大脑前动脉A_1段动脉瘤的血管内治疗

目的探讨大脑前动脉A_1段动脉瘤的血管内治疗方法及临床疗效。方法回顾性分析2013年4月至2017年2月采用血管内方法治疗的25例大脑前动脉A_1段动脉瘤的临床资料,15例采用单纯弹簧圈栓塞,5例采用支架辅助弹簧圈栓塞,1例A_1段宽颈动脉瘤合并烟雾综合征予以球囊辅助栓塞,1例微小动脉瘤使用2枚enterprise支架重叠释放置入,3例行弹簧圈闭塞载瘤动脉。结果术后即刻造影显示:Raymond分级Ⅰ级19例,Ⅱ级5例,Ⅲ级1例;无弹簧圈突入载瘤血管、术中动脉瘤破裂及支架内血栓形成等并发症。出院时,改良Rankin量表(mRS)评分0分17例,1分5例,2分1例,4分2例。16例术后临床和影像学随访3~24个月,未出现再出血和脑缺血并发症,m RS评分0分11例,1分3例,2分1例;2例复发,均为单纯弹簧圈填塞的动脉瘤,继续行支架辅助弹簧圈栓塞,术后无并发症。结论血管内方法治疗大脑前动脉A_1段动脉瘤安全有效,为保证成功栓塞,需要结合各种辅助技术和方法,其远期疗效需要进一步随访。     

大脑前动脉A1段形态学特点与前交通动脉瘤的关系

目的分析大脑前动脉A1段的形态学特点及其与前交通动脉瘤形成和指向的关系,以提高开颅夹闭术的预见性和指导血管内栓塞术中微导管塑形。方法回顾性分析264例前交通动脉瘤及随机选取的同期296例其他脑血管疾病的数字减影脑血管造影检查资料。A1段形态上可分为弧形(Ⅰa型:上弧形,Ⅰb型:下弧形),S形(Ⅱa型:反横S形,Ⅱb型:横S形),近线形(Ⅲ型)及不显影。动脉瘤依瘤体指向分为:前下型、前上型、后上型、后下型及复杂型。结果①双侧A1段形态:前交通动脉瘤组,Ⅰa型158侧,Ⅰb型11侧,Ⅱa型35侧,Ⅱb型87侧,Ⅲ型171侧,缺如66侧。其他脑血管病组,Ⅰa型195侧,Ⅰb型20侧,Ⅱa型47侧,Ⅱb型74侧,Ⅲ型217侧,缺如39侧。前交通动脉瘤组A1段不显影较其他脑血管病组多(掊2=11.482,P=0.001)。②前交通动脉瘤指向:前上型121例,前下型105例,复杂型16例,后下型12例,后上型10例。③优势显影侧A1段形态与动脉瘤指向的关系:A1段形态与动脉瘤指向之间关系密切(掊2=221.859,P<0.01;C=0.619,P<0.01)。当A1段为Ⅰa型或Ⅱa型,动脉瘤指向一般向下;A1段为Ⅰb型或Ⅱb型,动脉瘤指向一般朝上;当A1段为Ⅲ型时,动脉瘤指向可向上、向下及复杂形态。结论大脑前动脉A1段变异与前交通动脉瘤形成有关。A1段形态以近线形、上弧形和横S形多见。前交通动脉瘤指向以前上型与前下型多见。认识A1段形态与前交通动脉瘤指向的关系对动脉瘤手术有指导意义。     

支架辅助血管内栓塞前交通动脉破裂动脉瘤的疗效

目的 探讨支架辅助栓塞前交通动脉破裂动脉瘤的技术及临床疗效。方法 2005年7月至2015年4月采用支架辅助血管内栓塞治疗前交通动脉破裂动脉瘤21例。结果 栓塞后即刻造影示完全栓塞15例,瘤颈部分残留6例。术中动脉瘤破裂1例,术后再出血2例。21例患者术后随访6~24个月,平均12个月,其中DSA随访15例（9例即刻完全栓塞的患者造影复查动脉瘤仍完全不显影,载瘤动脉通畅;6例栓塞即刻大部分栓塞患者5例动脉瘤级瘤颈未显影,1例瘤颈仍部分显影;术后支架移位2例,载瘤动脉轻度狭窄1例）;所有患者均无神经功能损伤。结论 采用支架辅助血管内栓塞治疗前交通动脉破裂动脉瘤是安全的,复发率低,规范的操作、栓塞材料的合理选择可以降低手术并发症,达到最佳的临床疗效。     

支架辅助弹簧圈栓塞颅内前交通动脉瘤

目的 总结Solitaire AB支架辅助弹簧圈栓塞颅内前交通动脉瘤的有效性和安全性.方法 回顾分析2010年7月至2011年12月23例Solitaire AB支架辅助弹簧圈栓塞颅内前交通动脉瘤患者的病例资料,通过评估动脉瘤栓塞率、载瘤动脉保留、患者预后、并发症等,判断应用该支架的安全性和有效性.结果 手术成功率100％,动脉瘤完全栓塞17例(74％),近全栓塞4例(17％),不完全栓塞2例(9％).载瘤动脉完全保留.无死亡病例,随访见mRS评分0～1分22例,3分1例.支架引起脑血管痉挛并发症1例,无临床症状.结论 Solitaire AB支架用于辅助弹簧圈栓塞颅内前交通动脉瘤是有效和安全的.     

支架半释放技术辅助弹簧圈栓塞治疗破裂的颅内微小动脉瘤

目的探讨支架半释放技术辅助弹簧圈栓塞破裂颅内微小宽颈动脉瘤的可行性、有效性和安全性。方法2007年1月至2011年8月采用支架半释放技术辅助弹簧圈栓塞治疗破裂颅内微小宽颈动脉瘤37例。结果所有患者均成功通过支架半释放技术辅助弹簧圈栓塞治疗。术后即刻造影结果显示,Raymond分级I级26例,II级8例,III级3例。28例患者影像学随访3～24个月,平均10．4个月,未发现支架内再狭窄或复发。36例患者临床随访9—48个月,平均21．3个月,无再出血或死亡病例。结论支架半释放技术辅助弹簧圈栓塞治疗破裂颅内微小宽颈动脉瘤是安全、可行的。该技术通过增加瘤颈周围的填塞密度和改善血液动力学进一步提高长期疗效。     

支架辅助弹簧圈栓塞治疗颅内未破裂动脉瘤的疗效

目的 探讨支架辅助弹簧圈栓塞治疗颅内未破裂动脉瘤的疗效。方法 回顾性分析2014年1月至2016年3月收治的96例颅内未破裂动脉瘤的临床资料,根据治疗方法分为对照组（50例）与观察组（46例）。对照组采用单纯弹簧圈栓塞治疗,观察组采用支架辅助弹簧圈栓塞治疗。结果 观察组完全栓塞率、术后6个月GOS评分均明显高于对照组（P<0.05）,而复发率明显低于对照组（P<0.05）。结论 对颅内未破裂动脉瘤采用支架辅助弹簧圈栓塞治疗,可显著提高动脉瘤栓塞程度,降低复发率,改善预后。     

颅内破裂微小动脉瘤的栓塞治疗

目的 探讨栓塞治疗颅内破裂微小动脉瘤的临床效果。方法 回顾性分析16 例颅内微小动脉瘤（直径小于3 mm）在破裂后早期进行栓塞治疗及术后3~6个月的随访情况。结果 14例用弹簧圈行囊内栓塞,其中4例100%栓塞,8例90%栓塞,2例80%栓塞;2例单纯用支架覆盖,即刻造影未见动脉瘤显影。术中无破裂出血。出现手术相关并发症2 例,其中1 例死亡,1 例有偏瘫。16 例颅内动脉瘤随访3 ~6个月,有1 例复发出血。6例动脉瘤在3~6个月后复查脑血管造影,有1例复发。结论 在急性期使用微弹簧栓塞治疗颅内破裂微小动脉瘤是一种安全有效的方法,瘤颈的残留与动脉瘤复发的关系密切,颅内支架及辅助球囊的使用,有助于减少微小动脉瘤的复发率。     

血管内栓塞治疗大脑中动脉破裂动脉瘤的疗效分析

目的 探讨大脑中动脉破裂动脉瘤血管内栓塞治疗的安全性、有效性。方法 回顾性分析2010年1月至2017年11月栓塞治疗的37例（38枚动脉瘤）大脑中动脉破裂动脉瘤的临床资料,其中相对窄颈动脉瘤（瘤颈/瘤体<1/2）14枚,相对宽颈动脉瘤（瘤颈/瘤体≥1/2）18枚,绝对宽颈动脉瘤（瘤颈>4 mm）6枚。结果 栓塞后即刻DSA显示,Roymond分级Ⅰ级栓塞34枚,Ⅱ级4枚。1例术中出现动脉瘤破裂,术后病情加重死亡;1例术后出现载瘤动脉痉挛,1例术中出现血栓事件,经对症处理后治愈。术后随访6~18个月,改良Rankin量表评分0~2分33例,3~6分4例;预后良好率为89.1%。26例DSA随访显示动脉瘤未显影23例,复发3例。结论 血管内栓塞治疗大脑中动脉破裂动脉瘤是安全的、有效的,但需要严格把控手术适应证。     

支架辅助弹簧圈栓塞颅内破裂动脉瘤疗效及安全性分析

目的比较支架辅助弹簧圈栓塞颅内破裂与非破裂动脉瘤的疗效与并发症,以探究支架辅助弹簧圈栓塞颅内破裂动脉瘤的有效性及安全性。方法回顾性分析191例颅内动脉瘤支架辅助弹簧圈栓塞患者资料,观察术中及术后复查造影瘤腔填塞致密程度(Raymond分级)、术中及术后并发症,使用改良Rankin量表(mRS)评分术前术后改善程度评估临床预后改善程度。结果 191例患者被分为两组,未破裂组患者126例,破裂组患者65例;未破裂组术后即刻完全栓塞RaymondⅠ级患者111例(88%),RaymondⅡ级9例(7.1%),RaymondⅢ级6例(4.8%);破裂组RaymondⅠ级55例(84.6%);RaymondⅡ级6例(9.2%),RaymondⅢ级4例(6.1%),无统计学差异(P> 0.05);非破裂组复查脑血管造影平均时间为164.45 d,而破裂组为161.55 d,无统计学差异(P> 0.05),复查造影完全栓塞率非破裂组为84.1%,破裂组为84.6%,无统计学差异(P> 0.05)。未破裂组总并发症20例(15.9%),围手术期缺血事件10例(7.9%)、出血事件3例...     

球囊辅助弹簧圈栓塞治疗大脑中动脉动脉瘤

目的探讨应用球囊辅助弹簧圈栓塞治疗大脑中动脉动脉瘤的可行性、安全性、有效性及操作技巧。方法采用球囊辅助弹簧栓塞治疗25例大脑中动脉动脉瘤,其中动脉瘤位于大脑中动脉M1段末端5例,M2段4例,均应用HyperGlide球囊辅助栓塞;动脉瘤位于大脑中动脉分叉部16例,其中5例应用HyperGlide球囊辅助栓塞,11例应用HyperForm球囊辅助栓塞。结果 1例近全栓塞,其余患者均获100%栓塞,术中出现1例球囊回抽困难,术后3例患者出现脑缺血症状,2例经治疗完全缓解,1例残存不完全性失语。所有患者均随访无再出血。结论球囊辅助弹簧圈栓塞技术是治疗大脑中动脉动脉瘤的一种安全有效的方法,可增加动脉瘤的致密栓塞率,并有效减少并发症的发生。     

支架辅助栓塞破裂性前交通宽颈动脉瘤

目的 探讨支架辅助栓塞前交通宽颈动脉瘤的术前评估、支架植入策略、治疗效果.方法 回顾分析采用支架结合弹簧圈治疗的21例前交通宽颈动脉瘤及载瘤动脉解剖形态,支架植入技术操作程序,临床和造影结果.结果 21例动脉瘤均成功植入支架,其中Neuroform支架19枚、LEO支架2枚.12例支架远端位于同侧A2段、5例支架远端越过前交通植入对侧A2段、4例位于动脉瘤内.术后即刻致密栓塞18例;大部分栓塞2例;部分栓塞1例.术中动脉瘤破裂1例,经继续栓塞后出血得到控制.平均8.7个月后DSA随访12例,MRA随访4例,显示1例动脉瘤再通.结论 术前应根据动脉瘤及前交通动脉的解剖形态和功能制定支架植入策略.支架辅助栓塞前交通宽颈动脉瘤技术安全可行,动脉瘤致密栓塞率高.支架的长期疗效需进一步随访观察.     

Stent-assisted coil embolization of unruptured middle cerebral artery aneurysms using LVIS Jr. stents

Authors reported the anatomical and clinical results of the stent assisted coiling (SAC) of unruptured middle cerebral artery (MCA) aneurysms using Low-profile Visualized Intraluminal Support Junior (LVIS Jr.). Forty-seven MCA aneurysms in 46 patients were the subjects of this study. The mean aneurysm size, neck width were 4.5 ± 1.8 mm, 3.0 ± 1.0 mm, respectively. Immediate anatomical outcomes were class Ⅰ in 31 (65.0%), class Ⅱ in 5 (10.6%) and class III in 11 (23.4%) patients according to Raymond-Roy classification. The latest anatomical outcomes were class Ⅰ in 33 (86.8%), class Ⅱ in 2 (5.3%) and class III in 3 (7.9%) patients. The change of aneurysm obliteration status were unchanged in 27 (71.0%), improved in 9 (23.7%) and worsen in 2 (5.3%). There were no recurrence necessitating additional treatment. Two patients suffered from angiographically evident in-stent thrombosis, but their clinical outcomes remain good. The modified Rankin scale at discharge were 0 in 45 patients, 1 in 1 patient. No patient showed clinical worsening during the clinical follow-up period at outpatient clinic (mean, 27.4 months). SAC of unruptured MCA aneurysms using LVIS Jr. provide safe and durable effect with high complete obliteration rate recurrence rate.     

微小破裂前交通动脉瘤的血管内栓塞治疗

目的 总结应用血管内技术治疗微小破裂前交通动脉瘤的经验和体会。方法 回顾性分析应用血管内栓塞治疗的22例破裂的微小前交通动脉瘤患者的临床资料、栓塞过程以及结果。结果 22例全部成功栓塞,每个动脉瘤应用1～3个弹簧圈,平均2个。18例完全栓塞,3例95％栓塞,1例瘤颈残留。术中未发生动脉瘤破裂出血。10例影像学复查未见动脉瘤复发。结论 选择合适的病例,血管内栓塞可以安全有效地治疗破裂的微小前交通动脉瘤。     

手术治疗大脑前动脉远端动脉瘤(附九例报告)

目的 探讨大脑前动脉远端动脉瘤(DACAA)的诊断和显微外科手术治疗.方法 回顾分析2007年10月至2010年3月显微手术治疗DACAA 9例.术前Hunt-Hess分级0级1例,Ⅰ级2例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例.结果 9例DACAA经额纵裂入路成功夹闭动脉瘤11个,动脉瘤直径在3～30 mm之间,其中囊性动脉瘤9个,梭形动脉瘤1个,巨大动脉瘤1个;位于A2段2个,A3段8个,胼周动脉末梢段1个.2例为多发动脉瘤,1例合并动静脉畸形.1例梭形动脉瘤患者术后出现对侧肢体偏瘫,余治疗效果满意,无手术死亡,亦无其他并发症.按照GOS预后评分,8例恢复良好,1例重残.结论 通过术前3D-CTA和DSA等影像学诊断和准确手术定位,经额纵裂入路显微手术夹闭DACAA效果满意.

Abstract：

Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm(DACAA)patients treated over the last 3 years.Methods 9 consecutive cases of ruptured DACAA operated from October 2007 to March 2010 were reviewed and followed up.Methods 11 aneurysms were clipped through interhemispheric approach microsurgery in 9 cases with ruptured DACAA.The diameter of 11 aneurysms was between 3-30 mm.Of which 9 cases were saccular aneurysms,1 case was fusiform aneurysm and 1 case was giant aneurysm.There were 2 aneurysm located at A2 segment of the ACA,8 located at A3 and 1 located at distal pericallosal artery.So there were 2 cases with multiple aneurysms and 1 case combined with AVM.The clinical outcomes of these patients evaluated by Glasgow Outcome Scale were:Except 1 case of fusiform DACAA presented hemiplegic paralysis after the surgery,all 8 cases discharged without deficit and no mortality in the group.Conclusion Depending on precise understanding of angiography imaging and location of 3D- CTA and DSA,interhemispheric approach is a safe method to clip the DACAA.     

Single-centre comparison of procedural complications,clinical outcome,and angiographic follow-up between coiling and stent-assisted coiling for posterior communicating artery aneurysms

Aneurysm recurrence is a principle limitation of endovascular coiling procedures, especially in posterior communicating artery aneurysms, with reported recurrence rates of >30%. The adjunctive use of self-expandable stents has revolutionised the treatment of intracranial aneurysms, especially for complex morphologies, wide necks, or unfavourable dome-to-neck ratios. However, there are limited data concerning a direct comparison between simple coiling and stent-assisted coiling in posterior communicating artery aneurysms. This study aimed to compare the durability and outcomes of coiling versus stent-assisted coiling procedures. Imaging data of patients with posterior communicating artery aneurysms treated with coiling or stent-assisted coiling between January 2008 and October 2012 were retrospectively analysed. The initial angiographic results, procedural complications, and clinical outcomes were assessed at discharge. Imaging follow-up was performed with cerebral angiography. Complete aneurysm occlusion was achieved on initial angiography in 23/56 (41.1%) stent and 83/235 (35.3%) non-stent patients. At the latest follow-up (mean follow-up 14.3 ± 10.4 months for stent and 13.2 ± 9.5 months for non-stent patients), aneurysms had recurred in 5/47 (10.6%) stent and 57/203 (28.1%) non-stent patients (p = 0.014). Procedural complications occurred in 6/56 (10.7%) stent and 27/235 (11.5%) non-stent aneurysms. No rebleeding occurred during clinical follow-up (mean duration, 46.7 months). Recurrence rates at the latest follow-up were significantly lower in patients undergoing stent-assisted coiling than those undergoing simple coiling. Thus, use of the stent-assisted neck remodelling technique in the treatment of wide-necked posterior communicating artery intracranial aneurysms appears to improve the long-term clinical outcome.     

Stent-assisted coiling of cerebral aneurysms using the Enterprise and the Solitaire devices

Abstract

Objective:

To evaluate the technical feasibility, peri- and post-procedural morbidity and mortality as well as clinical and angiographic follow-up using the Enterprise and the Solitaire stent currently available to be used for stent-assisted coiling of broad-based cerebral aneurysms.

Material and methods:

We conducted a retrospective study to investigate differences in aneurysms stented with the Enterprise (n = 58) and Solitaire stents (n = 19). Angiographic follow-up (mean: 8·25 onths) was available in 82·6% of patients treated with stent-assisted coiling.

Results:

All stents were successfully deployed. There is a higher acute in-stent thrombosis complication in Solitaire stent placement (P = 0·012). However, we observed no significant differences in peri-procedural morbidity and mortality rate (P = 0·253), angiographic results (P = 0·411), recurrence rate (P = 1·000), or long-term neurological deficit (P = 0·435).

Conclusion:

Both stents exhibited similar immediate and mid-term results with major neurological morbidities and mortality rate being low. More thrombogenic complications overall were found in Solitaire group.     

大脑前动脉A_1段动脉瘤的临床特点及治疗(附8例分析)

目的探讨大脑前动脉A_1段动脉瘤的临床特征以及治疗方式。方法回顾性分析2010年1月至2014年3月收治的8例大脑前动脉A_1段动脉瘤的临床资料。结果蛛网膜下腔出血6例,未破裂2例;栓塞治疗4例,夹闭4例。术后随访12~36个月;6例可正常工作生活,2例生活基本能够自理;改良Rankin量表评分2分2例,1分2例,0分4例;8例DSA或CTA复查均未见复发。结论大脑前动脉A_1段动脉瘤破裂可主要表现为蛛网膜下腔出血,血管内栓塞治疗及显微夹闭术均是可行并有效的治疗方法。     

大脑前动脉水平段动脉瘤的血管内治疗

目的 总结大脑前动脉水平段(A1)动脉瘤血管内治疗经验及技术要点,为该部位动脉瘤的介入治疗提供临床经验.方法 回顾性分析经血管内治疗的A1段动脉瘤患者的影像及临床资料、治疗效果、手术技巧及随访情况.结果 16例A1段动脉瘤患者资料被收集,均经介入栓塞治疗,其中5例患者使用球囊辅助或支架辅助栓塞技术.根据动脉瘤部位及形态,微导管头端塑形技术进入瘤腔并维持稳定.动脉瘤均完全填塞,患者预后良好.结论 血管内治疗适用于A1段动脉瘤,有时需应用球囊或支架辅助技术,微导管塑形技术对于介入栓塞A1段动脉瘤至关重要.     

破裂前交通动脉动脉瘤的血管内治疗

目的 总结破裂前交通动脉动脉瘤血管内治疗的经验和体会.方法 回顾性分析我院38例应用支架辅助、双微导管技术进行血管内治疗破裂前交通动脉动脉瘤的临床资料、栓塞过程以及治疗结果.结果38例患者中致密填塞33例,大部分填塞3例,瘤颈残留l例,术中破裂出血后死亡l例.12例患者入院DSA复查未见动脉瘤复发.结论 破裂前交通动脉动脉瘤治疗比较困难,通过血管内治疗能够达到良好的治疗效果,但还需要积累大量的临床经验,不断提高血管内治疗水平.