Willis覆膜支架治疗颈内动脉血泡样动脉瘤15例临床分析

目的探讨Willis覆膜支架系统治疗颈内动脉血泡样动脉瘤的效果及安全性。方法 15例颈内动脉血泡样动脉瘤患者均采用Willis覆膜支架治疗,其中11例择期手术,4例急诊手术治疗,共置入Willis覆膜支架18枚。结果术中18枚Willis覆膜支架均成功置入载瘤动脉,其中11例(11枚)支架置入即刻病变消失,载瘤动脉通畅;1例(1枚)置入即刻有少量造影剂滞留,1周后消失;3例分别植入2枚支架后病变消失,载瘤动脉通畅;术后随访3~6个月,患者均未发生新发梗死、出血等,改良Rankin量表(mRS)评分0分13例,1分2例;均无复发,2例载瘤动脉远端轻度狭窄,但患者无神经功能障碍。结论应用Willis覆膜支架治疗颈内动脉血泡样动脉瘤疗效确切,术后复发率低,并发症少。     

带膜支架在颅内动脉瘤及颈内动脉海绵窦瘘中的应用

近年来，覆膜支架为颅内宽颈、大或巨大动脉瘤及颈内动脉海绵窦瘘血管内治疗提供新的方法，效果良好。自2004年7月以来，首都医科大学宣武医院神经外科应用覆膜支架治疗颅内动脉瘤及颈内动脉海绵窦瘘9例，取得满意效果，现报告如下：     

颅内覆膜支架的介入治疗

2004年4月至2009年12月,我们采用覆膜支架隔绝术治疗颅内动脉瘤及外伤性颈内动脉海绵窦瘘（TCCF）患者39例,现将临床经验介绍如下。1资料与方法1.1病例选择本组39例中,男24例,女15例,年龄34～72岁,平均（51.6±6.2）岁。     

覆膜支架治疗外伤性颈内动脉海绵窦瘘的临床经验

目的：探讨覆膜支架治疗外伤性颈内动脉海绵窦瘘（TccF）的临床治疗经验。方法：11例TCCF经血管内介入治疗,1例外伤性颈内动脉海绵窦瘘患者复发,压迫颈总动脉无效,行球囊闭塞颈内动脉及瘘口。结果：术后杂音立即消失,数天后结膜水肿消退,造影见瘘口完全闭塞,10例TCCF患者颈内动脉保持通畅。1例患者颈内动脉闭塞。无操作所产生的并发症出现。结论：覆膜支架是处理TCCF的有效手段;瘘口再通可能与支架移位、贴壁不良有关。压迫颈总动脉对再通瘘口的治疗无效。     

TCCF颅内覆膜支架植入术的围手术期护理

总结11例外伤性颈内动脉海绵窦瘘颅内覆膜支架植入围术期的护理体会。护理重点为术前做好心理护理及手术准备,手术过程中严密监护病情变化,术后注意休息,积极做好相关并发症的预防与护理,同时做好股动脉穿刺处的护理,出院时做好健康宣教。11例患者住院2~4周后出院,11例患者的搏动性突眼、球结膜充血水肿、持续性颅内杂音等症状术后1月消失,3例鼻出血术后次日止血,2例视力下降患者术后2月视力恢复,2例瘫痪患者术后6月能拄拐行走,3例失明患者术后6月视力恢复,1例眼球运动障碍术后半年恢复。     

封堵器联合覆膜支架植入术治疗复杂胸腹主动脉夹层1例

患者,男,47岁,主因"突发胸痛3天"于2009年5月20日收住青海大学附属医院心内科.查体:血压140/90mm Hg(1 mm Hg=0.133 kPa),意识清楚,精神差,呼吸平稳;能平卧,口唇发绀;双肺呼吸音粗,右肺底可闻及少量湿啰音;心界不大,心论72次/min,律齐,各瓣膜听诊区未闻及病理性杂音;腹软,肝脾未触及肿大,双下肢无水肿.     

单一支架置入技术治疗颈内动脉微小动脉瘤的初步探讨

目的探讨单一支架置入技术栓塞治疗微小颅内动脉颈内动脉段（ICA）动脉瘤的预后。方法收集2003年8月至2012年1月收治的微小ICA动脉瘤（直径小于3mm）患者14例的临床资料,其中男4例,女10例;年龄35-72岁。采用单一支架置入技术栓塞治疗5例,采用支架辅助弹簧圈栓塞技术治疗9例。结果 13例血管内栓塞治疗微小ICA动脉瘤手术完全成功,1例（7.1%）患者出现术中动脉瘤破裂出血。仅支架置入组9个月后动脉瘤完全闭塞率80.0%,完全无症状率60.0%;支架辅助弹簧圈组12个月后完全闭塞率88.9%,完全无症状率55.5%。统计结果显示,仅支架置入组患者的改良Rankin量表（mRS）评分较支架辅助弹簧圈组高（t=4.21,P=0.039）,但是其动脉瘤完全闭塞率较低（χ2=5.09,P=0.011）。结论采用单一支架置入栓塞微小动脉瘤的患者完全闭塞率较低,但是患者的并发症少、预后生存质量较高。     

血管内栓塞治疗外伤性颈内动脉海绵窦段假性动脉瘤

目的 利用电解可脱卸弹簧圈(GDC)或血管内支架结合GDC行血管内治疗外伤性颈内动脉海绵窦段假性动脉瘤。方法 脑血管造影确诊外伤性颈内动脉海绵窦段假性动脉瘤，对于窄颈的直接行GDC栓塞，宽颈的行支架植入结合GDC栓塞治疗。结果 术后3个月脑血管造影复查均有不同程度复发；二次治疗，脑血管造影随访6个月，未见复发。结论 应用GDC或血管内支架联合GDC可能成为治疗外伤性颈内动脉海绵窦段假性动脉瘤的有效方法。     

覆膜支架在颈动脉海绵窦瘘中的应用2例

近年来，覆膜支架应用为颈动脉海绵窦瘘血管内治疗提供新的方法，效果良好。自2005年11月以来，应用覆膜支架治疗颈动脉海绵窦瘘2例，取得满意效果，现报告如下。     

Neuroform支架结合弹簧圈治疗颅内复杂动脉瘤

目的:探讨血管内Neuroform支架置入联合弹簧圈栓塞治疗颅内复杂动脉瘤的疗效、技术要点、安全性及并发症防治.方法: 研究对象为20例颅内复杂动脉瘤患者,其中颈内动脉海绵窦段4例,眼动脉段3例,后交通动脉段7例,脉络膜前动脉起始部1例,大脑中动脉M1段1例,椎动脉颅内段4例.首先将微导管置入瘤腔,然后跨瘤颈释放支架,栓塞弹簧圈.结果: 所有病例栓塞操作均顺利完成.其中致密栓塞13例,大部分栓塞7例;术后脑梗塞1例,1个月后恢复;2例弹簧圈尾端疝入载瘤动脉,均未引起相应的临床症状.随访3～24个月,平均13个月,无再出血及血栓栓塞症状.结论: 血管内支架植入联合弹簧圈治疗颅内复杂动脉瘤安全有效.     

Endovascular treatment of blood blister-like aneurysms in the internal carotid artery using a Willis covered stent

Background Despite the current availability of flow diverter devices (FDD), problems remains regarding optimal endovascular treatment (EVT) for blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA).Objective To evaluate the safety and efficacy of EVT of BBAs in the ICA with a Willis covered stent.Methods 20 consecutive patients (5 men and 15 women) with ruptured BBAs underwent EVT using a Willis covered stent in two institutions from March 2013 to March 2018. Clinical observations, angiographic characteristics, and procedural and follow-up outcomes were retrospectively evaluated.Results 20 consecutive patients (5 men and 15 women) with ruptured BBAs underwent EVT using a Willis covered stent in two institutions from March 2013 to March 2018. Clinical observations, angiographic characteristics, and procedural and follow-up outcomes were retrospectively evaluated.Conclusion Our initial results demonstrate that reconstructive EVT using a Willis covered stent provides a viable approach to treat ICA BBAs. However, an expanded clinical evaluation and larger cohort are needed to confirm the results.     

Reconstructive treatment of symptomatic vertebral artery dissecting aneurysms with Willis covered stent: Initial experience

BackgroundSymptomatic vertebral artery dissecting aneurysm (VADA) is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature. Moreover, the outcomes of reconstructive treatment have not been well established.ObjectiveTo evaluate the safety and efficacy of reconstructive endovascular treatment (EVT) for symptomatic VADAs with Willis covered stent.MethodsWe evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent, compared with stent-assisted coiling (SAC) on the characteristics, posttreatment course, angiographic and clinical follow-up outcomes at an average of 14.4 months (range, 3–48 months).ResultsA total of 33 patients with symptomatic VADAs were reviewed, 23 of these patients with ruptured VADAs. The technical successful rate is 100% respectively in Willis covered stent (Group A) and SAC (Group B, n ​= ​20). The initial complete occlusion rate was significant higher in group A (100%) than group B (30%) (p ​< ​0.01). Major procedure-related complications were not significant different in the two groups. Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A (p ​> ​0.05). No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period. The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A (100%) than group B (80%), but no significant statistical difference (p ​> ​0.05). Clinical outcomes were favorable in 31 (93.9%), severe disability occurred in one in group B, and only one death in group A. The final clinical outcomes were also not significant difference in the two groups (p ​> ​0.05).ConclusionsOur initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments, which is similar to favorable results with SAC. However, an expanded clinical experiences and larger cohort studies are needed.     

Willis covered stent in the treatment of a recurrent blood blister-like aneurysm after pipeline implementation: A case report

Blood blister-like aneurysms(BBAs) are fragile and difficult to treat. However, the optimal treatment has yet to be determined. Pipeline embolization devices and Willis covered stent implementation are still controversial strategies for treating BBA. Herein, we report a case of recurrent BBA successfully treated with a Willis covered stent.A long-term follow-up angiography after the procedure indicated complete occlusion of the aneurysm. This case demonstrates the safety and efficacy of applying...     

Endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases using Willis covered stent

BackgroundTo report the clinical results and experiences of endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases (ICAVDs) using Willis covered stents. METHODS: Seventy-three patients with ICAVD who received Willis covered stent implantation between November 2013 and September 2018 were retrospectively reviewed. The clinical data of endoleak management and postoperative surveillance were analyzed. RESULTS: Seventy-three cases with ICAVD, including 57 aneurysms, 11 carotid-cavernous sinus fistulas (CCF), and 5 surgical injuries, were all successfully installed with covered stents. Total isolation of ICAVDs was achieved in 59 patients (80.8%), and endoleaks were observed in 14 patients (19.2%). Of the 14 patients with endoleaks, 12 had type I endoleaks and 2 had type II; 13 had aneurysms and one had CCF. 10 patients with type I endoleaks received balloon dilatation, and 7 of them underwent a second stent-graft implantation after then. One patient with type II endoleak received embolization of the branch artery, and another one received follow-up observation. Endoleaks resolved in 6 patients and were minimal in 5 patients after balloon dilatation or the second stent implantation. During the follow-up period, minor endoleaks spontaneously resolved in 4 patients and minimal endoleaks were still demonstrated in 4 patients without enlargement of residual lumen and rupture. CONCLUSIONS: Endoleaks are the major complication after endovascular repair of ICAVDs and represent one of the limitations of this procedure. Improving the understanding and management of endoleaks can be beneficial in the clinical setting, including the popularization and application of this technique.     

Initial clinical experience with Xpert-Pro peripheral self-expanding stent system for internal carotid artery dissection: Two case reports

Background: The standard treatment for internal carotid artery(ICA) dissection is obscure. Current therapeutic strategies include the use of antiplatelet drugs, anticoagulant drugs, intravenous thrombolysis, and endovascular treatment. Endovascular treatment is important in acute internal carotid artery dissection. This study reports two acute internal carotid artery dissection cases that were treated successfully using the Xpert-Pro peripheral selfexpanding stent system.Case summary: The first ...     

介入支架植入术治疗单侧颈内动脉狭窄的临床探讨

目的：探讨在远端脑保护装置下,结合围术期处理对介入支架治疗单侧颈内动脉狭窄疗效的影响。方法选择2012年6月至2014年1月该院收治的23例单侧颈内动脉狭窄患者,均行数字减影血管造影（DSA）证实单侧狭窄率大于或等于75％,其中C1段狭窄15例,C2段狭窄8例,在远端脑保护伞保护下,行介入支架植入术治疗。术后给予相应药物治疗及预防并发症。结果23例单侧颈内动脉狭窄患者,经DSA证实,术后狭窄率均低于30％,手术成功率100％,其中1例患者术中球囊扩张时出现血管痉挛（4．3％）,2例患者出现穿刺点皮肤及鼻黏膜出血,3例患者出现了不同程度的头痛、恶心、呕吐等症状,对症处理后症状均消失,术后6个月随访,均无栓塞及其他并发症发生。术后随访6个月,患者收缩压和舒张压明显下降（P＜0．05）。介入前后,在年龄（以60岁为界）、性别（女／男）、高血压、陈旧性脑梗死、糖尿病、血脂异常、吸烟（3年以上）等临床病理特征中,差异均无统计学意义（P＞0．05）。结论介入支架植入术能够有效治疗单侧颈内动脉段狭窄,通过术中应用保护伞并在围术期加强观察及对症治疗能够有效地减少和控制手术并发症,改善手术预后。     

Devastating iatrogenic internal carotid artery rupture in endoscopic endonasal surgery rescued by a covered stent

Iatrogenic ICA injury is a life‐threatening and underreported complication of EES. For selected patients, covered stent implantation is the best and only way to block the rupture spot immediately and maintain ICA blood flow.     

血管内支架技术治疗颅内椎动脉动脉瘤

目的探讨血管内支架技术在颅内椎动脉动脉瘤的应用价值.方法回顾性分析18例采用支架治疗的颅内椎动脉动脉瘤,其中椎动脉梭形动脉瘤10例,全部一期支架结合弹簧圈技术治疗;椎动脉夹层动脉瘤8例,单纯支架技术4例,支架技术二期联合弹簧圈技术治疗4例.结果 16例造影随访3～24个月全部治愈,无复发及狭窄.2例术后出现一过性脑缺血的表现.结论在治疗椎动脉梭形及夹层动脉瘤时应区别对待,血管内支架辅助GDC技术可保持载瘤动脉通畅,是一种安全、有效的选择.     

Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.