电解可脱性弹簧圈栓塞治疗大脑后交通动脉瘤

目的 讨论以电解可脱性弹簧圈血管内栓塞治疗后交通动脉瘤的疗效及技术要点。方法对42例后交通动脉瘤患者用电解可脱性弹簧圈进行动脉瘤囊内栓塞，术后早期处理出血。结果42个动脉瘤中38个瘤腔完全闭塞，3个95％闭塞，1个被90％闭塞。术后41例临床痊愈，1例死亡，死亡率2．4％。术中并发脑血管痉挛1例；术后弹簧圈末端逸出1例。1例复发者经二次补充GDc栓塞而治愈。全组出现与栓塞技术相关的并发症2例。术后随访3～50个月均无再出血。结论对后交通动脉瘤采用电解可脱性弹簧圈进行血管内囊内栓塞疗效可靠；早期栓塞及有效的术后处理是提高治愈率的重要方法。     

电解可脱性弹簧圈血管内栓塞颅内动脉瘤的技术及并发症防治

目的总结以电解可脱性弹簧圈(GDC)血管内栓塞治疗颅内动脉瘤的技术要点、并发症及其防治经验。方法采用GDC对168例颅内动脉瘤患者进行动脉瘤囊内栓塞。结果成功栓塞168个动脉瘤,其中100%闭塞的144个,95%闭塞的14个,90%闭塞的10个;全组6例死亡,死亡率3.6%。术中并发动脉瘤破裂3例,脑血管痉挛9例,脑梗死2例,术后弹簧圈末端逸出2例;3例复发者经二次补充GDC栓塞而治愈。随访5~54个月,全组术后均无再出血。结论动脉瘤的血管内治疗应根据病情进行个体化设计,并采用与之相应的栓塞技术才能最大限度的提高动脉瘤栓塞的治愈率、降低并发症。     

颅内动脉瘤破裂出血后假性动脉瘤的血管内治疗时机与并发症防治

目的探讨颅内动脉瘤破裂出血后在其破口周围所形成的假性动脉瘤与真性动脉瘤（TAN-FAN）复合体的血管内栓塞时机及并发症防治方法。方法采用电解可脱性弹簧圈对58例TAN—FAN复合体进行血管内栓塞。结果58例TAN—FAN复合体中24例（41．4％）为出血后7天内进行栓塞，20例（34．5％）为出血后7天～2周内进行栓塞，14例（24．1％）为出血后2周～1个月内进行栓塞。58个动脉瘤均被成功栓塞，其中真性动脉瘤腔100％闭塞者46个，95％闭塞者9个，90％闭塞者3个；13例A型与31例B型假性动脉瘤腔均未行弹簧圈填塞，14例C型中11例仅用弹簧圈疏松填塞假性动脉瘤腔，另3例用3D-GDC仅栓塞真性动脉瘤腔部分。术中并发动脉瘤破裂1例；并发脑血管痉挛2例；并发脑梗死3例。1例复发者经二次补充GDC栓塞而治愈。其治疗结果根据Glasgow预后评分：Ⅰ级43例，Ⅱ级11例，Ⅲ级3例，全组死亡1例，死亡率1．7％。术后随访3～60个月均无再出血。结论对动脉瘤破裂后形成的TAN—FAN复合体应早期进行血管内栓塞；只有根据TAN—FAN复合体不同的类型采用不同的栓塞方法进行个体化治疗，并具有丰富的动脉瘤栓塞经验，才能最大限度的降低并发症。     

显微手术和介入治疗急性期颅内动脉瘤破裂的对比性研究

目的 比较显微外科手术和血管内介入治疗急性期颅内动脉瘤破裂的疗效和相关并发症。方法 82例破裂性颅内动脉瘤，均在蛛网膜下腔出血急性期(72h以内)行外科治疗，其中行显微手术瘤颈夹闭40例，血管内电解可脱性弹簧圈栓塞治疗42例。对两组疗效和并发症进行对比分析。结果 显微手术组，完全夹闭率92．5％，手术相关并发症4例，死亡2例。弹簧圈栓塞组，完全闭塞率71．4％，栓塞组相关并发症6例，死亡1例。在前循环动脉瘤中，栓塞组完全闭塞率与手术组完全夹闭率相比较，显微手术组结果优于栓塞组。临床随访6个月，两者预后良好者均达95．0％。结论 显微瘤颈夹闭术和血管内栓寒治疗均是颅内动脉瘤治疗的有效方法。     

电解可脱性弹簧圈治疗前交通动脉瘤

前交通动脉瘤的发生率占全部颅内囊性动脉瘤的30％-35％，其破裂出血是蛛网膜下腔出血（SAH）常见的病因之一。1991年Guglielmi等发明电解可脱性弹簧圈（Guglielmi detachable coils，GDC）用于颅内动脉瘤的治疗，到如今应用日趋广泛。本文选择2006年1月至2007年6月本院DSA证实。并用电解可脱性弹簧圈（GDC）作血管内治疗前交通动脉瘤16例进行分析，探讨其技术特点。     

电解可脱性弹簧圈栓塞治疗颅内动脉瘤临床研究

目的探讨电解可脱性弹簧圈栓塞治疗颅内动脉瘤临床效果。方法回顾性分析2010年1月~2015年3月我院收治60例颅内动脉瘤患者,均经脑血管造影确诊为颅内动脉瘤,均为单发。根据手术方法的不同分为两组:治疗组30例,采用电解可脱性弹簧圈(GDS)栓塞治疗,对照组30例,采用开颅动脉瘤夹闭术治疗。比较两组手术结果、并发症发生率及预后(脑出血日常生活能力(ADL)评分)。结果治疗组30例患者中完全栓塞者22例(73.3%),90%栓塞者5例(16.7%),90%栓塞者3例(10.0%)。其中致密填塞者22例,弹簧圈均稳定;部分填塞者8例,其中稳定者7例,缩小者1例,且无出血。治疗组患者平均住院时间(16.1±3.1)d,明显短于对照组的(23.9±4.3)d(P0.05);两组患者手术室费用及总住院费用比较差异无统计学意义(P0.05)。治疗组无一例死亡,对照组死亡4例(13.3%),两组患者死亡率比较差异有统计学意义(χ~2=4.29,P0.05)。治疗组ADL≤Ⅱ级者明显多于对照组,差异有统计学意义(χ~2=5.73,P0.05)。治疗组术后4例(13.3%)发生并发症,其中脑梗塞、脑积水、偏瘫及肺部感染各1例。对照组术后11例(36.7%)发生并发症,其中脑梗塞3例,脑积水2例,偏瘫2例,肺部感染3例,消化道出血1例;治疗组并发症率明显低于对照组,差异有统计学意义(χ~2=4.69,P=0.03)。结论应用电解可脱性弹簧圈栓塞治疗颅内动脉瘤疗效可靠且安全,值得深入研究以推广应用。     

动脉瘤性蛛网膜下腔出血的血管内治疗

颅内动脉瘤是一种常见而又危害极大的脑血管疾病，一旦破裂出血其死亡率和致残率较高，而80％-85％的自发性蛛网膜下腔出血（SAH）是由颅内动脉瘤破裂引起。20世纪90年代，一种可脱性铂金弹簧圈装置（GDC）进入临床应用领域，随着栓塞材料的改进和栓塞技术的革新，运用血管内栓塞技术治疗动脉瘤预防再出血越来越广泛的应用于治疗颅内动脉瘤患．一些研究机构甚至建议将血管内栓塞作为治疗的首选方法。本研究主要探讨这些问题．明确血管内治疗颅内动脉瘤的安全性和有效性。     

介入栓塞治疗颅内动脉瘤46例临床分析

目的观察颅内不同部位和类型动脉瘤介入治疗疗效,总结个体化治疗经验。方法回顾性分析46例不同部位和类型共51个动脉瘤栓塞治疗的临床资料。结果 51个动脉瘤完全闭塞43个,闭塞95%以上5个,闭塞90%以上3个,术中动脉瘤破裂2例,死亡1例,成功随访30例。3¹2个月无复发。结论对不同部位和类型颅内动脉瘤采用可脱性弹簧圈栓塞及支架辅助弹簧圈栓塞疗效可靠。     

CT鉴别诊断颅内动脉瘤栓塞术后对比剂残留与蛛网膜下腔出血

目的观察CT鉴别颅内动脉瘤电解可脱式铂金弹簧圈（GDC）栓塞术后对比剂残留与蛛网膜下腔出血（SAH）的诊断价值。方法回顾性分析55例SAH患者及45例颅内未破裂动脉瘤GDC栓塞术后患者的CT特征。结果55例SAH患者中,出血以鞍上池（44／55,80．00％）、外侧裂（25／55,45．45％）分布为主;45例颅内未破裂动脉瘤GDC栓塞术后患者颅内高密度分布以静脉窦（39／45,86．67％）、后纵裂（20／45,44．44％）、小脑幕（18／45,40．00％）分布为主;GDC栓塞术后脑内高密度CT值升高明显,平均值大于75HU,与SAH比较边界相对清晰,对脑裂、脑池及静脉窦正常形态影响小。结论CT显示的病灶分布部位、密度、形态有助于鉴别GDC栓塞术后对比剂残留造成的颅内高密度影与动脉瘤破裂出血导致的SAH。     

电解可脱式微弹簧圈栓塞治疗颅内动脉瘤

目的 探讨电解可脱式微弹簧圈(GDC)栓塞治疗颅内动脉瘤的方法。方法 采用美国波士顿公司GDC栓塞治疗17例患者中18个颅内动脉瘤，其中15例蛛网膜下腔出血(SAH)发病者，术前Hunt和Hess分级：Ⅰ-Ⅱ级10例；Ⅲ级3例；Ⅳ级2例。结果1例死亡，3例轻度短期神经功能障碍，13例痊愈。结论 GDC栓塞治疗颅内动脉瘤较为理想，但还需随访观察。     

Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils

OBJECT: The purpose of this paper is to present the authors' experience with Guglielmi detachable coil (GDC) embolization of multiple intracranial aneurysms and to evaluate the results of this therapy in single-stage procedures. METHODS: Clinical and angiographic evaluations were performed in 38 consecutive patients with multiple intracranial aneurysms treated by GDC embolization between March 1990 and October 1997. Twenty-nine patients presented with subarachnoid hemorrhage (SAH), four with mass effect, and five were asymptomatic. These 38 patients harbored 101 aneurysms, 79 of which were treated with GDCs, 14 by surgical clipping, and eight were left untreated. Of the GDC-treated lesions, a complete endovascular occlusion was achieved in 55 aneurysms (70%), and 24 (30%) presented neck remnants. Twenty-five patients (66%) underwent GDC embolization of more than one aneurysm in the first session. Eighteen (86%) of 21 patients with acute SAH underwent treatment for all aneurysms within 3 days after admission (15 of 21 in one session). Follow-up angiographic studies in 30 patients demonstrated an unchanged or improved result in 94% of the aneurysms (59 lesions) and coil compaction in 6% (four lesions). The overall clinical outcome was excellent in 34 patients (89%), good in one (3%), fair in one (3%), and death in two (5%). CONCLUSIONS: Endovascular treatment of multiple intracranial aneurysms, regardless of their location, with GDCs was performed safely in one session, even during the acute phase of SAH. Treatment of all aneurysms in one session protected the patient from rebleeding and eliminated the risk of mistakenly treating only the unruptured aneurysms.     

Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience

OBJECT: The authors report on their 11 years' experience with embolization of cerebral aneurysms using Guglielmi Detachable Coil (GDC) technology and on the attendant anatomical and clinical outcomes. METHODS: Since December 1990, 818 patients harboring 916 aneurysms were treated with GDC embolization at University of California at Los Angeles Medical Center. For comparative purposes, the patients were divided into two groups: Group A included their initial 5 years' experience with 230 patients harboring 251 aneurysms and Group B included the later 6 years' experience with 588 patients harboring 665 aneurysms. Angiographically demonstrated complete occlusion was achieved in 55% of aneurysms and a neck remnant was displayed in 35.4% of lesions. Incomplete embolization was performed in 3.5% of aneurysms, and in 5% occlusion was attempted unsuccessfully. A comparison between the two groups revealed a higher complete embolization rate in patients in Group B compared with that in Group A patients (56.8 and 50.2%, respectively). The overall morbidity/mortality rate was 9.4%. Angiographic follow ups were obtained in 53.4% of cases of aneurysms, and recanalization was exhibited in 26.1% of aneurysms in Group A and 17.2% of those in Group B. The overall recanalization rate was 20.9%. Note that recanalization was related to the size of the dome and neck of the aneurysm. Overall incidence of delayed aneurysm rupture was 1.6%, a rate that improved in the past 5 years to 0.5%. Ten of 12 delayed ruptures occurred in large or giant aneurysms. CONCLUSIONS: The clinical and postembolization outcomes in patients treated with the GDC system have improved in the past 5 years. Aneurysm recanalization, however, is still a major limitation of current GDC therapy. Follow-up angiography is mandatory after GDC embolization of cerebral aneurysms. Further technical and device improvements are mandatory to overcome current GDC limitations.     

Shunt-dependent hydrocephalus after rupture of intracranial aneurysms: a prospective study of the influence of treatment modality

OBJECT: This study was designed to determine whether the frequency of shunt-dependent hydrocephalus in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) differs when comparing surgical clip application with endovascular obliteration of ruptured aneurysms. METHODS: In this prospective nonrandomized study, 245 patients with aneurysmal SAH treated using either surgical clip application or endovascular coil embolization were studied at our institution between September 1997 and March 2003. One hundred eighty patients underwent clip application and 65 had coil embolization. In those patients who underwent clip application of anterior circulation aneurysms, the lamina terminalis was systematically fenestrated. The occurrence of acute, asymptomatic, and shunt-dependent hydrocephalus was analyzed in both treatment groups. A subgroup analysis of patients with good clinical grade (World Federation of Neurosurgical Societies [WFNS] Grades I-III) and better Fisher Grade (1-3) and of patients with Fisher Grade 4 hemorrhage was performed. Acute hydrocephalus was observed in 19% of surgical cases and 46% of endovascular ones. The occurrence of asymptomatic hydrocephalus was similar in both treatment groups (p = 0.4). Shunt-dependent hydrocephalus occurred in 14% of surgical cases and 19% of endovascular cases. This difference did not reach statistical significance (p = 0.53). Logistic regression models controlling for patient age, WFNS grade, Fisher grade, and acute hydrocephalus in patients with good clinical grade and better Fisher grade revealed no significant difference in the rate of shunt-dependent hydrocephalus in both therapy groups (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.2-2.65). Results of similar models indicated that among patients with intraventricular hemorrhage (IVH), surgical clip application carried a lower risk of shunt-dependent hydrocephalus (OR 0.32, 95% CI 0.14-0.75) compared with that for endovascular embolization. CONCLUSIONS: Shunt-dependent hydrocephalus was comparable in the two treatment groups, even in patients with better clinical and radiological grades on admission. Only patients in the endovascular therapy group who had experienced IVH showed a higher likelihood of shunt-dependent hydrocephalus.     

Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography

The purpose of this study was to evaluate the potential of high quality computed tomographic angiography (CTA) to replace digital subtraction angiography (DSA) in cases of ruptured saccular aneurysms and perform early surgical clipping or coiling on the basis of CTA alone. In a prospective study, 100 patients with aneurysmal subarachnoid haemorrhage (SAH) diagnosed by computed tomography underwent CTA. CTA revealed a total of 118 aneurysms including all ruptured aneurysms. A decision of direct surgical clipping, endovascular coiling or therapeutic abstention was made in 89 cases (89%) on the basis of CTA alone. Sixty-one direct surgical procedures were performed after CTA. Twenty-six cases underwent DSA for immediate endovascular treatment of the ruptured aneurysm. In 11 cases (11%), a DSA was performed prior to the therapeutic decision because of unclear aneurysm. Four cases were not treated because of initial poor clinical grade. The surgical findings were compared with CTA data and were considered accurate in all but one case. All patients underwent postoperative DSA within 10 days after SAH. The sensitivity and the specificity of CTA for the detection of all aneurysms, as compared with postoperative DSA, were 95.1 and 100%, respectively. A total of six unruptured aneurysms were missed initially, but were visible retrospectively on CTA in all but one case and were found in patients with multiple aneurysms in whom the ruptured aneurysm was detected by CTA. Current quality CTA allows reliable pretreatment planning for the majority of cases of aneurysmal subarachnoid haemorrhage and diminishes the pretreatment evaluation time critically. Complementary pretreatment DSA is required in situations where CTA characteristics of the ruptured aneurysm is unsatisfactory.     

治疗Ⅳ~Ⅴ级动脉瘤蛛网膜下腔出血的临床体会

目的探讨动脉瘤蛛网膜下腔出血Ⅳ-Ⅴ级患者的治疗方法。方法对33例Ⅳ-Ⅴ级动脉瘤蛛网膜下腔出血患者急诊动脉瘤血管内栓塞后,并给予脑室外、腰大池引流、血肿清除治疗。结果17例患者恢复良好,神经功能恢复（51．52％）,4例术后出现脑积水,但神经功能基本恢复（12．12％）,5例患者植物生存（15．15％）,7例术后临床死亡（21．21％）。结论早期血管内栓塞治疗可以改善动脉瘤蛛网膜下腔出血Ⅳ-Ⅴ级患者的预后。     

The effect of clipping and coiling in acute severe subarachnoid hemorrhage after international subarachnoid aneurysmal trial (ISAT) results.

Cerebral aneurysms are treated by two methods: direct microsurgical clipping and endovascular coiling. Both are selected based on definite guidelines for clinicoradiological criteria as follows: Endovascular therapy comprising of GDC embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial hemorrhage), age>70 years, subacute stage (4--14 days of vasospasm), basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a drainage procedure was performed in cases with Hunt and Kosnik grades 0--3, grade 4 (GCS 9--12), age less than 70 years, grade 5 with hydrocephalus or intracerebral hematoma and acute stage (0--3 days after bleed). The patient's outcome was measured using GOS (Glasgow outcome score) at the time of discharge. In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Although they accounted for 37.8 % and 48 % of total SAH cases, respectively, the outcome was satisfactory. Good recovery and moderate disability, together termed "favorable outcome" was found in 69.16 % of clipping cases and 44.06 % of coiling cases. Clipping had a better outcome than coiling in cases of acute severe SAH in our series. The golden hour resuscitation, pre-hospital care and the adjunctive treatment strategies like hypothermia are discussed. A critical appraisal of the ISAT of microsurgical clipping versus coiling is used for comparison of our results.     

Emergency treatment of cerebral aneurysms with large haematomas

Of 469 patients with subarachnoid haemorrhage (SAH) from ruptured intracranial aneurysms, 31 had large intracerebral haematomas and were treated as emergency cases at the University Central Hospital, Kuopio, Finland during 1979-1985. The haematomas were evacuated and the aneurysms clipped immediately after diagnosis with CT and angiography. The mean diameter of the haematomas was 48 mm. Of the 31 patients 15 died. Mortality was lower for patients with aneurysms of the middle cerebral artery and for those with a better clinical grade (Gr. IV) at the time of the operation (41%); all patients with dilated pupils in grade V died. Five patients returned to work, and 10 are living a useful and independent life at home. Because early CT is increasingly used as the first diagnostic tool in vascular catastrophies, the pressure for early emergency treatment of aneurysmal intracerebral haematoma is increasing. The almost 100% mortality with conservative treatment should be compared to the 41% mortality with selection of the surgical candidates.