栓塞,41例42个动脉瘤用电解式可脱性弹簧圈(Guglielmi detachabe coil,GDC)栓塞.结果:成功栓塞126例132个动脉瘤,123例痊愈,3例死亡.100%栓塞124个,95%栓塞6个,90%栓塞2个.并发动脉瘤破裂4例,并发脑梗死2例,其中1例痊愈,1例死亡;1例微弹簧末端逸出并顽固性脑血管痉挛.2例复发者再予GDC栓塞而治愈.结论:血管内栓塞治疗颅内动脉瘤是一种比较安全、可靠、有效的治疗手段,但动脉硬化明显导管到位困难者及术前呼吸、循环功能衰竭者不宜行血管内治疗.术前尼莫通化,术中导管内推注罂粟碱可有效防止脑血管痉挛.动脉瘤较大者,术     

APA介入显影栓塞剂治疗脑动静脉畸形

目的 研究APA介入显影栓塞剂对脑动静脉畸形的治疗效果。方法 用海藻酸钠—聚赖氨酸—海藻酸钠(APA)法制成单纯栓塞剂，包埋金属粉制成在X线下显影栓塞剂。将2种栓塞剂分别在X线下观察体外显影效果，注入兔股动脉观察体内显影效果，并对2例脑血管畸形患进行初步临床试验。结果 与单纯栓塞剂相比，显影栓塞剂在X线下显影效果良好，将显影栓塞剂注入家兔股动脉后在X线下显影效果良好，临床试验表明不但显影效果良好，而且栓寒效果可靠。结论 APA介入显影栓塞剂治疗脑动静脉畸形有较好疗效。     

基质结构蛋白在脑血管畸形中的表达差异

背景：有研究表明脑血管畸形中存在管壁结构基质蛋白的表达差异,但血管畸形间结构基质蛋白的差异及结构蛋白差异与畸形血管管壁异形关系少有报道。 目的：观察基质结构蛋白在脑血管畸形中的差异性表达。 方法：对50例脑血管畸形手术标本和34例正常颞浅动脉标本进行苏木精-伊红染色,并应用美国Santa Cruz公司生产单/多克隆抗体对4种基质结构蛋白-Ⅳ型胶原蛋白、a-血管平滑肌蛋白、层粘连蛋白和纤维连接蛋白免疫组织化学染色。 结果与结论：苏木精-伊红染色显示,脑血管畸形壁结构与正常血管相比呈现明显紊乱和构成异形性;且脑血管畸形中,脑动静脉畸形与海绵状血管瘤结构存在明显差异。免疫组织化学染色显示：正常颞浅动脉和畸形血管中Ⅳ型胶原和a-血管平滑肌蛋白全部呈阳性表达且无显著性差异,但结构排列差异明显;正常颞浅动脉与畸形血管层粘连蛋白和纤维连接蛋白表达阳性率差异有显著性意义(P < 0.05),正常血管表达更多层粘连蛋白,畸形血管表达更多纤维连接蛋白;畸形血管中脑动静脉畸形和海绵状血管瘤间层粘连蛋白和纤维连接蛋白的阳性率表达差异有显著性意义(P < 0.05),脑动静脉畸形血管表达更多层粘连蛋白,海绵状血管瘤血管表达更多纤维连接蛋白。结果证实：与正常血管相比,脑血管畸形者管壁结构存在明显异形性,结构蛋白Ⅳ型胶原和a-血管平滑肌蛋白结构明显紊乱,且低表达层粘连蛋白而高表达纤维连接蛋白,这种差异可能是导致脑血管壁结构异常的原因。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Determination of Blood Flow Velocity and Transit Time in Cerebral Arteriovenous Malformation using Microdroplet Angiography

Advancement in imaging and biomedical technology has improved the use of catheter-based transarterial embolization (occlusive therapy) of cerebral arteriovenous malformations (AVMs). Among a variety of embolic agents, liquid adhesives (acrylates) have proven to be more successful in permanent obliteration of AVMs. The use of liquid adhesives requires the experience and skill of the operator. However, acquiring accurate information on blood flow and transit times through the AVM prior to embolization can optimize the treatment. In addition, knowledge of the polymerization time and behavior of the acrylate enables a complete and safe occlusion of the arteriovenous transition within the AVM nidus. Standard commercially available iodine-based contrast agents seem to be insufficient to determine AVM transit times from angiograms. For a more accurate assessment of AVM transit times, the use of a nonsoluble contrast agent (Ethiodol) and a high-speed digital subtraction angiography (DSA) is suggested. Small amounts (<20 l) of Ethiodol were infused to create microdroplets and traced using DSA at 15 fps. Transit time, defined as the time interval required for a droplet to reach the venous part of the AVM after being flushed from the tip of the catheter, could be accurately calculated. Postprocessing was used to calculate trajectories and velocities of microdroplets. © 2001 Biomedical Engineering Society. PAC01: 8719Uv, 4755Dz, 8719La, 8759Bh     

Computational modelling for the embolization of brain arteriovenous malformations

Treatment of arteriovenous malformations (AVMs) of the brain often requires the injection of a liquid embolic material to reduce blood flow through the malformation. The type of the liquid and the location of injection have to be carefully planned in a pre-operative manner. We introduce a new model of the interaction of liquid embolic materials with blood for the simulation of their propagation and solidification in the AVM. Solidification is mimicked by an increase of the material's viscosity. Propagation is modelled by using the concept of two-fluids modelling and that of scalar transport. The method is tested on digital phantoms and on one anatomically derived patient AVM case. Simulations showed that intuitive behaviour of the two-fluid system can be confirmed and that two types of glue propagation through the malformation can be reproduced. Distinction between the two types of propagation could be used to identify fistulous and plexiform compartments composing the AVM and to characterize the solidification of the embolic material in them.     

颅内动静脉畸形显微手术疗效与其解剖关系

目的：通过颅内动静脉畸形显微外科的治疗，探讨手术疗效与畸形的解剖关系。方法：显微镜下全部切除颅内解剖特性不同的脑动静脉畸形８例，并复习临床资料。结果：８例中，术后近期出现偏瘫者３例，单纯运动性失语２例，余３例术后无神经病学定位体征：经远期随访，仅１例遗留偏瘫，余７例均恢复正常，无死亡。上述结果表明：颅内动静脉畸形显微外科手术疗效，除与手术技巧有关外，主要与畸形自身的解剖学特性有关；同时，与畸形周边的解剖学改变，血肿、水肿等也有一定的关系     

Willis环周围窄颈动脉瘤与栓塞材料选择的相关性*

背景：随着影像学设备与栓塞材料的不断发展,颅内动脉瘤的血管内栓塞治疗也成为治疗方法之一。 目的：探讨Willis环周围窄颈动脉瘤的形态学特点与栓塞材料选择及血管内栓塞治疗的关系。 方法：用双源CT血管成像检查筛选患者,采用Seldinger技术行全脑血管造影,根据动脉瘤的不同解剖学形态选用合适的弹簧圈进行介入栓塞治疗。 结果与结论：31例患者共36枚动脉瘤均成功栓塞,完全栓塞31枚、占86.11%,大部分栓塞5枚、占13.89%;随访6~12个月,所有患者均未发生再出血或脑血栓形成;动脉瘤的栓塞程度不仅与动脉瘤的形态有关,而且与栓塞材料直接相关。故认为根据不同的形态学特点选用合适的弹簧圈进行血管内栓塞治疗,是一种安全有效的方法。     

自制Fe3O4微粒和明胶海绵的肺微循环栓塞效果

背景：有研究表明,小颗粒的栓塞剂易经微导管行栓塞,50-100 μm的颗粒能很好栓塞小动脉,减少侧支循环的产生。 目的：观察自制栓塞剂介入栓塞兔肺微循环的病理改变。 方法：用自制的50,100,150,200,250 μm粒径的Fe3O4微粒、直径500-1 000 μm明胶海绵自制颗粒,对新西兰大白兔行动脉介入肺动脉栓塞,观察其栓塞效果。 结果与结论：数字减影血管造影及病理检测结果显示,50,150,250 μm粒径Fe3O4微粒及明胶海绵自制颗粒均能栓塞兔不同直径肺动脉微循环血管。Fe₃O₄微粒能栓塞兔毛细血管及毛细血管前小动脉,介入栓塞后1-4周兔栓塞血管未见再通,能达到长期栓塞效果,50-250 μm粒径Fe₃O₄微粒能顺利通过微导管行栓塞治疗,且未见明显异位栓塞。明胶海绵自制颗粒能栓塞直径(1 300±348) μm的小动脉,不易通过微导管,在一两周后可被吸收,血管易再通。结果证实,Fe₃O₄微粒具有良好的栓塞效果,栓塞持久、完全、彻底栓塞后血管不易再通,侧支循环不易建立,是良好的肺微循环永久栓塞剂。明胶海绵作为栓塞剂多栓塞于分支小动脉,不能栓塞微循环。     

Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas

Curative transarterial embolization of noncavernous sinus dural arteriovenous fistulas (dAVFs) is challenging. We sought to evaluate the role of the middle meningeal artery (MMA) in endovascular treatment of these lesions. We performed a retrospective cohort study on patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVFs with contribution from the MMA at a major academic institution in the United States from January 2009 to January 2015. Twenty consecutive patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVF were identified. One patient was excluded as there was no MMA contribution to the dAVF. All of the remaining 19 patients (61.3 ± 13.8 years of age) underwent transarterial embolization through the MMA. Six patients (31.6%) presented with intraparenchymal or subarachnoid hemorrhage from the dAVF. The overall angiographic cure rate was 73.7% upon last follow up. In 71.4% of successfully treated patients transarterial embolization of the MMA alone was sufficient to achieve angiographic cure. When robust MMA supply was present, MMA embolization resulted in angiographic cure even after embolization of other arterial feeders had failed in 92.9% of patients. A robust contribution of the MMA to the fistula was the single most important predictor for successful embolization (P = 0.00129). We attribute our findings to the fairly straight, non‐tortuous course of the MMA that facilitates microcatheter access, navigation, and Onyx penetration. Noncavernous sinus dAVF can be successfully embolized with transarterial Onyx through the MMA, as long as supply is robust. A transvenous approach is rarely necessary. Clin. Anat. 29:718–728, 2016. © 2016 Wiley Periodicals, Inc.     

颈外动脉系血管病变的血循环特点及栓塞治疗

目的　分析颌面鼻咽部血循环特点,探讨安全有效的颈外动脉(ECA)超选择性插管栓塞技术。方法　37例患者,疾病包括鼻咽纤维血管瘤、颌面血管畸形、鼻出血、上颌窦血管瘤、右眶内骨折出血、颈静脉球瘤、颈静脉球瘤并颈动脉体瘤、脑膜瘤、颅底硬脑膜动静脉瘘。均经ECA及分支数字减影血管造影(DSA),有25例共行32支ECA及分支栓塞治疗。结果　均取得治愈或好转疗效。其中1例右眼失明,1例左颊及耳廓坏死。结论　颌面鼻咽部血供丰富,侧支吻合多,ECA及分支DSA可明确病变血供,了解侧支及危险吻合情况。应尽量高超选择直接栓塞病灶,以提高疗效和减少并发症。正确选择导管及熟练操作是高超选择性插管成功的保证。不能超选择性插入分支者采用血流再分布原理进行栓塞。对活动性出血不能超选择性插管时可采取主干栓塞后局部降压而止血。     

Iodine-containing cellulose mixed esters as radiopaque polymers for direct embolization of cerebral aneurysms and arteriovenous malformations.

The present study deals with the synthesis and characterization of radiopaque polymers which could, when solubilized in an appropriate water-miscible solvent, be useful embolic materials for the treatment of cerebral aneurysms and arteriovenous malformations. For this purpose cellulose (both microcrystalline and powdered) and partially substituted cellulose acetate (two different viscosity grades) were selected as starting materials to prepare iodine-containing polymers through various synthetic routes. The materials obtained were characterized by IR and NMR spectroscopy, molecular weight, iodine content, radiopacity and solubility in selected injectable organic solvents. The embolic liquids were evaluated for their precipitation behavior in a phosphate buffer solution (pH 7.4) mimicking physiological conditions using an in vitro aneurysm model. A sheep model was also used to assess in vivo the radiopacity and precipitation properties of a highly concentrated solution of a cellulose acetate 2,3,4-triiodobenzoate mixed ester. All materials with 4-iodo- and 2,3,5-triiodobenzoyl groups gave sufficient radiopacity to be regarded as possible embolization materials, whereas iododeoxycellulose and iododeoxycellulose acetate were not radiopaque because of their low iodine content. Esters synthesized using cellulose as starting material were not soluble in the selected organic solvents due to the presence of many residual hydroxyl groups, but could be used for other biomedical applications where insoluble radiopaque materials are used. In contrast, solubility of the materials as well as satisfactory precipitation properties were ensured using cellulose acetate as the starting material. In conclusion, cellulose acetate iodobenzoate mixed esters dissolved in diglyme or dimethyl isosorbide (dimethyl sulfoxide is probably less appropriate because of its toxicity and hemolytic properties) could be useful embolic liquids for the treatment of cerebral aneurysms or arteriovenous malformations.