Neuroform stent-assisted coil embolization: a new treatment strategy for complex intracranial aneurysms. Results of medium length follow-up

Background and purposeWe present detailed results of using Neuroform stent-assisted coil embolization to treat complex cerebral aneurysms over a three-year period.Material and methodsOnly patients who underwent Neuroform stent-assisted coil embolization were included in this study. We assessed patients' history, aneurysm morphology, indications for stenting, and technical details of the procedures, as well as complications and the midterm follow-up data.ResultsThis study included 26 patients with 39 aneurysms. A total of 32 of 39 aneurysms were treated by Neuroform stent-assisted embolization (SAC), whereas 3 aneurysms were stented without coiling, 2 aneurysms coiled without stenting and 2 aneurysms surgically clipped. The indications for use of stent included broad-neck aneurysms (n = 28), giant or large aneurysms (n = 6), and fusiform aneurysms (n = 5). Of the 32 aneurysms treated with Neuroform SAC, we achieved complete (100%) and near complete (> 95%) occlusion in 27 aneurysms, and partial (< 95%) occlusion in 5 aneurysms. Follow-up angiographic data available in 22 of 32 aneurysms treated with Neuroform SAC (68.7%) demonstrated recanalization in 3 aneurysms (13.6%), and stable occlusion in 19 aneurysms (86.4%). There was no delayed progressive embolization or in-stent stenosis.ConclusionsDirect and midterm follow-up results confirmed that Neuroform stent-assisted coil embolization was a safe and effective technique in the treatment of complex cerebral aneurysms. Although clinically significant complications were uncommon and the evaluation at midterm follow-up is encouraging, further studies need to assess the long-term stability and durability of the stent.     

Enlargement of a Middle Cerebral Artery Aneurysm after Intra-Aneurysmal Embolization with Parent Artery Preservation for an Ipsilateral Large Internal Carotid Artery Aneurysm: A Case Report

We report a 77-year-old woman with marked enlargement of a middle cerebral artery (MCA) aneurysm 4 years after the successful intra-aneurysmal embolization of an ipsilateral large internal carotid artery (ICA) aneurysm. She intially presented with right third cranial nerve palsy due to a large ICA aneurysm, 20.8 mm in diameter. Initial magnetic resonance angiography (MRA) revealed a signal decrease in the right MCA, suggesting hemodynamic disturbance based on the contrast pooling in the right large ICA aneurysm exhibiting “Windkessel phenomenon”. The large ICA aneurysm was successfully managed by intra-aneurysmal embolization with parent artery preservation, and immediate post-treatment MRA demonstrated significant signal recovery in the right MCA. Meticulous follow-up by MRA identified sudden growth in the aneurysmal height within 1 week after embolization, with further growth over the following 4 years, necessitating microsurgical clipping. Enlargement of the ipsilateral distal aneurysm following the treatment of proximal large aneurysm could be altered by marked distal hemodynamic change in view of the sudden amelioration of the “Windkessel phenomenon”. Thus, we recommend meticulous follow-up of the associated distal aneurysm after the management of proximal large or giant aneurysms with parent artery preservation.     

Pipeline血流导向装置治疗复发颅内动脉瘤的临床效果分析

目的探讨Pipeline血流导向装置(PED)治疗复发颅内动脉瘤的疗效。方法回顾性分析2016年1月至2019年4月于首都医科大学附属北京天坛医院神经介入中心采用PED治疗的14例复发颅内动脉瘤患者的临床资料。14例患者中,仅行PED治疗10例,PED联合弹簧圈治疗4例。所有患者均行临床随访,采用改良Rankin量表评分(mRS)评估患者的预后;行影像学随访[数字减影血管造影(DSA)]评估颅内动脉瘤的栓塞情况。结果14例患者共成功置入15枚PED。所有PED均到位良好。术后即刻DSA检查显示动脉瘤内血流滞留,载瘤动脉的分支血管均通畅;Dyna CT检查显示支架均准确覆盖瘤颈,贴壁良好。术后2例患者出现手术并发症,其中1例为脑梗死,经抗血小板聚集等对症治疗后症状改善;另1例发生中脑出血后死亡。除死亡患者外,余13例患者均获临床随访,中位随访时间为26个月(范围为12~48个月),无一例发生脑出血或脑梗死,无新发神经功能缺损症状,末次随访mRS均为0分。11例患者行影像学随访,中位随访时间为6个月(范围为3~16个月),其中完全栓塞8例(包括1例单纯弹簧圈栓塞术后复发、3例开颅夹闭术后复发、3例支架辅助弹簧圈栓塞术后复发以及1例单纯支架置入术后复发的患者),瘤颈残余2例(均为支架辅助弹簧圈栓塞术后复发的患者),瘤体部分显影1例(为支架辅助弹簧圈栓塞术后复发的患者)。结论应用PED进行再治疗的单纯弹簧圈栓塞或开颅夹闭术后复发的动脉瘤患者预后良好,而PED治疗曾行支架置入术的复发动脉瘤的效果仍需进一步验证。     

Blister-like aneurysms of the supraclinoid internal carotid artery: Challenging endovascular treatment with stent-assisted coiling

'Blister-like' aneurysms of the supraclinoid segment of the internal carotid artery are usually small and have fragile walls, necessitating special care to prevent rebleeding. These lesions are considered high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. In this report, we describe the use of stent-assisted, repeated coil embolization in the treatment of a ruptured blister-like aneurysm that experienced rapid growth. Stent-assisted coil embolization is an alternative, but sometimes hazardous, treatment for select blister-like aneurysms. Careful serial follow-up angiography will provide documentation as to the long-term stability of the endovascularly treated blister-like aneurysm described here, but early results are encouraging. Alternatively, placement of telescoped stents or graft-stent devices offers promise for future endovascular therapy.     

LVIS支架辅助栓塞治疗颅内动脉瘤20例的临床分析

目的探讨LVIS支架辅助栓塞颅内动脉瘤的安全性及有效性。方法选取应用LVIS支架辅助栓塞治疗20例患者的颅内动脉瘤20个。并对其临床资料、血管内治疗方法及效果进行回顾性分析,根据Raymond分级评价动脉瘤栓塞程度,改良Rankin量表(modified Rankin Scale,mRS)评估其预后效果。结果所有患者支架释放满意。术后即刻造影见Raymond分级Ⅰ级栓塞15例(75%),Ⅱ级栓塞4例(20%),Ⅲ级栓塞1例(5%)。经术后3~12月随访的18个动脉瘤中,均未见复发,其中16个动脉瘤影像学治愈(88.9%),2个瘤颈残留但稳定(11.1%)。在访的18位患者中15位预后良好(mRS:0-2分)。结论 LVIS支架辅助弹簧圈栓塞安全可行,可提高动脉瘤的栓塞率和降低复发率,远期临床效果还有待大样本随访和临床经验的总结。     

Transbrachial Stent-Assisted Coil Embolization of Right Posterior Inferior Cerebellar Artery Aneurysm: Technical Case Report

OBJECTIVE AND IMPORTANCE: We describe a case of stent-assisted coil embolization of a wide neck right posterior inferior cerebellar artery (PICA) aneurysm via a transbrachial artery approach. CLINICAL PRESENTATION: A 73-year-old woman with a past medical history of hypertension, hyperlipidemia, colon cancer, and osteoporosis presented with a throbbing occipital area headache. Magnetic resonance angiography revealed a wide neck right PICA aneurysm. She presented for a planned endovascular stent-assisted coil embolization. TECHNIQUE: The initial transfemoral approach was complicated by persistent guide catheter instability due to marked tortuosity of the right vertebral artery (VA). The left VA could not be accessed due to left subclavian occlusion with steal syndrome. Neuroform-2 (Boston Scientific; Natick, MA) stent-assisted Matrix (Boston Scientific; Natick, MA) coil embolization was successfully performed through a 6-French guide catheter using a transbrachial approach. CONCLUSION: Current advances in technology produce neuroendovascular devices that are smaller with increased flexibility, allowing nonfemoral vascular access to the cerebral circulation via alternate arterial routes. This patient case demonstrates transbrachial access is a viable approach for endovascular aneurysm coil embolization, with or without stent assistance, in cases with an unstable guide catheter due to tortuous vessels or abnormal anatomy when femoral access is complicated or contraindicated.     

Endovascular Treatment of Aneurysms Arising from the Proximal Segment of the Anterior Cerebral Artery

Objective

Aneurysms arising from the proximal segment of the anterior cerebral artery (A1) are rare and challenging to treat. The aim of this study was to report our experience with endovascular treatment of A1 Aneurysms.

Methods

From August 2007 through May 2012, eleven A1 aneurysms in eleven patients were treated endovascularly. Six aneurysms were unruptured and 5 were ruptured. One patient with an unruptured A1 aneurysm presented with subarachnoid hemorrhage due to rupture of an anterior communicating artery aneurysm. Procedural data, clinical and angiographic results were reviewed retrospectively.

Results

All of the aneurysms were successfully treated with coil embolization. Six were treated with a simple technique while the remaining 5 required adjunctive technique : double catheters (n=2), balloon-assisted (n=2), and stent-assisted (n=1). The immediate angiographic control showed a complete occlusion in all cases. Procedure-related complication occurred in only one patient : parent artery occlusion, which was not clinically significant. All patients had excellent clinical outcomes but one patient was discharged with a slight disability. No neurologic deterioration or bleeding was seen during the follow-up period in this cohort of patients. Follow-up angiography (mean, 20 months) was available in ten patients and revealed stable occlusion in all cases.

Conclusion

Endovascular treatment is a feasible and effective therapeutic modality for A1 aneurysms. Tailored microcatheter shaping and/or adjunctive techniques are necessary for successful aneurysm embolization because of the projection and location of A1 aneurysms.     

LVIS支架辅助弹簧圈栓塞在颅内宽颈破裂动脉瘤治疗中的应用

目的分析低剖面可视化腔内支撑装置（LVIS）支架辅助弹簧圈栓塞在颅内宽颈破裂动脉瘤治疗应用中的安全性和有效性。 方法回顾性分析南昌大学第二附属医院神经外科自2016年7月至2017年7月收治的行LVIS支架辅助弹簧圈栓塞治疗的43例颅内宽颈破裂动脉瘤伴蛛网膜下腔出血患者。采用改良Raymond分级标准评价术后即刻的栓塞结果以及术后6个月第1次的动脉瘤随访闭塞程度;采用改良Rankin评分（mRs）评估患者预后疗效情况。 结果43例颅内宽颈破裂动脉瘤伴蛛网膜下腔出血患者动脉瘤共47枚,其中2例（4.6%）患者为多发动脉瘤,均成功栓塞。43例动脉瘤患者中1例（2.3%）出现术中动脉瘤破裂出血,2例（4.6%）术中出现支架内急性血栓;术后即刻闭塞情况：Ⅰ级栓塞35例（81.4%）,Ⅱ级6例（13.9%）,Ⅲ级2例（4.7%）;术后6个月随访结果：Ⅰ级栓塞40例（93.0%）,Ⅱ级2例（7.0%）,1例（2.3%）复发,后期予再栓塞治疗;术后1年mRs评分为0~2分有41例（95.3%）。 结论LVIS支架辅助下栓塞颅内宽颈破裂动脉瘤是安全、有效的治疗方法,但长期疗效仍需要进一步验证。     

Giant fusiform aneurysm with dissection in the middle cerebral artery: a case report]

A rare case of a giant fusiform aneurysm with dissection in the middle cerebral artery is reported. A 37-year-old man was referred to our hospital for severe headache and left retrobulbar pain. MRI and angiography showed a giant aneurysm in the temporal branch(M 2) of the left middle cerebral artery. We supposed that dissection had occurred from a giant fusiform aneurysm in the middle cerebral artery judging from presentation, MRI findings, angiography findings, and operative findings. Giant fusiform aneurysms in the middle cerebral artery(MCA) are uncommon cerebral aneurysms. The surgical approach or endovascular treatment to giant fusiform aneurysms in the MCA is technically difficult, so some patients are treated conservativery. However they have a poor natural history that differs from that of typical saccular aneurysms. And they have character of weakness in the internal elastic lamina, and therefore have the potential to dissect. We suggest that appropriate therapy including conservative therapy and surgical techniques is necessary for giant fusiform aneurysms even if they are found incidentally.     

Endovascular treatment of ruptured tiny,wide-necked posterior communicating artery aneurysms using a modified stent-assisted coiling technique

The endovascular treatment of patients with tiny, wide-necked aneurysms is technically challenging, due to the small volume for microcatheterization and coil stabilization inside the aneurysm sac. We performed a retrospective study to evaluate the feasibility, effectiveness, and safety of stent-assisted embolization for patients with ruptured, tiny, wide-necked posterior communicating artery (PcomA) aneurysms. Between January 2007 and August 2011, 17 tiny, wide-necked PcomA aneurysms that had ruptured were treated at our institution using a modified stent-assisted technique, with delivery of the first coil inside the aneurysm followed by placement of a self-expanding stent via a second microcatheter. All patients were treated successfully using this modified stent-assisted coiling technique. Initial results showed aneurysm occlusion of Raymond Class 1 in 10 patients, Class 2 in four patients, and Class 3 in three patients. The angiographic follow-up results for 13 patients (mean, 12.5 months) showed that all aneurysms remained stable or improved, without any in-stent stenosis or recurrence. Of the other four patients, three refused angiography for economic or personal reasons, and one was lost in follow-up. Clinical follow-up of 16 patients for a mean of 23.8 months showed no death or rebleeding. These results imply that endovascular treatment of ruptured tiny, wide-necked PcomA aneurysms using our modified stent-assisted coiling technique is safe and feasible. This technique improves the long-term outcomes of these aneurysms by increasing the packing density and diverting the intra-aneurysmal blood flow.     

Endovascular Treatment of Wide-Necked Intracranial Aneurysms : Techniques and Outcomes in 15 Patients

Objective

It is technically difficult to treat wide-necked intracranial aneurysms by the endovascular method. Various tools and techniques have been introduced to overcome the related technical limitations. The purpose of this study was to evaluate the radiologic and clinical results of wide-necked intracranial aneurysm treatment using the endovascular method.

Methods

Fifteen aneurysms in 15 patients were treated by the endovascular method from October 2009 to August 2010. Seven patients presented with subarachnoid hemorrhage (SAH), seven patients had unruptured aneurysms, and one patient had an intracerebral hemorrhage and intraventricular hemorrhage due to an incompletely clipped aneurysm. The mean dome-to-neck ratio was 1.1 (range, 0.6-1.7) and the mean height-to-neck ratio was 1.1 (range, 0.6-2.0). We used double microcatheters instead of a stent or a balloon for the first trial. When we failed to make a stable coil frame with two coils, we used a stent-assisted technique.

Results

All aneurysms were successfully embolized. Eleven aneurysms (73%) were embolized by the double microcatheter technique without stent insertion, and four aneurysms (27%) were treated by stent-assisted coil embolization. One case had subclinical procedure-related intraoperative hemorrhage. Another case had procedure-related thromboembolism in the left distal anterior cerebral artery. During the follow-up period, one patient (7%) had a recanalized aneurysmal neck 12 months after coil embolization. The recurrent aneurysm was treated by stent-assisted coil embolization.

Conclusion

We successfully treated 15 wide-necked intracranial aneurysms by the endovascular method. More clinical data with longer follow-up periods are needed to establish the use of endovascular treatment for wide-necked aneurysm.     

介入栓塞治疗不同直径颅内动脉瘤的临床效果观察

目的 观察介入栓塞治疗对不同直径颅内动脉瘤的临床效果及安全性。方法 回顾性分析本院在2015年8月-2017年1月收治的87例颅内未破裂动脉瘤患者的临床资料,根据动脉瘤直径不同分为小型动脉瘤组(瘤体直径≤3 mm)41例,中大型动脉瘤组46例,均行介入栓塞治疗; 比较2组患者栓塞效果、并发症、复发率及预后。结果 术后6个月小型动脉瘤组完全栓塞率为100%,中大型动脉瘤组完全栓塞率为91.30%(42/46),动脉瘤瘤颈残留3例(6.52%),动脉瘤腔残留1例(2.17%),2组比较无明显差异(P>0.05); 小型动脉瘤组单纯弹簧圈栓塞16例,支架辅助弹簧圈栓塞25例,中大型动脉瘤组单纯弹簧圈栓塞23例,支架辅助弹簧圈栓塞18例,球囊辅助弹簧圈栓塞5例,2组比较也无明显差异(P>0.05); 小型动脉瘤组并发症发生率较中大型动脉瘤组低(7.32% vs 15.22%),但无明显差异(P>0.05); 术后6个月小型动脉瘤组无复发病例,中大型动脉瘤组复发率为8.69%(4/46),2组比较也无明显差异(P>0.05); 术后30 d,小型动脉瘤组GCS预后评分中恢复良好例数明显多于中大型动脉瘤组(87.80% vs 58.69%),2组比较有明显差异(P<0.05)。结论 介入栓塞治疗对不同直径的颅内动脉瘤均具有较好的疗效,但小型动脉瘤预后较好。     

Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的长期预后分析

目的研究Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的长期预后。方法回顾性分析收治的2011年1月至2015年12月100例颈内动脉眼动脉段动脉瘤患者的临床和影像学资料,总结研究Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤患者的长期预后。结果 100例患者中,共计104个颈内动脉眼动脉段动脉瘤,其中77个小动脉瘤(直径≤15mm),27个大动脉瘤(直径15mm至≤25mm)。根据颈内动脉眼动脉段动脉瘤的分类,36个动脉瘤属眼动脉瘤(Ⅰ型),68个动脉瘤属垂体上动脉动脉瘤(Ⅱ型)。94%患者完成临床随访[平均随访时间(28.89±17.63)个月],随访患者中97.8%患者远期预后良好(m RS 0~2分);82%患者完成影像学随访[平均随访时间(12.34±7.69)个月],其中7个动脉瘤出现颈部残留,4个动脉瘤复发再通。手术并发症发生率为8.0%,血栓形成3例、弹簧圈脱出2例、血管痉挛2例、动脉瘤破裂出血1例。单因素回归分析提示动脉瘤大小(P=0.000)与动脉瘤不完全栓塞相关;多因素回归分析提示动脉瘤不完全栓塞(P=0.038)与动脉瘤复发相关。结论 Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤安全有效,动脉瘤体积越大难以完全栓塞,复发率相对更高。     

颅内破裂微小动脉瘤介入栓塞术临床疗效和安全性研究

目的探讨介入栓塞颅内破裂微小动脉瘤的技术要点,评价其临床疗效和安全性。方法回顾性分析2014年4月-2016年10月云浮市人民医院因微小颅内动脉瘤破裂致蛛网膜下腔出血而行介入栓塞治疗患者的临床资料,评价栓塞治疗的临床疗效、手术并发症及患者预后情况。结果研究共纳入23例微小颅内动脉瘤破裂患者,均在全身麻醉下采用弹簧圈栓塞治疗,其中17例采用单纯弹簧圈栓塞,6例采用支架辅助治疗。致密栓塞19例(82.61%),4例(17.39%)瘤颈残余。所有患者载瘤动脉均通畅,术中无动脉瘤破裂出血,1例(4.35%)术中发生载瘤动脉狭窄闭塞,置入支架后载瘤动脉恢复通畅。术后6~30个月DSA随访均无再出血。1例(4.35%)瘤颈残余患者1年后出现瘤颈部动脉瘤复发,给予支架辅助栓塞治疗。23例患者术后6个月时改良Rankin量表(modified Rankin Scale,mRS)评分0分共21例,2分有2例。结论介入栓塞技术治疗颅内破裂微小动脉瘤是一种安全、有效的治疗手段,术后治疗效果良好。     

LVIS支架在颅内动脉瘤血管内栓塞治疗中的应用

目的 探讨LVIS支架辅助弹簧圈栓塞治疗颅内动脉瘤的可行性、安全性及有效性。方法 回顾性分析宁夏医科大学总医院神经外科2014年5月至2017年9月应用LVIS支架辅助弹簧圈栓塞治疗的83例（89枚动脉瘤）颅内动脉瘤的临床资料。结果 共使用LIVS支架90个,双LVIS支架辅助栓塞动脉瘤1枚;支架全部与微导管平行释放,术中完全释放支架61枚,半释放支架28枚;栓塞后即刻DSA示,Raymond分级Ⅰ级64枚,Ⅱ级22枚,Ⅲ级3枚。术中发生血栓形成4例（3例为支架内血栓形成）、动脉瘤破裂1例。术后随访4~36个月;DSA复查52例,6例由即刻栓塞Raymond Ⅱ级转变为Ⅰ级,3例复发;改良Rankin量表评分0~1分 63例,2分 9例,3分及以上11例。结论 LVIS支架辅助弹簧圈栓塞治疗颅内动脉瘤可行、安全,疗效显著;但支架内血栓事件以及如何选择适当型号的支架,仍是值得探讨的问题     

颅内动脉瘤的支架辅助弹簧圈栓塞的疗效分析

目的 探讨支架辅助弹簧圈栓塞治疗颅内动脉瘤的有效性和安全性。方法 回顾性分析2019年6～9月支架辅助弹簧圈栓塞治疗的62例颅内动脉瘤的临床资料。结果 所有动脉瘤均成功栓塞,62个动脉瘤共置入支架64枚,其中Neuroform支架3枚,Solitaire支架8枚,LVIS支架10枚,Enterprise支架43枚;2个动脉瘤各置入2枚。术后即刻造影显示Raymond分级Ⅰ级53例（85.48%）,Ⅱ级3例（4.84%）,Ⅲ级6例（9.68%）。术中发生动脉瘤破裂2例（3.23%）,术后发生缺血性事件2例（3.23%）。出院时,改良Rankin量表（mRS）评分0～2分50例（80.65%）,3～5分10例,死亡2例。57例临床随访6～32个月,平均19.7个月,未出现动脉瘤再出血或新发梗死;m RS评分0～2分48例（84.21%）分,3～5分9例。30例影像学随访3～24个月,平均9.3个月,1例（3.33%）出现少量瘤颈复发。结论 支架辅助弹簧圈栓塞治疗颅内动脉瘤是可行、安全的,术中需要根据动脉瘤和载瘤动脉的具体情况以及治疗策略决定选取合适的支架。     

Endovascular treatment of a "blister-like" aneurysm of the internal carotid artery

BACKGROUND: "Blister-like" aneurysms of the supraclinoid internal carotid artery have recently been recognized as having unique pathological and clinical features. Little is known regarding their optimal treatment modality. METHODS: We report a case of a "blister-like" aneurysm of the internal carotid artery treated with Guglielmi detachable coil (GDC) embolization. CASE REPORT: A 55-year-old man presented with a Hunt & Hess grade II subarachnoid hemorrhage. Computed tomography revealed diffuse subarachnoid blood. Cerebral angiography demonstrated a broad-based bulge on the medial wall of the right distal internal carotid artery. The patient was taken to the operating room and underwent a right pterional craniotomy and wrapping of this unclippable aneurysm. On postoperative day 11, he developed signs of vasospasm, and repeat angiography showed remarkable growth of the aneurysm. The aneurysm was believed to be amenable to endovascular therapy and was treated by GDC embolization. The patient recovered well and remained neurologically intact on follow-up examinations. Repeat cerebral angiography was performed three and nine months following his initial presentation and revealed a significant aneurysm neck remnant. This neck remnant was treated by repeat GDC embolization 13 months following his subarachnoid hemorrhage. CONCLUSIONS: "Blister-like" aneurysms of the internal carotid artery are important to recognize and are difficult to manage using traditional surgical approaches. Early repeated cerebral angiography is indicated and, where appropriate, endovascular therapy should be considered in the management of these patients.     

Endovascular treatment of a ruptured accessory middle cerebral artery aneurysm

A 51-year-old female presented with bilateral accessory middle cerebral arteries (MCA) with associated ruptured aneurysm manifesting as a subarachnoid hemorrhage. Angiography demonstrated the bilateral accessory MCA and associated ruptured aneurysm at the junction of the left anterior cerebral artery and left accessory MCA. This was successfully treated by coil embolization. Magnetic resonance angiography obtained 6 months later revealed no evidence of residual or recurring aneurysm.     

后循环动脉瘤的血管内介入治疗

目的探讨后循环动脉瘤血管内介入治疗的临床应用。方法 14例后循环动脉瘤患者Hunt&Hess分级分为Ⅱ级11例,Ⅲ级2例,Ⅳ级1例;数字减影血管造影(DSA)显示椎动脉瘤2例,小脑后下动脉远端动脉瘤5例,基底动脉尖动脉瘤2例,基底动脉末端动脉瘤1例,小脑前下动脉瘤2例,大脑后动脉瘤2例。入组者均给予血管内介入治疗,其中7例囊性动脉瘤采用单纯弹簧圈栓塞术,5例采用Onxy胶载瘤动脉局部栓塞术,分别有1例应用支架辅助微弹簧圈栓塞术及支架塑形术。结果术后DSA显示动脉瘤完全栓塞10例,近全栓塞3例。1例支架塑形术后梭形膨出明显好转。格拉斯哥预后量表评分为5分12例,3分1例,2分1例。随访3个月～5年,8例恢复正常,1例左侧偏瘫,1例死亡,4例失访。结论颅内后循环动脉瘤多为复杂动脉瘤,个体化血管内介入治疗是安全、有效的方法。     

LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤

目的 探讨LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤（DA-SICA）的可行性、有效性。方法 回顾性分析2015年1月至2020年7月运用LVIS支架辅助弹簧圈栓塞治疗的28例DA-SICA的临床资料。结果 双LVIS支架辅助栓塞13例，术后即刻造影显示Raymond分级Ⅰ级10例，Ⅱ级3例；单LVIS支架辅助栓塞15例，术后即刻造影显示均为Raymond分级Ⅰ级。术中动脉瘤破裂出血2例。围手术期死亡3例，其中2例死于恶性脑肿胀，1例死于再出血。存活25例术后随访3~49个月，平均（26.5±2.5）个月；2例术后复发，再次使用LVIS支架辅助弹簧圈栓塞治愈；其余23例术后3个月复查DSA无动脉瘤复发及载流动脉狭窄。结论 LVIS支架辅助弹簧圈栓塞治疗DA-SICA，是一种有效、可行的选择，使用支架的数目应根据术中具体情况决定，术后应制定个体化的抗血小板治疗方案。