普通弹簧圈联合Interlock可解脱弹簧圈栓塞体肺侧支在复杂先天性心脏病治疗中的临床应用

目的探讨COOK普通弹簧圈联合可解脱带纤维毛弹簧圈栓塞系统栓塞体肺侧支在复杂先天性心脏病(先心病)外科治疗中的应用价值及经验。方法回顾性分析2016年1月至2018年8月中国医学科学院阜外医院收治的15例复杂先心病合并体肺侧支患者的临床资料,评价COOK普通弹簧圈联合可解脱带纤维毛弹簧圈栓塞系统在体肺侧支栓塞术中的可行性、安全性和有效性。结果15例患者中共发现33支体肺侧支血管,均栓塞成功,无血管损伤、弹簧圈移位及脱落等术中并发症发生。术中共用COOK普通弹簧圈34枚,直径3~8 mm,长度3~8 cm;共用Interlock可解脱弹簧圈28枚,其中15枚为钻石型,13枚为普通2D型,弹簧圈直径为2~6 mm,长度为2.3~8.0 cm。15例患者中10例属于杂交手术,即在杂交手术室行体肺侧支栓塞术后即刻行外科手术;5例因先心病外科术后发生灌注肺或左心功能不全需持续呼吸机辅助通气,不能拔除气管插管而行心血管造影及体肺侧支栓塞术,术后均顺利拔除气管插管。结论COOK普通弹簧圈联合可解脱带纤维毛弹簧圈栓塞系统栓塞体肺侧支在复杂先心病治疗中疗效确切,可推广应用。     

Interlocking detachable coil embolization for giant tandem bronchial aneurysms: A case report

Rationale:Bronchial artery aneurysm (BAA) is a rare disease that can be life-threatening if it ruptures. Tandem connections of multiple aneurysms are even rarer and more challenging to manage.Patient concerns:A 46-year-old woman presented to the hospital with intermittent hemoptysis for a week. A bronchial artery computed tomographic angiography scan revealed 2 BAAs associated with bronchial artery-to-pulmonary artery fistulas in the left lung. Three-dimensional CT reconstruction showed 2 bronchial aneurysms in tandem and 1 aneurysm adjacent to the descending aorta.Diagnoses:Giant tandem bronchial aneurysms were confirmed using computerized tomographic angiography.Interventions:Nine interlocking detachable coils and 11 standard pushable coils were introduced into aneurysms for embolization.Outcomes:There was no episodes of hemoptysis. CT angiography indicated that the coils were closely knit and in their proper position 1 month later; at follow-up, the patient had no adverse effects and no recurrence of hemoptysis.Lessons:BAA is a rare disease that can be life-threatening if it ruptures. It should be treated aggressively to determine the presence of symptoms.     

True aneurysm originating from the costocervical trunk: surgical excision for recurrence after successful proximal coil embolization

A rare, true aneurysm of a branch of the right subclavian artery is described. Transcatheter coil embolization of the feeder artery was successful in obliterating blood flow into the aneurysm and the mass reduced in size. However, the aneurysm reenlarged over the next week of follow-up due to development and enlargement of the collateral vascular network. Extirpation of the aneurysm was performed. Histopathological examination revealed a true aneurysm. Received: July 30, 2001 / Accepted: September 22, 2001     

Stent-assisted detachable coil embolization of pseudoaneurysms in the coronary circulation.

Pseudoaneurysms in the coronary circulation are an uncommon occurrence that can develop spontaneously in the setting of atherosclerosis or can develop after catheter-based coronary interventions. The natural history, clinical outcome, and optimal therapy for pseudoaneurysms in the coronary circulation are not clearly established. Recent advances in the techniques and technologies used for endovascular treatment of intracranial aneurysms may be applicable to the management of coronary aneurysms and pseudoaneurysms. We present a case of spontaneous coronary pseudoaneurysm formation after paclitaxel drug-eluting stent implantation and a case of pseudoaneurysm formation in a saphenous vein graft that were both successfully treated with stent-assisted detachable coil embolization.     

Jasper电解可脱性弹簧圈治疗颅内动脉瘤的多中心临床试验研究

目的验证国内研发的Jasper颅内电解可脱性弹簧圈在栓塞颅内动脉瘤临床应用中的非劣效性。方法试验为前瞻性、多中心平行对照临床试验,方案由国家药品监督管理局审定。选择Hunt-Hess0～Ⅲ级的非宽颈颅内动脉瘤患者134例,其中使用Jasper弹簧圈(试验组)64例,使用电解可脱性弹簧圈(GDC)和Sapphire弹簧圈(对照组)70例。评估手术操作过程中,弹簧圈的临床性能(输送系统推送、定位、释放和回撤等操作的方便性与可靠性)及置入的成功率;术后1、6个月行改良Rankin评分;对术后即刻和6个月的造影结果进行评定;观察不良事件发生、再次蛛网膜下腔出血、死亡和卒中的发生率。结果①试验组共使用345枚Jasper弹簧圈,置入成功率为99.3%(344/345)。对照组为100%(304/304),两组弹簧圈的置入成功率和临床性能的比较差异均无统计学意义(P>0.05)。在试验过程中,两组均未出现弹簧圈脱落、血管痉挛、血栓形成、动脉瘤破裂、血管穿孔等并发症。②改良Rankin评分、不良事件发生率、再次蛛网膜下腔出血、死亡和卒中发生率两组比较,差异均无统计学意义(P>0.05)。③试验组术后即刻造影显示动脉瘤闭塞率为(95.4±6.4)%,不完全闭塞6例(9.4%),完全闭塞58例(90.6%);对照组术后动脉瘤闭塞率为(94.8±5.5)%,不完全闭塞5例(7.1%),完全闭塞65例(92.9%),两组比较差异均无统计学意义(P>0.05)。④试验组40例和对照组32例术后6个月获得血管造影随访。动脉瘤闭塞率两组差异无统计学意义(P>0.05)。结论应用Jasper颅内电解可脱性弹簧圈治疗颅内动脉瘤,具有与目前国外同类成熟产品相同的临床安全性和有效性。     

Total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism

AIM:To study the safety and feasibility of total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.METHODS:Fifteen consecutive patients with hypersplenism due to cirrhosis were enrolled in this study from January 2006 to June 2010.All patients underwent total embolization of the main splenic artery.Clinical symptoms,white blood cell(WBC) and platelet(PLT) counts,splenic volume,and complications ...     

Atrial tachycardia treated by coil embolization of a giant coronary artery fistula

Coronary artery fistulas are the second most frequently seen coronary anomaly following abnormalities of coronary artery origin and distribution. A coronary fistula is defined as a direct communication between a coronary artery and any cardiac chamber or vessel. Treatment options include percutaneous embolization and surgical intervention. Herein, we present a case of a giant coronary artery fistula and right atrial tachycardia that was induced during a diagnostic electrophysiologic study but was not inducible after the successful treatment of the fistula. This is the first case indicating this association.     

Coronary steal by IMA bypass graft side-branches: A novel therapeutic use of a new detachable embolization coil

Coronary artery steal syndromes following coronary artery bypass grafting (CAB) may occur as a result of the presence of large side-branches arising from the internal mammary artery (IMA). We report the first successful deployment of a new detachable vascular embolization coil device to occlude the IMA side-branches in two patients. Optimal positioning is easily obtained with the unique operator-controlled, safety-release protected mechanism of this device. Complete retraction is possible, with safe and efficient removal of the coil even after deployment. This feature was appreciated during one procedure in which the initially selected coil was found to be oversized, requiring immediate removal. Acute thrombo-occlusion of the IMA side-branches in both patients was observed. We conclude that IMA bypass graft side-branches causing coronary steal can be safely and effectively occluded using this new technique. However, due to observed delayed partial recanalization noted on distant follow-up angiography, we recommend placement of multiple coils at the time of initial embolization. Cathet. Cardiovasc. Diagn. 45:301–306, 1998. Published 1998 Wiley-Liss, Inc.     

球囊辅助弹簧圈栓塞术治疗椎动脉夹层动脉瘤一例

患者男,46岁。因突发意识不清,醒后头痛2h,呕吐3次,于2010年2月15日入上海同济大学附属同济医院神经重症监护室（NICU）。入院时患者意识清楚,头痛、头晕及呕吐症状无明显加剧,急诊行头部CT,提示第四脑室及蛛网膜下腔出血（SAH）。患者既往无明确高血压病史,入院时血压为160／90mmHg,     

Bronchial artery embolization for malignant hemoptysis: a single institutional experience

Objective

To assess the effectiveness of bronchial artery embolization (BAE) in patients with malignant hemoptysis.

Methods

An IRB-approved retrospective study at our academic institution was conducted on all patients treated by BAE for hemoptysis from lung malignancy. Outcome and safety measures were documented according to Society of Interventional Radiology (SIR) practice guidelines.

Results

A total of 26 patients (13 male, 13 female) with lung malignancy underwent BAE for hemoptysis from 2003-2013. Histologic analysis revealed 80% (21/26) of cases were from primary lung malignancies, while the remaining 20% (4/26) represented metastatic disease. Sixty-five percent (17/26) of patients underwent bronchoscopy prior to BAE. Follow-up ranged from 2 to 1,909 days, with average of 155 days. Technical success was achieved in 77% of patients (20/26). Clinical success rate was 75% (15/20). Eighty-five percent of embolized patients (17/20) were treated with particles, 15% (3/20) with gelfoam, and 20% (4/20) with coils. Single-vessel embolization was performed in 70% (14/20), two-vessel in 20% (4/20), and multiple vessels in 10% (2/20). No complications were reported. Six-month all-cause mortality of treated cases was 55% (11/20) with an in-hospital mortality of 25% (5/20). Ten percent (2/20) had remote re-bleeding events beyond 6 months. Statistically significant predictors of mortality were intubation status, hemoglobin/hematocrit at presentation, and thrombocytopenia.

Conclusions

BAE is a safe and useful treatment for clinically significant hemoptysis in patients with primary or metastatic lung masses despite high overall mortality. Intubation status, low hemoglobin/hematocrit, and thrombocytopenia may represent clinical predictors of short term mortality following BAE. Advances in knowledge: Most patients undergoing BAE for malignant hemoptysis achieve high clinical success despite suffering a high mortality from underlying disease.     

Rescue balloon-assisted remodeling technique for protrusion of coil loop: A case report

Rationale:Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop.Patient concerns:A 53-year-old man was admitted to our hospital with severe bursting headache, nausea, and vomiting. Computed tomography showed subarachnoid hemorrhage and digital subtraction angiography revealed an anterior communicating artery aneurysm. We decided to obliterate the aneurysm with endovascular embolization using detachable coilsDiagnosis:A small loop protruded into the parent artery during the removal of the microcatheter.Interventions:We performed successful repositioning of the protruded coil loop using balloon inflation.Conclusion:The rescue balloon-assisted remodeling technique was useful in the management of protrusion of a small coil loop into the parent artery during endovascular coil embolization of an intracranial aneurysm. The procedure was associated with minimal complications.     

Novel technique for coil embolization of intercostal branch of internal mammary artery graft

Coronary artery steal resulting from a large unligated intercostal or pericardial side branch of the internal mammary artery graft causing postoperative angina has been previously described. Transcatheter coil occlusion of internal mammary artery side branch has successfully been performed to treat coronary steal syndrome. Unsuccessful deployment of the microcoils can be due to inadequate guiding support in the LIMA or prolapse of the delivery catheter in the side branch. We report a new approach for the precise deployment of coils in the side branch of a LIMA graft, when inadequate guiding support is present. Cathet. Cardiovasc. Diagn. 42:229–231, 1997. © 1997 Wiley-Liss, Inc.     

Near-fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: a case report of bilateral uterine artery embolization

Severe transfusion-dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of life-threatening uterine hemorrhage in a 38-year-old woman in the setting of transfusion-refractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, epsilon-aminocaproic acid, and intracavitary thrombin-soaked gauze tamponade. At the point of near-exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/microL, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting.     

A case of ascending colon variceal bleeding treated with venous coil embolization

A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia.An esophagogastroduodenoscopy did not demonstrate any bleeding source,and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus.The source of the bleeding could not be found with a mesenteric artery angiography.We performed an enhanced abdominal computed tomography,which revealed a distal ascending colonic varix,and assumed that the varix was the source of the bleeding.We performed a venous coil embolization and histoacryl injection to obliterate the colon varix.The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed.We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.     

Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage： A case report

We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization （TAE） for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and finally obstruction.     

Ileus caused by cholesterol crystal embolization: A case report

Cholesterol crystal embolization(CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered.     

支架辅助弹簧圈栓塞治疗颈内动脉夹层动脉瘤:1例报道并文献复习

颈部夹层动脉分离(cervical artery dissection, CeAD)是指各种原因引起的颈部脑供血动脉内膜撕脱,血液进入血管壁形成壁间血肿,血肿逐渐累及管腔造成血管狭窄,或向血管外膜延伸形成夹层动脉瘤.CeAD在中青年卒中人群中的患病率高达8%~25%,具体病因不明,高血压、外伤、头颈部推拿按摩、感染、偏头痛、先天性血管纤维肌性发育不良等可能是其危险因素[1].颈内动脉夹层动脉瘤是一种常见的脑血管病,分为自发性和外伤性,以颅外段最为常见.随着医学的发展和影像学技术的提高,许多CeAD患者在症状较轻时即可被确诊,其发病率为2.67/10 万,是青年卒中的重要原因之一.由于该病临床表现各异,缺乏特异性,可表现无或轻微到大面积脑梗死或脑出血,因此常被漏诊[2].CeAD可自愈或反复发作甚至遗留严重后遗症,因此早期筛查和积极诊治对改善患者预后具有重要意义[2].现报道武汉市第一医院神经外科收治的1例支架辅助弹簧圈栓塞治疗的颈内动脉夹层动脉瘤患者.     

介入及手术联合治疗伴有体肺侧枝的法鲁氏四联症和肺动脉闭锁

目的评价介入栓堵侧枝合并手术矫治伴有体肺侧枝的重症法鲁氏四联症和肺动脉闭锁的临床结果,总结临床应用经验。方法回顾1992年至2006年我院介入加外科手术治疗25例伴有体肺侧枝的重症发鲁氏四联症和肺动脉闭锁,其中法四12例,肺动脉闭锁13例,年龄6月～17岁,体重7～55公斤,男性16例,女性9例,造影发现体肺侧枝共65支,平均2.6/例。外科根治手术23例,2例肺动脉闭锁行姑息手术,术前栓堵20例,术后栓堵5例,共栓堵侧枝53支,完全栓堵率86.8%。结果全组病例死亡6例,总死亡率24%,肺动脉闭锁根治术11例,死亡4例,死亡率36.4%,肺动脉闭锁姑息手术2例,死亡1例,法四根治术12例,死亡1例,死亡率8.3%。介入栓堵后根治术共18例,死亡3例,均为肺动脉闭锁,死亡率13%,根治术后介入栓堵5例,死亡2例,死亡率40%,其中法四4例死亡1例,肺动脉闭锁1例死亡1例。死亡原因为充血性心衰1例,低心排1例,肺出血1例,广泛肺渗出1例,肺缺血坏死1例,下腔静脉梗阻致多器官功能衰竭1例。结论介入栓堵体肺侧枝与外科手术联合治疗伴有体肺侧枝的重症法鲁氏四联症和肺动脉闭锁安全有效,可以减轻手术难度,减少术中出血,缩短手术时间,提高手术矫治成功率,减少手术创伤。术前栓堵侧枝对于手术成功尤为重要,术前明确体肺侧枝与固有肺动脉交通情况,对于单独供血的大体肺侧枝不宜拴堵,应于术中进行融合重建。与国外同期治疗结果比较我们的总死亡率较高。     

Duct-Occlud封堵器和Cook可控弹簧栓子治疗动脉导管未闭的对比研究

目的　对比研究Duct Occlud封堵器和Cook可控弹簧栓子治疗直径≤ 4mm动脉导管未闭 (PDA)的疗效。方法　 1996年 4月至 2 0 0 2年 8月 ,4 2例直径 <2mm和 2 9例直径 2～ 4mm的PDA患者施行了Duct Occlud封堵器 (2 5例 )和Cook可控弹簧栓子 (4 6例 )封堵术。结果　 (1)直径 <2mm的PDA行Duct Occlud封堵器和Cook可控弹簧栓子封堵后 10min、2 4h和 12个月残余分流率显著小于直径 2～ 4mm的PDA(分别为 4 8%与 6 2 0 % ,0与 37 9% ,0与 13 8% ;P均 <0 0 5 )。 (2 )Duct Oc clud封堵器治疗直径 2～ 4mm的PDA后 10min ,2 4h ,1和 12个月残余分流率显著高于Cook可控弹簧栓子组 (分别为 94 4 %与 9 1% ,6 1 1%与 0 ,4 4 4 %与 0 ,33 3%与 0 ;P均 <0 0 5 ) ,其中Duct Occlud封堵器脱落至腹主动脉远端 1例 ,向左肺动脉内凸出 4例 ;2例直径 2～ 4mm的PDA患者置入 2枚Cook可控弹簧栓子。结论　Duct Occlud封堵器和Cook可控弹簧栓子均是治疗直径 <2mmPDA的安全有效方法 ;Cook可控弹簧栓子封堵直径 2～ 4mm的PDA近、中期疗效优于Duct Occlud封堵器 ,但部分患者需置入 2枚栓子。