支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤临床观察

目的探讨支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤的临床疗效。方法 63例(63处)复杂动脉瘤患者,均行支架辅助弹簧圈栓塞治疗,术后即刻脑血管造影评估栓塞效果,术后6个月脑血管造影评估疗效。结果支架辅助弹簧圈栓塞治疗术后即刻造影显示38例动脉瘤达完全栓塞,13例栓塞程度达95%,7例为90%,3例为80%,2例80%;术中未出现弹簧圈游走事件,围手术期无死亡病例,并发症发生率7.9%;术后6个月,4例复发者再次行栓塞治疗,栓塞程度均≥95%。结论支架辅助弹簧圈栓塞术治疗颅内复杂动脉瘤微创、安全、有效。     

Neuroform3自膨式支架在弹簧圈介入栓塞宽颈前交通动脉瘤中的作用

背景：近年来,采用支架辅助弹簧圈栓塞保持载瘤动脉通畅,防止弹簧圈脱入载瘤动脉,可显著提高疗效和安全性。目的：探讨Neuroform3自膨式支架在弹簧圈介入栓塞治疗宽颈前交通动脉瘤中的应用。方法：回顾性分析在Neuroform3自膨式支架辅助下,采用弹簧圈介入栓塞32例宽颈前交通动脉瘤患者的临床资料,其中男15例,女17例,年龄41-71岁,随访观察治疗效果及不良反应情况。结果与结论：32例患者技术操作顺利,宽颈前交通动脉共置入32枚Neuroform3支架,弹簧圈置入顺利,释放位置满意,技术成功率达到100%。在Neuroform3支架辅助水解脱弹簧圈栓塞完成后造影显示,32枚动脉瘤完全栓塞30枚,占94%;部分栓塞2枚,占6%。术后患者恢复良好,平均住院6.3 d。32例患者术后随访3-6个月,再行全脑血管造影未见再次脑出血、脑血管栓塞或动脉瘤复发。表明在Neuroform3自膨式支架辅助下采用弹簧圈介入栓塞治宽颈前交通动脉瘤,材料与宿主生物相容性好且安全有效。     

Solitaire AB支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤

目的：探讨Solitaire AB支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤的有效性和安全性。方法对2011年1月～2013年10月33例患者34个前循环宽颈动脉瘤采用Solitaire AB支架辅助弹簧圈栓塞,回顾性分析其临床资料和疗效。结果所有患者均采用支架半释放技术,33例患者共应用Solitaire AB支架34个,均成功到位并准确释放。1个支架内血栓形成,其余无手术相关并发症。动脉瘤完全栓塞26个,瘤颈残留6个,部分栓塞2个。载瘤动脉通畅。除1例后交通动脉瘤病人术后3 d并发颅内出血死亡外,余32例临床随访6～12个月无临床症状加重,未发生再出血及缺血并发症。22例术后6～12个月行DSA随访,2个动脉瘤瘤颈有残留,未见支架内狭窄和闭塞。结论 Solitaire AB支架操作简便,采用支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤是安全的和有效的。     

支架在治疗颅内宽颈动脉瘤中的应用

目的分析颅内支架在治疗颅内宽颈动脉瘤中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的治疗过程,其中3例动脉瘤位于颈内动脉海绵窦段,2例位于颈内动脉眼动脉段,2例位于颈内动脉后交通段,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）动脉瘤9例,相对宽颈3例,瘤颈/瘤体均〉0.7。术中将颅内支架引至动脉瘤处并释放支架覆盖动脉瘤颈,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。本组患者无死亡。10例术后3个月随访造影,9例动脉瘤腔完全闭塞,1例达95%栓塞,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栓塞的致密程度,效果较好,并且可降低穿支血管阻塞的发生率。     

介入栓塞治疗术在颅内微小动脉瘤中的应用

目的探讨介入栓塞治疗术治疗颅内微小动脉瘤的可行性与安全性。方法选择23例颅内微小动脉瘤患者为研究对象,相对宽颈动脉瘤患者采用Neuroform支架辅助弹簧圈填塞动脉瘤,窄颈动脉瘤直接采用弹簧圈填塞动脉瘤。观察术后即刻栓塞情况及术中并发症发生情况,出院后6~12个月造影复查,评价介入栓塞治疗疗效。结果所有患者均成功实施弹簧圈栓塞,窄颈动脉瘤完全栓塞率为80.00%(4/5),次全栓塞率为20.00%(1/5);宽颈动脉瘤完全栓塞率为11.11%(2/18),次全栓塞率为72.22%(13/18),部分栓塞率为16.67%(3/18),二者比较,差异有统计学意义(P0.01)。手术相关并发症发生率为13.04%(3/23),经相应治疗后好转,未遗留明显神经功能障碍。4例患者术后6个月仍有部分残留,但残留部分与术中相比未见增大。结论介入栓塞治疗颅内微小动脉瘤复发率低,安全有效,值得临床应用。     

破裂性前交通动脉瘤的血管内栓塞治疗

目的:总结32例破裂性前交通动脉瘤血管内栓塞治疗的经验和体会.方法:经血管内途径,采用可脱性弹簧圈对32例破裂性前交通动脉瘤患者行栓塞治疗:术后早期处理出血、预防和治疗脑血管痉挛及有效的对症治疗.结果:成功栓塞32个动脉瘤,术后动脉瘤腔100%闭塞者21例,95%闭塞者9例,90%闭塞者2例.术中动脉瘤破裂1例,并发脑血管痉挛4例,死亡1例.术后26例随访3个月～2年无再出血.结论:对破裂性前交通动脉瘤采用微弹簧圈进行血管内栓塞疗效可靠;早期治疗、正确处理术中并发症及术后早期处理出血、预防和治疗脑血管痉挛是减少术后并发症、提高治愈率的重要方法.     

单一支架置入技术治疗颈内动脉微小动脉瘤的初步探讨

目的探讨单一支架置入技术栓塞治疗微小颅内动脉颈内动脉段（ICA）动脉瘤的预后。方法收集2003年8月至2012年1月收治的微小ICA动脉瘤（直径小于3mm）患者14例的临床资料,其中男4例,女10例;年龄35-72岁。采用单一支架置入技术栓塞治疗5例,采用支架辅助弹簧圈栓塞技术治疗9例。结果 13例血管内栓塞治疗微小ICA动脉瘤手术完全成功,1例（7.1%）患者出现术中动脉瘤破裂出血。仅支架置入组9个月后动脉瘤完全闭塞率80.0%,完全无症状率60.0%;支架辅助弹簧圈组12个月后完全闭塞率88.9%,完全无症状率55.5%。统计结果显示,仅支架置入组患者的改良Rankin量表（mRS）评分较支架辅助弹簧圈组高（t=4.21,P=0.039）,但是其动脉瘤完全闭塞率较低（χ2=5.09,P=0.011）。结论采用单一支架置入栓塞微小动脉瘤的患者完全闭塞率较低,但是患者的并发症少、预后生存质量较高。     

支架和球囊辅助技术在颅内宽颈动脉瘤栓塞中的应用

目的 探讨支架和球囊辅助瘤颈重塑技术治疗颅内宽颈动脉瘤栓塞的疗效.方法 将26例颅内宽颈动脉瘤患者按手术方法分为支架辅助组(19例)和球囊辅助组(7例).对于体/颈比＜2而＞1的动脉瘤,选择球囊辅助瘤颈重塑技术进行动脉瘤弹簧圈栓塞术;对于体/颈比＜1或瘤颈过于宽大的动脉瘤,选择支架辅助瘤颈重塑技术进行动脉瘤弹簧圈栓塞术.术后3个月对2组患者的预后进行改良Rankin量表评分,术后6个月复查数字减影血管造影技术(DSA),观察预后良好率和复发率.结果 支架辅助组19例患者,动脉瘤完全栓塞12例,次全栓塞7例;球囊辅助组7例患者,动脉瘤完全栓塞4例,次全栓塞2例,部分栓塞1例.所有病例手术均成功,无动脉瘤破裂出血.2组患者均进行3～6个月的随访,术后3个月改良Rankin量表评分,支架辅助组0分16例,1分2例,2分1例,预后良好率为84.2％;球囊辅助组0分6例,1分1例,预后良好率为85.7％.术后6个月支架辅助组13例患者复查DSA,11例影像学稳定,2例次全栓塞转为完全栓塞,载瘤动脉均通畅,支架未见移位;球囊辅助组5例患者复查DSA,4例影像学稳定,1例有瘤颈残留.2组均无死亡病例,无再出血发生.结论 支架和球囊辅助瘤颈重塑结合弹簧圈栓塞均是治疗颅内宽颈动脉瘤安全、有效的方法.     

血管内支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理

目的探讨颅内自膨式支架Neuroform联合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理经验。方法对20例行Neuroform支架治疗宽颈动脉瘤的患者做好心理护理严防动脉瘤破裂,术后加强病情观察,预防并发症发生。结果20例患者全部治愈出院,16例完全栓塞,1例次全栓塞,3例不全栓塞。临床随访2～10个月,未见动脉瘤复发及支架移位。结论Neuroform自膨胀式支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤是一种安全可行的新技术,近期疗效好,正确的护理,可提高治愈率,减少致残率。     

经导管弹簧圈漂流法治疗脾动脉瘤的疗效与安全性

目的：评价弹簧圈漂流法治疗脾动脉瘤的疗效及安全性。方法：回顾分析2005—2010年介入治疗25例共28个脾动脉瘤患者的临床资料,其中女性16例,男性9例;年龄33-86岁,中位年龄54岁。真性动脉瘤占85.7%（24/28个）,单发者占76%（19/25例）,囊状占89.3%（25/28个）,伴门脉高压者占36%（9/25例）;瘤体直径15-65mm,中位直径32mm,瘤体位于脾动脉近端8个,中段9个,脾门以远11个。20例患者行经导管载瘤动脉远近段栓塞术＋动脉瘤腔栓塞术,1例行动脉瘤腔填塞术,1例采用瘤腔完全填塞＋远端脾动脉栓塞术。其中15例采用弹簧圈漂流法栓塞脾动脉远端分支,脾动脉近端采用NESTER弹簧圈＋普通弹簧圈彻底栓塞;2例行覆膜支架植入术＋远端脾动脉栓塞术;1例合并肝动脉瘤者因脾动脉瘤体直径〈2cm选择临床随访。结果：24例患者手术成功率为100%,术后有10例（28%）患者中出现轻度栓塞后综合征,其余病例无明显手术相关并发症。栓塞术后随访2-37个月（平均18.1个月）未见动脉瘤复发、增大或破裂出血。2例覆膜支架植入患者分别随访12和18个月,支架血流均保持通畅,瘤腔未见造影剂再灌注。1例未干预动脉瘤者随访48个月,动脉瘤体无明显增大。7例出现〈30%的脾梗死,无其他动脉瘤相关并发症。弹簧圈漂流法栓塞治疗组与非弹簧圈漂流法栓塞治疗组相比在一次手术成功率、30d病死率、栓塞后综合征、脾脏梗死例数、随访出现内漏等方面均无显著差异。结论：经导管弹簧圈漂流法治疗脾动脉瘤安全、有效。     

Hybrid,Y-configured,dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms

In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms.We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts.In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one.Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.     

血管内介入治疗椎动脉夹层动脉瘤的疗效分析

目的：评价血管内介入治疗椎动脉夹层动脉瘤的技术方法及临床疗效。方法：应用血管内介入治疗技术对29例椎动脉夹层动脉瘤的患者进行治疗,回顾性分析临床资料、血管内治疗方法以及临床疗效。结果：29例患者中有19例直接闭塞动脉瘤和载瘤动脉,5例行支架置入,5例行支架辅助弹簧圈栓塞。术后21例患者接受随访,随访时间为3～24个月,平均8个月。其中14例闭塞动脉瘤和载瘤动脉患者复查示动脉瘤未显影,3例支架辅助弹簧圈栓塞患者中1例复发,2例单支架置入患者复查示1例动脉瘤完全消失而另1例仍有动脉瘤残留,2例双支架置入患者复查示1例动脉瘤完全消失,另1例动脉瘤缩小。结论：将载瘤动脉连同动脉瘤完全闭塞是血管内治疗以破裂出血起病的椎动脉夹层动脉瘤最有效的方法。如果动脉瘤位于优势椎动脉,或动脉瘤体累及小脑后下动脉,使用支架置入技术是可供的选择。     

前交通动脉瘤介入治疗分析

目的 探讨前交通动脉瘤的介入治疗适应证,手术方法和疗效.方法 回顾性分析行血管内介入治疗的前交通动脉瘤63例患者的临床资料,分析术前影像学检查结果及手术方式和术后随诊结果.结果 54例为责任动脉瘤破裂出血,另外9例为其他部位动脉瘤破裂出血而行DSA检查发现的前交通动脉瘤或者因其他原因行DSA检查发现的前交通动脉瘤.63例患者应用电解脱或者压力解脱铂金弹簧圈,利用微导管辅助3例,球囊辅助6例,支架辅助3例;57例动脉瘤完全闭塞,6例少量瘤颈残留;13例术后行脑室外引流;死亡2例.结论 血管内治疗前交通动脉瘤是一种安全、微创、有效的方法,但前交通动脉瘤患者术后容易合并电解质紊乱以及脑积水等合并症,应注意合并症的处理.     

Assisted coiling using LEO Baby or LVIS Jr stents: Report of six cases

Background and purpose

Endovascular treatment of broad-neck, complex cerebral aneurysms is a challenging issue. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows dense packing of the coils. Another challenge is represented by distal aneurysms situated in small vessels. In these cases, the use of little stents, which we are going call ministents, could be a good decision. These low-profile intracranial ministents can be deployed into arteries with diameters between 1.5 and 3.10 mm and delivered through microcatheters with an internal diameter of 0.0165 inches, which allows easier navigation in small-sized, delicate vessels. We present six cases of wide-neck aneurysms, with small parental arteries less than 2.5 mm using a low-profile ministent system (LEO Baby and LVIS Jr) plus coil embolization.

Materials and methods

We retrospectively reviewed patients in whom LEO Baby or LVIS Jr stent was used for the treatment of intracranial aneurysms. Five aneurysms were treated during 2013–2014 in our service using the LEO Baby stent and one aneurysm using LVIS Jr. Stent-assisted coil embolization was performed using the jailing technique in all cases. Clinical and angiographic findings, procedural data, and follow-up are reported.

Results

Six consecutive patients were included in this study. Four patients presented with subarachnoid hemorrhage in the subacute–chronic phase and two patients had unruptured aneurysms. Two of the six aneurysms were located at branches of the sylvian artery, one at the basilar artery, two at the anterior communicating artery, and one at the P1–P2 artery. The procedures were successful. Six-month control digital subtraction angiograms were obtained in all cases; they demonstrated complete occlusion of the aneurysms in all instances. All patients had good clinical outcomes on follow-up, as measured with the Glasgow Outcome Scale and Modified Rankin Scale.

Conclusions

The results of this small study show that the LEO Baby and LVIS Jr ministents could be safe and efficient for endovascular treatment of intracranial broad-neck aneurysms situated in small arteries.     

DSA三维重建和路径图技术在电解可脱性弹簧圈栓塞治疗颅内动脉瘤中的应用

目的:总结DSA血管三维重建和路径图技术在电解可脱性弹簧圈(GDC)栓塞治疗颅内动脉瘤中的应用。方法:回顾性分析利用三维重建和路径图技术对43例颅内动脉瘤患者进行介入栓塞治疗的过程和效果。结果:43例病例中,栓塞颅内动脉瘤45个。其中动脉瘤单发41例,多发2例。按动脉瘤发生部位分后交通动脉瘤19个,前交通动脉瘤15个,颈内动脉瘤4个,眼动脉动脉瘤2个,大脑中动脉2个,大脑后动脉2个,基底动脉瘤1个。本组45个有39个为完全闭塞,有6个为大部分闭塞。无死亡及永久并发症发生。结论:DSA三维重建和路径图技术在GDC栓塞治疗颅内动脉瘤中具有重要价值。     

Y-stent-assisted coil embolization of anterior circulation aneurysms using two Solitaire AB devices: a single center experience

Wide-neck intracranial aneurysms remain a challenge to endovascular treatment. We describe our experience in repairing wide-neck aneurysms of the anterior circulation located at arterial branch points using coil embolization assisted by Y-stenting using two Solitaire(?) stents.Six wide-neck intracranial aneurysms located on the middle cerebral artery bifurcation( 3), pericallosal artery( 1), and anterior communicating artery( 2) were repaired by Y-stent-assisted coil embolization using two Solitaire(?) stents. Four cases were incidental findings of aneurysm and two cases were previously treated ruptured aneurysms that had undergone recanalization. All the cases were successfully treated without complications. Follow-up by digital subtraction angiography and magnetic resonance angiography at six months showed the stents to be patent with no recanalization of the aneurysm sacs. Repairing wide-neck aneurysms of the anterior circulation by Y-stent-assisted coil embolization using two Solitaire(?) stents is a simple and safe method of treating complex aneurysms. While the results are promising, larger series with longer term follow-ups are needed to corroborate that this treatment method is superior to other techniques.     

Solitaire支架辅助弹簧圈栓塞颅内宽颈动脉瘤26例分析

目的 探讨Solitaire支架辅助弹簧圈栓塞颅内宽颈动脉瘤的经验及栓塞效果.方法 2009年6月至2011年12月,我们对26例颅内宽颈动脉瘤患者应用Solitaire支架辅助微弹簧圈栓塞,围术期给予抗凝及抗血小板治疗,术后3个月复查脑血管造影评价栓塞效果.结果 26例患者共使用27枚Solitaire支架,其中1例患者使用2枚支架.术中支架均顺利到位,放置位置满意,即刻血管造影致密栓塞24例,次全栓塞2例,支架释放位置满意,载瘤血管通畅,3个月后,23例患者获得数字减影血管造影随访,无动脉瘤复发迹象.结论 Solitaire支架辅助弹簧圈栓塞颅内宽颈动脉瘤,操作简单,栓塞率高,复发率低.     

颅内动脉瘤的数字减影血管造影诊断及介入治疗

目的：总结数字减影血管造影(DSA)在颅内动脉瘤诊断中的价值及电解式可脱弹簧圈栓塞颅动脉瘤的疗效。方法：对60例蛛网膜下腔出血病例行全脑血管数字减影血管造影(DSA)检查，总结颅内动脉瘤的数字减影血管造影表现；对适合进行血管内治疗的8例进行了电解式可脱弹簧圈栓塞治疗。结果：60例中，发现颅内动脉瘤26例、共33个，其中单发病例2l例，多发病例5例；后交通动脉瘤12例，颈内动脉瘤11例，前交通动脉瘤7例，大脑中动脉瘤3例；动脉瘤呈囊状16例，梭形5例，球形4例，葫芦形4例，其他不规则形4例；动脉瘤直径在2～21mm之间；8例伴脑血管痉挛，7例动脉瘤内有血栓形成。8例GDC栓塞病例中，动脉瘤腔100％栓塞5例，95％栓塞2例，80～90％栓塞l例。弹簧圈少量脱出动脉瘤l例次，过度栓塞l例次。结论：数字减影血管造影(DSA)是确诊颅内动脉瘤不可缺少的检查方法；电解式可脱弹簧圈栓塞是一种治疗颅内动脉瘤有效的新方法。