支架辅助弹簧圈栓塞术治疗颈内动脉血泡样动脉瘤

目的 评估支架辅助弹簧圈栓塞在血泡样动脉瘤治疗中的作用.方法 回顾性分析8例采用支架辅助弹簧圈栓塞治疗的颈内动脉血泡样动脉瘤的临床特点、治疗过程及脑血管造影结果及随访结果.本组8例中,成功实施支架辅助弹簧圈栓塞术5例.2例因动脉瘤体积过小无法进一步实施弹簧圈栓塞,以单纯支架治疗.1例患者在成功释放支架后填塞弹簧圈过程中发生动脉瘤破裂,改行颈内动脉闭塞术.结果 患者出院时改良 Rankin 评分为1分4例,2分1例,3分1例,2例患者因术后再出血死亡.术后9～36个月(平均21.5个月)的临床随访结果提示4例患者改良Rankin评分为0分,1例1分,1例2分.所有患者均接受影像学随访,证实动脉瘤影像学复发3例,均接受再次血管内栓塞治疗.结论 支架辅助的弹簧圈栓塞术是治疗颈内动脉血泡样动脉瘤血泡样动脉瘤的町行方法之一.此方法用于急性期治疗有较高的安全性,可降低急性期病死率,应用多支架技术或使用新型低孔率支架辅助栓塞可能会进一步降低再出血和复发的风险.     

可脱微弹簧圈栓塞术治疗颅内动脉瘤

目的 探讨颅内动脉瘤可脱微弹簧圈栓塞治疗术的效果。方法 经股动脉Seldinger穿刺法,将导引管送至C2以上,将微导管置于动脉瘤腔,结合不同的方式,进行可脱微弹簧圈栓塞动脉瘤。结果 36例用GDC,6例Metrix,18例DCS,2例ORBIT,3例EDC,4例配合支架栓塞;65例患者,59例康复,3例后遗偏瘫,1例自动出院,5例死亡。59例随访,头颅平片GDC均在瘤腔,无再出血,5例患者复查DSA,无复发。结论 微弹簧圈栓塞是治疗颅内动脉瘤微创有效安全的方法。     

微弹簧圈栓塞前交通动脉瘤效果评价

目的：评价微弹簧圈栓塞治疗前交通动脉瘤的有效性及安全性。方法回顾性分析盐城市第三人民医院采用微弹簧圈栓塞术治疗的连续27例前交通动脉瘤患者的临床资料,其中多发前交通动脉瘤1例。通过评估动脉瘤栓塞率、患者预后、并发症、神经功能等判断微弹簧圈栓塞治疗前交通动脉瘤的有效性及安全性。结果27例前交通动脉瘤患者全部栓塞治疗成功,其中使用双导管技术3例,支架辅助技术3例。致密栓塞21例,瘤颈残余6例;所有患者保留载瘤动脉且载瘤动脉通畅,未见动脉瘤破裂出血、弹簧圈逸出。术后1 d再次出血,2 d后死亡1例;术后6个月轻度复发1例。术后6个月改良Rankin量表(mRS)评分显示24例患者0~1分,1例2分,1例4分。结论采用适宜的血管内栓塞治疗技术,可安全有效地治疗前交通动脉瘤。     

颅内破裂动脉瘤栓塞术后早期破裂再出血危险因素分析

目的探讨颅内破裂动脉瘤栓塞术后早期破裂再出血的临床特点及危险因素,以减少动脉瘤栓塞术后早期再出血的发生率,为临床治疗方法的选择提供依据。方法回顾性分析我科2002年7月至2007年10月经全脑血管造影确诊的颅内破裂动脉瘤并行血管内介入栓塞治疗的病例,分析栓塞术后早期再出血病例(病例组)的临床及影像学特征,从同期治疗的未再出血的患者中随机抽取123例病例作为对照组,对两者的可疑危险因素进行单变量与多变量的统计学分析。结果881例行介入栓塞治疗的颅内破裂动脉瘤中有17例(1.93%)发生早期破裂再出血,其中12例(占70.6%)死亡。颅内破裂动脉瘤栓塞术后早期破裂再出血的独立危险因素为动脉瘤的真假性、术前动脉瘤的破裂次数、术中造影有明显的脑血管痉挛及动脉瘤的栓塞程度4项。并得到预测栓塞术后早期再出血概率的方程。结论本研究显示栓塞术后早期破裂再出血的发生率低,但预后差,病死率高。术前针对危险因素进行预防、术中尽可能致密栓塞动脉瘤、术后早期及时复查脑血管造影有利于减少颅内破裂动脉瘤栓塞术后早期再出血率,积极再治疗可以改善早期再出血患者的预后。     

颈内动脉血泡样动脉瘤的研究进展

起源于颈内动脉床突段前壁的血泡样动脉瘤非常罕见,有其独有的特征及治疗方法。本文回顾性分析近年与之相关的国内外文献,综合研究了血泡样动脉瘤的形态学、病理学特征、发病原因及治疗策略。关于血泡样动脉的治疗,不同时期选择适合的方法进行综合治疗是有效的。     

长期抗凝引起颅内动脉瘤钢圈栓塞后致命性再出血

颅内动脉瘤的栓塞治疗已经很普遍,但栓塞前后病人的处理人们并未熟知。作者报道了两例动脉瘤病人,女性,年龄分别为63岁和77岁,均有高血压病史。CT显示蛛网膜下腔出血,脑动脉造影均显示左侧后交通动脉瘤。行钢圈栓塞治疗,动脉瘤栓塞80％和75％,有残余瘤颈。     

支架治疗颈内动脉分叉部宽颈动脉瘤

目的初步评价支架治疗颈内动脉分叉部宽颈动脉瘤的可行性、安全性和有效性。方法收集2004年1月至2010年12月11例颅内动脉瘤患者,共检出16枚颅内动脉瘤。其中位于颈内动脉分叉部的11枚动脉瘤均为宽颈动脉瘤,动脉瘤直径2.5～18 mm。所有患者采用不同类型支架及支架技术治疗,并于术后1、3、6、12个月进行随访。结果治疗中采用不同类型支架11枚,其中球扩支架1枚,自膨胀支架10枚。动脉瘤即刻栓塞结果按Raymond分级.Ⅰ级4枚,Ⅱ级2枚,Ⅲ级5枚。未发生手术相关并发症,出院时改良Rankin评分0～1分11例。11例患者随访1～108个月,均病情稳定,无新发的神经功能障碍。影像学随访7例,随访时间1～48个月,动脉瘤不显影4例,改善2例,稳定1例。结论对于颈内动脉分叉部宽颈动脉瘤,支架治疗技术可行,且安全有效,长期疗效有待于进一步研究。     

血管内治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血

目的探讨鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血的血管内治疗方式、疗效及安全性。方法 回顾性分析福建医科大学附属协和医院收治的21例鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血患者的临床资料,其中8例行覆膜支架植入,6例行支架辅助弹簧圈栓塞,7例直接行载瘤动脉闭塞治疗。分析手术策略、治疗结果以及临床与影像学随访结果。结果 21例患者均成功接受血管内治疗。术后即刻止血效果均良好,瘤颈残留2例,瘤体残留1例。术后出血复发5例,其中4例再次行载瘤动脉闭塞后出血停止,1例为覆膜支架植入后发生内漏,予球囊扩张后血止,但1个月后不明原因死亡;1例覆膜支架植入术后出现昏迷,CT示蛛网膜下腔出血、脑肿胀,治疗后未好转自动出院;3例在随访中发现颈内动脉闭塞;2例术后未随访。随访的19例患者中mRS评分0分9例,1分6例,2分2例,5分1例,6分1例。结论 针对鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血,血管内治疗效果确切,安全性较高。覆膜支架短期疗效好,但也存在着动脉瘤复发、内漏等问题,载瘤动脉闭塞可能远期疗效更可靠。     

血管内支架结合电解可脱弹簧圈治疗颅内动脉瘤

目的 初步总结使用血管内支架结合电解可脱卸弹簧圈（GDC）治疗颅内梭形及宽颈动脉瘤的体会,探讨其适应证、方法、疗效及并发症。方法 5例颅内梭形动脉瘤及12例宽颈动脉瘤,首先将冠脉支架跨动脉瘤颈放置,通过支架的网孔将微导管送入动脉瘤腔,继续填塞GDC。结果 13例动脉瘤致密填塞,3例大部分填塞,1例支架未能送入颅内而单用弹簧圈部分栓塞,载瘤动脉通畅,临床效果优良。结论 联合使用支架及微弹簧圈是治疗颅内梭形及宽颈动脉瘤的有效方法,远期疗效需进一步随访。     

颅内破裂动脉瘤血管内介入治疗后再出血危险因素研究进展

再出血是颅内破裂动脉瘤最危险的并发症,虽然发生率非常低,但是预后极差,病死率高,需引起高度重视。本文分析了近年与之相关的国内外文献,综合分析了颅内破裂动脉瘤血管内介入治疗后再出血的相关危险因素和机制,以及降低再出血率的措施。     

Post-herpetic aneurysm in the intrapetrosal portion of the internal carotid artery

Summary The occurrence of an aneurysm, 2x2.5 cm in size, in the intrapetrosal portion of the internal carotid artery in a 24-year-old female patient, during the course of herpes zoster ophthalmicus, is described.     

Giant aneurysms of the internal carotid artery: endovascular treatment and long-term follow-up

We report the long-term follow-up of 18 patients with giant aneurysms of the internal carotid artery (ICA) referred for endovascular occlusion of the parent vessel. There were 10 aneurysms involving the infra- and/or supraclinoid cavernous segment, six the ophthalmic segment, one the petrous segment and one the bifurcation. One patient who did not tolerate test occlusion was treated medically. Clinical and imaging follow-up were obtained in 16 patients for a mean of 30 months, range 6–80 months. Endovascular treatment led to excellent clinical outcome in 16 patients. One 34-year-old woman, who presented with subarachnoid haemorrhage (SAH), died from bilateral middle cerebral artery infarcts due to severe vasospasm 4 days after treatment. The patient treated medically died from SAH. Long-term imaging follow-up in 16 patients revealed a markedly smaller aneurysm sac in all cases.     

Tension pneumocephalus following pterional craniotomy for treatment of intracavernous internal carotid artery aneurysm

The occurrence of tension pneumocephalus following intracranial aneurysm surgery is a rare event. Here, we present a case of extradural tension pneumocephalus following pterional craniotomy for the treatment of intracavernous internal carotid artery aneurysm. It has been caused by a fistulous communication between the posterior wall of the frontal sinus and the extradural space. Successful obliteration of this aberrant communication tract was performed using fibrin glue, with complete resolution of the pneumocephalus.     

Anomalous origin of the posterior meningeal artery from the internal carotid artery

Summary A rare case of anomalous origin of the posterior meningeal artery from the internal carotid artery, normally arising from the vertebral artery, is presented.     

Endovascular coil embolization for anterior choroidal artery aneurysms

Introduction We retrospectively evaluated the ischemic complications related to the anterior choroidal artery (AChA) and clinical outcome after coiling of AChA aneurysms. Methods We included 37 patients (27 with subarachnoid hemorrhage, 10 without) harboring 38 AChA aneurysms (23 ruptured, 15 unruptured) who were treated by coiling at four institutions. Ischemic complications related to the AChA and clinical outcomes were retrospectively evaluated. Results Intraprocedural transient AChA occlusion occurred in five aneurysms, all of which had AChA incorporated into the aneurysm neck. Two of the five patients suffered postprocedural transient contralateral hemiparesis, but recovered completely. The remaining three patients had no postprocedural symptoms. Incidence of transient AChA occlusion was significantly higher in those aneurysms in which the AChA was incorporated into aneurysm neck (group 2) than in those in which the AChA was not incorporated (group 1). Of the 37 patients, 31 (83.8%) had good recoveries (modified Rankin scale score 0–2). Two patients died from the consequences of subarachnoid hemorrhage. During follow-up for a mean of 27 months (range 4–72 months), none of the 35 living patients re-bled. A total of 29 aneurysms in 28 patients were followed-up angiographically. Recurrences were found in 5 of the 29 aneurysms during follow-up (mean 18 months, range 6–45 months). Re-embolization achieved near complete occlusion of two recurrent aneurysms, both of which were still stable at the time of the next two follow-up angiographies. The other three recurrent aneurysms were not retreated due to the small size of the recurrences. Conclusion Coiling of AChA aneurysms resulted in good outcomes without AChA-related permanent ischemic complications. Transient AChA occlusion, potentially associated with ischemic complications, was significantly more frequent in the aneurysm in which the AChA was incorporated into the aneurysm neck.     

Post-traumatic dissecting aneurysm of extracranial internal carotid artery: endovascular treatment with stenting

Traumatic internal carotid dissection occurs frequently in motor vehicle accidents, typically extracranially, close to the skull base. Dissection may lead to stenosis or occlusion of the vessel, possibly with a pseudoaneurysm, symptoms ranging from neck pain to neurological deficits. In symptomatic patients and in cases of pseudoaneurysm, when conservative medical treatment fails, surgery or endovascular treatment are indicated. We report a post-traumatic dissecting aneurysm of the extracranial internal carotid artery successfully treated with stenting via a transfemoral approach. Received: 5 November 1998 Accepted: 5 December 1998     

Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume

Our purpose was to evaluate the postoperative aneurysm occlusion volume and clinical results of treating unruptured intracranial aneurysm using three-dimensional (3D) coils. Over a 2-year period 62 aneurysms (39 with a neck 4 mm, 23 with a neck >4 mm) in 62 patients in five participating centres were treated. The procedure consisted, firstly, of framing the aneurysm with one or more spherical 3D coils, and secondly, of filling it with two-dimensional (2D) helical coils. Anatomical and clinical results were evaluated by univariate analysis. Multivariate analysis was used to identify independent predictors of these results. For neck sizes 4 and >4 mm, angiographic occlusion was complete in 31 (79%) and 16 (70%) aneurysms, respectively; the mean percentage of occlusion volume was 31.4% and 29.5%, respectively, and postoperative morbidity was 3% and 4%, respectively, with no significant differences between the two groups. There were no deaths. However, occlusion volume correlated with sac size (P=0.037) and sac-to-neck ratio <1.5 (P=0.073), except when three or more 3D coils per aneurysm were used (P=0.516 and P=0.308, respectively). Occlusion volume correlated with the number of 3D coils per aneurysm (P<0.001) and was an independent predictor of angiographic complete occlusion (P=0.002). The use of the largest number of 3D coils per aneurysm was safe and may improve the postoperative volume and angiographic occlusion of aneurysms with a neck >4 mm, provided the sac-to-neck ratio is 1.5.     

GDC血管内栓塞治疗颅内动脉瘤

目的 探讨电解可脱性弹簧圈（GDC）血管内栓塞治疗颅内动脉瘤的疗效和技术要点。方法 对31例动脉瘤患者应用微导管技术,通过数字减影全脑血管造影,采用GDC作动脉瘤囊内填塞治疗。结果 31例31枚动脉瘤中28枚瘤腔完全闭塞,3枚95％闭塞。术后30例临床痊愈;1例死亡;病死率3．2％。术中并发动脉瘤再破裂出血1例;术后弹簧圈末端逸出1例。术后随访0．5～3年均无再出血。结论 GDC血管内栓塞治疗颅内动脉瘤疗效可靠,早期栓塞及有效的术后处理是提高治愈率的重要方法。     

血管内支架治疗颈内动脉狭窄27例体会

目的总结血管内支架治疗颈内动脉狭窄的疗效及其体会。方法选择我院2004年12月至2006年3月经DSA证实颈内动脉狭窄患者27例，全部经全脑血管造影及颈部超声检查后，行经皮腔内血管成形和支架植入术治疗。结果术后超声及DSA证实，手术成功率100％，治疗后残余狭窄率均低于30％，27例患者中与操作相关的并发症包括2例（7．4％）出现可逆性小卒中；3例（11．1％）出现术中球囊扩张时对侧肢体局灶性癫痫发作；5例（18．5％）血管痉挛；6例（22．2％）出现低血压和心动过缓。18例随访6个月～18个月，无1例再次发生脑梗死。结论血管内支架成形术是一种治疗颈内动脉狭窄安全有效的方法，提高术者操作技巧及加强围手术期监护可以大大降低手术并发症和病死率。