脑动静脉畸形供血方式与栓塞的关系研究

目的探讨脑动静脉畸形供血方式与栓塞的关系。方法回顾性分析12 4例4 0 0次超选择性微导管造影所显示的脑动静脉畸形的供血方式及其栓塞后并发症的发生率。结果4 0 0次微导管超选择性造影显示终末型供血方式2 92次,占73% ,穿枝型供血方式2 8次,占7% ,动静脉直接交通型36次,占9%。畸形血管团内伴有动脉瘤2 4例,占6 %。畸形血管团内含有静脉瘤或引流静脉呈瘤样扩张者2 0例,占5 %。除穿枝型供血方式16例未行栓塞外,余者栓塞后无严重并发症发生。结论了解脑动静脉畸形供血方式便可知道能否安全的进行栓塞,而测定脑动静脉畸形的动静脉循环时间可指导栓塞用胶的配制浓度。     

Cerebral arterial air embolism due to an esophago-atrial fistula seen on CT

Summary A case of cerebral air embolism from a rather unusual cause is reported; an esophago-cardiac fistula permitted food particles and air to enter the systemic arterial circulation. Massive embolization caused the patient to become deeply comatose rather suddenly. The computed tomogram (CT) revealed massive cerebral edema with the contradictory finding of wide superficial subarachnoid spaces. These subarachnoid spaces on further evaluation proved to be air in the cerebral vessels.     

Shotgun pellet embolization to the intracranial internal carotid artery: Report of a case and review of the literature

We report a patient with the angiographic diagnosis of embolization of a shotgun pellet from its presumed left internal carotid artery entry site to the ipsilateral intracranial internal carotid artery. Subsequently, a left middle cerebral artery territory infarct developed. Review of the literature reveals 30 previous reports of intracranial embolization of metallic missile fragments. Observations of patient demographics, foreign body type, embolization patterns, neurologic deficits and presentations, and patient evaluation and therapy are discussed.     

明胶海绵栓塞建立实验动物急性脑梗死模型

目的 探讨明胶海绵栓塞猴颈内动脉复制急性脑梗死模型的可行性。方法选用成年猴6只，经股动脉穿刺插管，明胶海绵栓塞颈内动脉，然后行数字减影血管造影（DSA）显示血管闭塞情况，栓塞后3h，4h，6h，8h，12h，24hCT平扫，观察脑梗死CT表现。结果6只猴栓塞后DSA显示颈内动脉闭塞，大脑前、中动脉未显影。栓塞后6hCT平扫可见栓塞侧大脑半球片状低密度坏死区。结论用明胶海绵栓塞颈内动脉复制急性脑梗死模型可行。     

出血性脑动静脉畸形的影像特点与血管内治疗

目的：探讨以出血发病的脑动静脉畸形的影像学特点与血管内治疗的技术操作。方法：经脑CT或MRI确认为脑实质内出血的56例病例，经DSA全脑血管造影证实为脑动静脉畸形(AVM)，根据AVM病灶的特点，行经血管内超选择应用α-氰基丙烯酸正丁酯栓塞或结合放射外科治疗。结果：56例在1-3次栓塞后，36例病灶完全消除；1例因AVM中有新生的动脉瘤及1例术后1年发生出血而行第2次栓塞治愈，1例在接受X-刀治疗后3个月再次出血，经手术后痊愈。结论：AVM病灶内或病灶旁存在动脉瘤和动脉囊样扩张、引流静脉细小和脑室内生长的AVM是引起脑出血的主要原因，而在栓塞中优先处理动脉瘤样病变对防止脑出血有重要意义。     

A case of iatrogenic cerebral infarction demonstrated by postmortem cerebral angiography

A 37-year-old man with a meningioma compressing the right frontal lobe underwent preoperative embolization of the feeding vessels from the right meningeal artery. Although the first challenge was apparently successful, an excess amount of embolization agent was accidentally injected during the next procedure. X-ray monitoring demonstrated flow of contrast medium into the right internal carotid, anterior and middle cerebral arteries, and then the patient suddenly developed left hemiparesis, nausea, and deep coma. He died 48 days after the embolization treatment without improvement of the coma. A medicolegal autopsy was performed to determine whether malpractice had occurred during the embolization procedure. An internal examination demonstrated massive necrosis of the cerebral hemispheres and lobar pneumonia with abscess in the lungs. Due to the extensive brain necrosis, it was impossible to carry out ordinary macroscopic examination to identify the precise site of the craniocerebral vessel occlusion. Postmortem angiography was therefore performed, and this successfully revealed occlusion of the right internal carotid artery. In this case, postmortem angiography played a key role in identification of the intracranial vascular lesion that was responsible for the iatrogenic cerebral infarction.     

Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms

Objective

The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms.

Methods

Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale.

Results

Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose.

Conclusion

The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.     

56例脑动静脉畸形真丝栓塞治疗

本文报道以真丝线段血管内栓塞治疗56例脑 AVM,结果表明:真丝线段对畸形血管床和其供血动脉具确切栓塞作用。综合56例治疗结果,作者认为,真丝线段是一种便宜易得、制作简单、注射容易掌握、并发症少,近期栓塞作用可观的新型栓塞材料。值得进一步探索。     

联合血管内外神经介入技术治疗急性期破裂颅内动脉瘤

目的　评估联合血管内外神经介入技术治疗急性期破裂颅内动脉瘤 (aneurysm ,AN)的疗效。方法　对 4 0例急性破裂期AN采用电解脱弹簧圈栓塞 ,随后穿刺腰蛛网膜下腔 ,导丝导向的微导管在透视下插管至枕大池 ,2h后注入 10万U尿激酶 (UK)溶解血块并经微导管持续引流血性脑脊液。根据CT复查结果决定是否继续注射UK。结果　AN栓塞及枕大池插管均获成功 ,无技术相关并发症 ,术后 3～ 7d时的CT见所有患者脑池内的出血消失。除 1例有一过性症状性脑血管痉挛 (CVS)外 ,其余患者无症状性CVS、所有患者无AN再出血。结论　联合血管内外神经介入技术既闭塞了AN ,又清除了蛛网膜下腔积血 ,可防止再出血和继发性CVS的发生 ,达到了对因、对症治疗的双重目的。     

Multiple cerebral aneurysms associated with Takayasu arteritis successfully treated with coil embolization

The cerebrovascular complications of Takayasu arteritis are primarily related to the presence of occlusive lesions. Cerebral aneurysms rarely occur as complications; only 18 cases have been reported thus far. The use of coil embolization to treat cerebral aneurysms occurring as a complication of Takayasu arteritis has not been previously reported. We report a case of Takayasu arteritis with a basilar tip aneurysm and a P1 segment aneurysm of the left posterior cerebral artery that were successfully treated with coil embolization. Because coil embolization for cerebral aneurysms associated with Takayasu arteritis requires the use of limited access routes that have extremely curved and tortuous courses, catheter navigation was difficult. The guide catheter, microcatheter, and guidewire must be selected and navigated with greater care than is usually required for common aneurysm embolization.     

螺旋CT血管造影在脑动脉瘤诊断及治疗中的应用—兼与MR血管造影比较

目的探讨无创性的螺旋CT血管造影(SCTA)与MR血管造影(MRA)对脑动脉瘤的诊断价值以及对治疗的指导价值,并对两者作比较.材料和方法28例患者同时行SCTA、MRA、DSA,以DSA作为金标准,对SCTA与MRA作比较.结果(1)23例行SCTA及时间飞跃法(TOF)MRA者,SCTA诊断脑动脉瘤的准确性高于TOFMRA,但差异无显著统计学意义(p＞0.05).(2)SCTA较TOFMRA测量脑动脉瘤的最大径准确性高(p＜0.01),TOFMRA测量值常偏小.(3)SCTA测量的栓塞治疗最佳投照角度与DSA符合率94.7%.(4)动态增强(DCE)MRA的图像清晰度及价值与SCTA相似.结论SCTA对体积小、破裂出血的脑动脉瘤的检出率以及对动脉瘤测量的精确性高于TOFMRA,SCTA可较准确地测量动脉瘤栓塞治疗的最佳投照角度,MRA是脑动脉瘤电解可脱弹簧圈(GDC)栓塞术后随访的较好方法,DCEMRA的实用价值与SCTA相似.     

乙烯-乙燃基醇共聚物在脑动静脉畸形治疗中的研究进展

自1960年首次报道栓塞治疗脑动静脉畸形(AVM)来,现不仅成为外科手术前的重要辅助方法,而且在许多脑AVM的治疗中为首选[1]。理想的栓塞材料至少应具备以下条件:①良好的生物相容性;②能有效地栓塞血管病变;③无毒,不致癌,不致畸;④易制备;⑤易通过不同规格的导管;⑥能产生非损害     

颅内动脉瘤合并脑血管痉挛栓塞术后的观察与护理

目的:探讨颅内动脉瘤合并脑血管痉挛栓塞术后观察与护理的重要性。方法:本组36例颅内动脉合并脏血管痉挛患者入院72h内在全麻下行颅内动脉瘤栓塞术。术前、术中常规罂粟硷30mg/10ml持续静脉内泵入,术后持续泵入3d,给予尼莫通抗血管痉挛。术后第2天开始实施三高疗法,术后常规腰大池引流,放出血性脑脊液。结果:本组行颅内动脉瘤栓塞术后,32例恢复良好(可恢复工作,无明显神经系统功能障碍),2例持续昏迷自动出院;2例中度致残(轻度神经系统功能障碍,但生活能自理)。结论:利用护理手段干预4方面中的可控因素,如平均动脉压、颅内压、中心静脉压、血流速度(血液稀释度),使其控制在预设定目标范围内可保证脑的有效灌注压,预防CVS的发生。     

可脱性弹簧圈栓塞治疗脑血管痉挛期颅内动脉瘤

目的　探讨可脱性弹簧圈在脑血管痉挛期 (4～ 14d)栓塞治疗颅内动脉瘤的方法及效果。方法　 2 0 0 4年 3～ 8月共栓塞颅内动脉瘤 14例 ,其中颈内动脉瘤 1例 ,后交通动脉瘤 8例 ,前交通动脉瘤5例 ,所有患者均在 4～ 14d内采用DCS MATRIX材料进行栓塞。结果　 11例栓塞 10 0 % ,2例栓塞 70 %～ 90 % ,1例栓塞 5 0 % ;其中有 6例发现有脑血管痉挛。结论　在脑血管痉挛期 ,血管内栓塞动脉瘤也是一种安全、微创、有效的治疗方法。     

颈内动脉狭窄或闭塞后侧支循环与脑缺血的关系研究

目的 探讨颈内动脉狭窄或闭塞后侧支循环与脑缺血的关系。资料与方法 颈内动脉狭窄或闭塞患者40例．分析MRA、MRI表现及临床资料。结果 40例患者59侧有颈内动脉分叉以上狭窄或闭塞，MRI上大面积脑梗死10例．腔隙性梗死15例．介于二者之间者4例．严重半球脑萎缩3例，轻度脑萎缩4例．无异常表现者4例。MRA上大面积梗死及严重脑萎缩者侧支循环很差或缺乏。腔隙性梗死、轻度脑萎缩及表现正常者均有较丰富的侧支循环。结论 颈内动脉狭窄或闭塞后脑缺血程度与侧支循环有密切关系。侧支循环差或缺乏，会引起大面积梗死．侧支循环丰富，不出现梗死或只引起小的梗死。     

脑分水岭梗死血管造影分析

目的:分析脑分水岭梗死(CWI)血管造影的表现,探讨脑分水岭梗死与脑血管狭窄的相关性。方法:回顾性分析32例经CT或MR证实的CWI患者的脑血管造影表现。结果:32例CWI患者中发现28例(87.5%)有脑血管狭窄或者闭塞,4例(12.5%)血管造影正常。前循环大脑中动脉和颈内动脉受累最为常见。后循环受累的血管中以椎动脉最为常见。结论:脑分水岭梗死血管造影显示大部分患者有肯定的脑血管狭窄或者闭塞,及时行脑血管造影检查有利于指导治疗,判断预后。     

Embolization of cerebral angiomas by catheterization of cortical arteries

Summary A method of combined direct embolization of submillimetric cortical arteries, after peroperative arteriography, is described and 3 cases of cerebral angiomas presented with striking symptomatic improvement after embolization. Postoperative angiography in one case showed considerable diminution in the size of the angioma.     

脑动静脉循环时间在重度颈动脉狭窄诊断和评估中的应用价值

目的:采用数字减影脑血管造影测量正常人和重度颈动脉狭窄患者的脑动静脉循环时间,探讨其在重度颈动脉狭窄诊断和评估中的应用价值。 方法:选取36例正常人数字减影脑血管造影图像,测定脑动静脉循环时间,同时测定24例重度颈动脉狭窄（狭窄率≥70%）患者的脑动静脉循环时间,采用独立样本t检验比较二者的差别。 结果:正常人脑动静脉循环时间为（6.01±0.50）s;颈动脉重度狭窄患者的患侧脑动静脉循环时间为（6.60±0.56）s,高于正常人,差异有统计学意义（t=4.264, P<0.05）。 结论:采用脑血管造影进行脑血管疾病诊断时计算脑动静脉循环时间简单、准确、易行,可作为初步评估脑组织灌注的参考指标;颈动脉重度狭窄患者患侧的脑动静脉循环时间延长,提示脑组织供血延迟。     

Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms

One of the feared complications during detachable coil embolization of cerebral aneurysms is herniation of a coil loop into the parent artery. Although coil protrusion of one or two loops into the parent vessel may not cause adverse events and in some instances can be ignored, the authors believe that coil retrieval is indicated if a free end is seen pulsating along the blood flow stream to prevent migration of the entire coil mass. In one patient, a microballoon was inflated across the neck of the aneurysm during retrieval of a herniated coil to prevent further coil herniation from the aneurysm sac. We present two cases in which prolapsed coils were successfully retrieved either using a microsnare and balloon combination or a microsnare alone. This report focuses on the efficacy of the Amplatz microsnare for such retrievals and the circumstances in which a herniated coil needs to be retrieved. We report two cases in which embolization coils partially migrated into the parent artery during endovascular treatment of cerebral aneurysm and were retrieved using the Amplatz Nitinol microsnare.     

Moyamoya病脑出血与侧支循环的关系研究

目的 探讨Moyamoya病脑出血与侧支循环的关系。资料与方法 分析37例脑出血型Moyamoya病患者的临床资料及DSA，MRA，MRI和CT结果。结果 全部病例在DSA和MRA像上均显示颈内动脉分叉以上狭窄或闭塞，其中双侧病变25例，单侧12例，在62个病变侧中，53侧基底节区可见异常血管网形成，其中丰富者43侧，较少者10侧，极少或没有者9侧，32个病变侧显示扩张的软脑膜吻合支，后交通动脉增粗23支，眼动脉增粗26支，通过前交通动脉供血5侧，所有造影像上均未见血管造影可显示的动脉瘤，在MRI和CT像上显示基底节脑出血12例，脑叶内出血7例，丘脑出血2例，蛛网膜下腔出血6例，脑室内出血10例，脑出血以突发头痛，神志不清，失语，偏瘫为主要症状。结论 Moyamoya病临床表现与其侧支循环有密切关系，丰富的侧支循环对脑循环起重要代偿作用。可以保护缺血的脑组织；另一方面，如果异常扩张的侧支血管破裂，可引起脑出血，笔者认为Moyamoya病脑出血与其丰富的侧支循环关系密切，基底节，丘脑及脑室出血与脑底异常血管网有关，脑叶内出血可能与扩张的软脑膜吻合支破裂有关，而这两种侧支血管破裂均可引起蛛网膜下腔出血。