犬实验性颈总动脉动脉瘤的血管内支架治疗系列研究之一:犬实验性颈总动脉动脉瘤模型建立

目的：探讨将一侧颈外静脉与双侧颈总动脉吻合建立侧壁动脉瘤的可行性。材料与方法：对10只犬应用显微外科技术进行颈外静脉、颈总动脉端侧吻合,作血管造影证实瘤腔存在及载瘤动脉通畅。结果：10只犬均成功地建成颈总动脉侧壁动脉瘤,其中8例为宽颈动脉瘤。结论：应用犬一侧颈外静脉与双侧须总动脉吻合建立双侧颈总动脉动脉瘤特别是宽颈动脉瘤切实可行。     

新型实验性颈内动脉虹吸段模型的建立

目的建立用于测试颅内支架性能的颈内动脉虹吸段动物模型。方法使用快速原型及脱蜡技术建立6只颈内动脉虹吸段约束装置。手术暴露并游离6只犬双侧颈总动脉。左侧颈总动脉近端暂时性夹闭,远端结扎并沿结扎点近侧切断。右侧颈总动脉远端暂时性夹闭,近端结扎并沿结扎点远侧切断。左侧颈总动脉近侧段穿过塑型装置,并与右侧颈总动脉远侧游离段端端吻合。术后1、2周、1个月血管造影,视觉评估虹吸段模型形态,血管通畅,吻合口狭窄及附壁血栓形成情况。结果所有实验犬均能耐受手术,无一只死亡或出现神经功能障碍。建模平均手术时间90min。术后1、2周、1个月血管造影,显示虹吸段模型空间结构与其人体原形高度相似,2例发生吻合口狭窄,1例吻合口附壁血栓形成。所有模型虹吸段随访中均保持通畅。结论采用体外约束装置,手术建立虹吸段模型切实可行,该模型具有高度可重复性、可靠性,可用于测试神经血管内材料。     

犬实验性颈总动脉动脉瘤的血管内支架治疗系列研究之二：载 …

目的：探讨将血管内支架置于动脉瘤附近载瘤动脉后发生的血流动力学改变，为动脉瘤的载瘤动脉内支架治疗提供实验依据。材料与方法：向６只犬７个颈总动脉侧壁动脉瘤附近载瘤动脉内置入血管内支架，而后作血管造影，比较支架置入前后瘤胚闭褰主载瘤动脉通畅情况。结果：７个动脉瘤载瘤动脉内支架置入后３天瘤腔均发生闭塞，载瘤动脉保持通畅；３周后瘤腔仍见闭塞且载瘤动脉保持通畅。结论：向动脉瘤附近载瘤动脉内置入血压管内支架。     

犬实验性颈总动脉动脉瘤的血管内支架治疗系列研究之一：犬？…

目的;探讨将一侧颈外静脉与双侧颈总动脉吻合建立侧壁动脉瘤的可行性。材料与方法：对１０只犬应用显微外科技术进行颈外静脉、颈总动脉端侧吻合,作血管造影证实瘤腔存在及载瘤动脉通畅。结果：１０只犬均成功地建成颈总动脉侧壁动脉瘤,其中８例为宽颈动脉瘤。结论：应用犬一侧颈外静脉与双侧颈总动脉吻合建立双侧颈总动脉动脉瘤特别是宽颈动脉瘤切实可行。     

MRA评价颈总动脉分叉的正常解剖及其变异

目的：研究颈总动脉分叉（ＣＣＡＢ）的正常影像学解剖及其变异。材料与方法：用ＧＥ Ｓｉｇｎａ１．５Ｔ ＭＲ机对７３例行ＣＣＡＢ ＭＲＡ检查。分别测量ＣＣＡＢ最大角度、分叉高度及颈内动脉（ＩＣＡ）与颈外动脉（ＥＣＡ）的相对位置关系。结果：８０．６％的ＣＣＡＢ角度在２０￣４０°之间；６０．６％两侧ＣＣＡＢ高度在同一水平，３９．４％不在同一水平，相差最大１８ｍｍ；７４．３％ＩＣＡ起始段居ＥＣＡ后外侧，其中     

左侧颈总动脉起始处狭窄血管内治疗二例

本文报道2例左侧颈总动脉起始处狭窄,分别应用同轴技术及非同轴技术进行支架成形术。术后神经科体检及头颅CT检查未见异常。随访时CTA提示支架通畅,无卒中事件发生。左侧颈总动脉起始处狭窄的患者可以选择血管内治疗,术中根据血管解剖形态选择保护装置的应用方法。     

1mm内径涤纶小血管桥接大鼠颈总动脉的实验研究

采用４８只ＳＤ雄性大鼠，切除７ｍｍ一段左颈总动脉，以１０ｍｍ长、１．０ｍｍ内径的涤纶小血管桥接之．术后２４、７２小时及１、２、３、４、８和１２周分别以多普勒超声监测血流通畅情况．每次随访时，对５例通畅者（８周时３例，１２周时４例）及所有不通畅者行手术探查或血管造影检查，以进一步证实多普勒检查结果的正确性，同时取下桥接血管．部分桥接血管经处理后作扫描电镜检查．结果显示桥接后１２周的累积通畅率为７７．１％．快速而完全的内皮化过程在桥接后３周即完成，形成一光滑的内皮细胞层．１１例桥接血管因血栓形成而失败，其中１０例发生在桥接后３周之内，即内皮化之前．提示涤纶小血管可成功地用于大鼠颈总动脉桥接，失败主要发生在内皮化之前，其原因为血栓形成，若用抗凝药物或内皮细胞种植防止早期血栓形成，可望进一步提高通畅率，有可能使其成功地用于临床．     

犬实验性颈总动脉动脉瘤的血管内支架治疗系列研究之三：：？…

目的：从组织病理学角度研究血管内支架置于动脉瘤附近载瘤动脉闭塞动脉斩作用机制。材料与方法：对７个动瘤动脉内置入支架后３天，１周、３周动脉瘤及载瘤动脉取材，观察其组织病理学改变。结果：支架置入后瘤腔完全被血栓充填，且血栓质地由软变硬，最后与壁连为一体，支架表面纤维肌样组织覆盖。结论：将血管内支架置于动脉胶附近载瘤动脉，可同时促使瘤腔内形成血栓而闭塞动脉瘤     

犬颈动脉囊状动脉瘤模型的建立实验研究

目的探讨建立犬颈总动脉囊状动脉瘤模拟人体颅内动脉瘤的可行性。方法采用外科手术方法建立犬颈动脉囊状侧壁动脉瘤模型。结果建立20条健康实验犬颈动脉囊状侧壁动脉瘤模型40枚,血管造影证实动脉瘤与载瘤动脉均通畅者有36枚,4枚动脉瘤腔自发性完全性闭塞,但颈总动脉均保持通畅,模型建立成功率为90.0%。结论犬颈总动脉囊状侧壁动脉瘤是模拟人体颅内动脉瘤的最佳模型之一。     

兔颈总动脉侧壁型动脉瘤模型制作的改进

目的 对兔颈总动脉侧壁型动脉瘤模型进行改进,以评价建模的成功率及支架植入后颈总动脉的通畅率.方法 取新西兰大白兔20只,饲养1周后行左侧颈内动脉结扎.1个月后行颈部3.0 TMRA检查评价颈动脉与椎动脉的变化情况.采用间断式外翻缝合法吻合静脉囊与颈总动脉,建立侧壁型动脉瘤.在植入覆膜支架前、术后即刻、3个月、6个月行血管造影.结果 20只实验兔均顺利行左侧颈内动脉结扎.MRI示结扎前右颈总动脉中段平均直径为(2.35±0.08) mm,结扎后1个月右颈总动脉中段平均直径为(2.89±0.22) mm,与术前比较差异有显著统计学意义(P＜0.01).MRA示17只兔右颈总动脉明显增粗,而双侧椎动脉略增粗;3只兔颈总动脉增粗不明显,而双侧椎动脉明显增粗.建立兔颈总动脉囊状动脉瘤模型17只,术后均健康成活.DSA示覆膜支架植入前所有动脉瘤及右颈总动脉通畅,4个动脉瘤腔内有少量血栓形成,但无自发性完全闭塞.Willis或镁合金覆膜支架植入术后即刻造影示动脉瘤闭塞,右颈内动脉通畅.术后3个月DSA示16只兔右颈内动脉通畅,1只闭塞.术后6个月DSA示16只兔右颈内动脉通畅.动脉瘤模型的成功率为100％ (17/17),覆膜支架植入后右颈总动脉的通畅率为94.1％(16/17).结论 兔颈总动脉侧壁型动脉瘤模型制作的改进提高了动脉瘤模型的成功率及覆膜支架植入后右颈总动脉的通畅率.     

Duplication of the internal carotid artery

Summary The angiographic appearance of a duplicated internal carotid artery is described.     

Anomalous origin of the posterior meningeal artery from the internal carotid artery

Summary A rare case of anomalous origin of the posterior meningeal artery from the internal carotid artery, normally arising from the vertebral artery, is presented.     

Colour-coded Doppler sonography of common carotid artery dissection

Colour Doppler sonography allowed noninvasive confirmation of bilateral common carotid artery dissection in a patient with previous aortic dissection. It also cast light on the pathophysiology.     

Separate origins of the left internal and external carotid arteries from the aorta in a patient with intracerebral hemorrhage

Agenesis of the left common carotid artery with separate origins of the left internal and external carotid arteries from the aorta is an extremely rare anomaly. This anomaly is typically asymptomatic unless associated with other conditions. We report a case of separate origins of the left internal and external carotid arteries from the aorta in a patient with intracerebral hemorrhage. A 42-year-old man was transferred to our hospital by ambulance because of left hemiparesis. Computed tomography scan revealed right putaminal hemorrhage. Computed tomography angiography and digital subtraction angiography demonstrated independent origins of the left internal carotid artery and external carotid artery from the aortic arch. Right internal carotid angiography revealed blood supply to the left anterior cerebral artery and middle cerebral artery via the anterior communicating artery. The separate origins of the left internal and external carotid arteries from the aorta may cause hemodynamic stress to the contralateral side, leading to right intracerebral hemorrhage.     

颈动脉分叉部动脉瘤模型的建立

目的探讨建立犬颈动脉分叉部动脉瘤模型的可行性。方法建立18只犬新的颈总动脉(CCA)分叉部动脉瘤模型,随机分为分叉部顶端弹性蛋白酶处理组(实验组,n=9)和生理盐水处理组(对照组,n=9)。术后即刻、12周和24周分别行血管造影观察动脉瘤顶端形态变化,术后12周和24周分别行组织病理学分析。结果血管造影显示实验组中5只模型动脉分叉顶部观察到新生动脉瘤形成,平均直径(3.2±0.4)mm,对照组中所有模型分叉部顶端均未观察到有新生动脉瘤形成。实验组中新生动脉瘤在随访过程中未见到动脉瘤破裂。组织病理学分析显示实验组中分叉部顶端动脉瘤表现为内弹力膜不连续、弹力纤维断裂、肌层变薄、平滑肌细胞减少(与对照组相比,P<0.001)。结论犬重建颈动脉分叉顶端经弹力酶消化所致动脉壁退化可引起新生动脉瘤形成。     

Using Onyx in endovascular embolization of internal carotid artery large or giant aneurysms

Background and purpose

Internal carotid artery (ICA) large or giant saccular aneurysms is challenging for endovascular coil embolization and surgical clipping with a high recanalization and rebleeding rate. We report our results using Onyx in the endovascular treatment of ICA large or giant saccular aneurysms.

Methods

During 2008–2010, 5 patients with 5 large or giant saccular aneurysms in ICA were treated with a liquid embolic agent (Onyx; Micro Therapeutics, Irvine, CA). One aneurysm was small (<10 mm), 2 were large (≥10 mm, <25 mm) and 2 were giant saccular aneurysms (≥25 mm). Of 3 female and 2 male patients, 3 were incidental and 2 had bleeding. Selective embolization was performed with Onyx alone or a combination with coils. Clinical and anatomic outcomes were assessed with the Modified Glasgow Outcome Scale and follow-up angiography was performed at 4–21 months (mean 12.2 months).

Results

Complete aneurysm occlusion was obtained in all of the aneurysms on immediate control angiogram. There was not any procedure-related complication. No recanalization was observed at the follow- up periods. There were 2 ICA occlusions in giant ICA aneurysms. The 5 patients were all clinically asymptomatic at follow-up.

Conclusion

Endovascular embolization with Onyx is a useful treatment for ICA large or giant aneurysms, which is unsuitable for coiling or surgical treatment.     

Decreased hyperintense vessels on FLAIR images after endovascular recanalization of symptomatic internal carotid artery occlusion

Background and purpose

Hyperintense vessels (HV) on fluid-attenuated inversion recovery (FLAIR) images were assumed to be explained by slow antegrade or retrograde leptomeningeal collateral flow related to extracranial or intracranial artery steno-occlusion. The aim of this study was to investigate the effect of recanalization after endovascular therapy of symptomatic internal carotid artery (ICA) occlusion on the presence of HV.

Methods

Eleven patients with symptomatic ICA occlusion were retrospectively enrolled. Changes in the HV on FLAIR images were examined in affected hemisphere of each patient after successful treatment with endovascular recanalization (angioplasty, n = 3; stent-assisted angioplasty, n = 8). The relationship between postoperative changes in the HV and Thrombolysis In Cerebral Ischemia (TICI) scale (I-III) was assessed.

Results

After operation, HV of the 11 affected hemispheres were showed to be decreased (n = 3) or disappeared (n = 8) in treated side. The median interval between pre- and postoperative MRI examinations was 97.0 h (range, from 69. to 48.7 h). Of the 8 patients with disappeared HV, 7 achieved high TICI grade flow (III) and 1 had relatively low TICI grade flow (IIc) in treated side. However, all the 3 patients with decreased HV were found to be relatively low TICI grade flow (IIc).

Conclusion

Our data indicate that endovascular recanalization of ICA occlusion was effective for decreasing HV. Postoperative decrease in HV can be considered as a marker for hemodynamic improvement.     

Post-herpetic aneurysm in the intrapetrosal portion of the internal carotid artery

Summary The occurrence of an aneurysm, 2x2.5 cm in size, in the intrapetrosal portion of the internal carotid artery in a 24-year-old female patient, during the course of herpes zoster ophthalmicus, is described.