Neuroform支架治疗颅内宽颈动脉瘤的初步结果

目的探讨和总结应用Neuroform自膨式支架结合弹簧圈治疗颅内宽颈动脉瘤的技术与初步结果。方法回顾性分析32例颅内宽颈动脉瘤，瘤颈／瘤体为1／2～1／1，均采用Neuroform自膨式支架结合弹簧圈技术治疗。结果24例完全栓塞，8例大部分（〉95％）栓塞。2例术后出现一过性脑缺血的表现。14例随访0．5～1年，有2例出现动脉瘤复发。结论在栓塞宽颈颅内动脉瘤时应用Neuroform自膨式支架结合弹簧圈技术，使弹簧圈无法突入载瘤动脉，提高了宽颈颅内动脉瘤的疗效。     

血管内支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理

目的 探讨颅内自膨式支架Neuroform联合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理经验.方法 对20例行Neuroform支架治疗宽颈动脉瘤的患者做好心理护理严防动脉瘤破裂,术后加强病情观察,预防并发症发生.结果 20例患者全部治愈出院,16例完全栓塞,1例次全栓塞,3例不全栓塞.临床随访2～10个月,未见动脉瘤复发及支架移位.结论 Neuroform自膨胀式支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤是一种安全可行的新技术,近期疗效好,正确的护理,可提高治愈率,减少致残率.     

支架结合弹簧圈栓塞大脑中动脉分叉部宽颈动脉瘤

目的 总结应用支架结合弹簧圈栓塞大脑中动脉分叉部宽颈动脉瘤的技术.方法 回顾性分析15例大脑中动脉分叉部宽颈动脉瘤,均采用 Neuroform自膨式支架结合弹簧圈栓塞治疗.结果 11例完全栓塞,4例大部分(>95%)栓塞.1例术后出现一过性脑缺血表现.8例随访6~12个月,1例出现动脉瘤复发.结论 在栓塞大脑中动脉分叉部宽颈动脉瘤时应用Neuroform自膨式支架结合弹簧圈技术,保护了载瘤动脉,疗效满意.     

宽颈动脉瘤血管内栓塞治疗

目的:探讨颅内宽颈动脉瘤的血管内治疗方法及疗效。方法:对2005年～2009年24例颅内宽颈动脉瘤的血管内介入治疗进行回顾分析。结果:单纯应用可脱弹簧圈栓塞治疗宽颈动脉瘤6例,应用颅内支架结合弹簧圈栓塞治疗宽颈动脉瘤18例,其中100%栓塞17例,95%栓塞5例,90%栓塞2例。术中并发症3例:弹簧圈溢入载瘤动脉2例,支架移位1例。24例术后2～46个月随访,均无再次蛛网膜下腔出血表现。结论:应用血管内栓塞治疗颅内宽颈动脉瘤是一种微创、安全、有效的方法。     

微弹簧圈结合LEO支架栓塞颅内宽颈动脉瘤的效果

目的探讨微弹簧圈结合可伸缩自膨式（LEO）支架栓塞颅内宽颈动脉瘤的临床效果。方法蛛网膜下隙出血经DSA或CTA证实为颅内宽颈动脉瘤病人14例（7例后交通动脉瘤,5例椎动脉瘤,2例基底动脉瘤）,1例选择先释放支架,微导管穿过支架网眼填塞微弹簧圈;2例先填塞动脉瘤,栓塞完全后再在瘤口释放LEO支架;11例选择先半释放LEO支架后填塞动脉瘤,待栓塞完全后,再完全释放支架。结果 13例宽颈动脉瘤均应用Remod微弹簧圈结合LEO支架完全栓塞,1例部分栓塞。结论微弹簧圈结合LEO支架治疗宽颈动脉瘤具有易操作、输送方便、支架进出外微导管顺利的特点,效果好。     

血管内支架置入结合弹簧圈治疗颅内宽颈动脉瘤患者的护理

随着电解可脱性微弹簧圈(GDC)栓塞术的不断完善与改进,其安全、微创、有效的特点已经成为颅内动脉瘤的一种主要的治疗方法.但是宽颈颅内动脉瘤的血管内治疗仍是难题之一,单纯微弹簧圈治疗会出现栓塞率低、复发率高,还有导致载瘤动脉闭塞的风险,部分患者甚至无法实施介入治疗[1].相继出现的Remodeling技术和三维弹簧圈篮筐编制技术使得部分宽颈动脉瘤得以栓塞,但仍不能完全解决这一难题.而今,自Higashida等[2]1997年率先报道了采用支架结合弹簧圈治疗1例颅内椎动脉梭形动脉瘤以来,支架技术在动脉瘤血管内治疗中的应用已逐渐开展起来,并成为梭形、宽颈动脉瘤的重要治疗手段.此后,采用血管内支架置入结合后续的弹簧圈栓塞治疗,使这类动脉瘤的介入治疗成为可能[3].我科采用的新型Neuroform Ⅱ型专用颅内支架结合生物活性Matrix弹簧圈治疗宽颈动脉瘤取得了良好的效果,现将其的相关护理总结如下.     

血管内支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理

目的探讨颅内自膨式支架Neuroform联合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理经验。方法对20例行Neuroform支架治疗宽颈动脉瘤的患者做好心理护理严防动脉瘤破裂,术后加强病情观察,预防并发症发生。结果20例患者全部治愈出院,16例完全栓塞,1例次全栓塞,3例不全栓塞。临床随访2～10个月,未见动脉瘤复发及支架移位。结论Neuroform自膨胀式支架联合弹簧圈栓塞治疗颅内宽颈动脉瘤是一种安全可行的新技术,近期疗效好,正确的护理,可提高治愈率,减少致残率。     

支架在治疗颅内宽颈动脉瘤中的应用

目的分析颅内支架在治疗颅内宽颈动脉瘤中的临床疗效及应用体会。方法回顾性分析12例颅内宽颈动脉瘤患者的治疗过程,其中3例动脉瘤位于颈内动脉海绵窦段,2例位于颈内动脉眼动脉段,2例位于颈内动脉后交通段,1例位于前交通动脉,2例位于大脑中动脉分叉部,1例位于椎动脉,1例位于基底动脉;绝对宽颈（瘤颈〉4mm）动脉瘤9例,相对宽颈3例,瘤颈/瘤体均〉0.7。术中将颅内支架引至动脉瘤处并释放支架覆盖动脉瘤颈,然后行弹簧圈栓塞术。结果7例采用Neuroform自膨式支架,5例采用Leo支架,12枚支架全部成功释放。其中100%栓塞8例,95%栓塞3例,1例支架释放后动脉瘤不显影未行弹簧圈栓塞。1例术中出血经迅速填塞弹簧圈及支持对症治疗后患者治愈。本组患者无死亡。10例术后3个月随访造影,9例动脉瘤腔完全闭塞,1例达95%栓塞,载瘤动脉无狭窄。结论颅内自膨式支架辅助弹簧圈闭塞颅内宽颈动脉瘤,既可保护载瘤动脉通畅,又可提高宽颈动脉瘤栓塞的致密程度,效果较好,并且可降低穿支血管阻塞的发生率。     

血管内支架结合弹簧圈栓塞治疗颅内宽颈动脉瘤的效果观察

目的:探讨血管内支架结合弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效。方法:选取颅内宽颈动脉瘤患者83例,其中接受血管内支架结合弹簧圈栓塞治疗38例(观察组),接受非支架辅助治疗45例(对照组),随访观察2组患者疗效及复发情况。结果:观察组术后即刻造影完全栓塞38例,栓塞效果优于对照组,差异有统计学意义(Z=-2.083,P0.05)。观察组术中发生动脉瘤再破裂,弹簧圈移位、脱出、解旋,动脉瘤缺血事件和脑血管痉挛发生率分别为2.63%、0.00%、5.26%和7.90%,与对照组比较差异无统计学意义(P0.05)。2组随访动脉瘤复发率比较差异无统计学意义(P0.05)。结论:血管内支架结合弹簧圈栓塞治疗颅内宽颈动脉瘤安全有效。     

支架辅助弹簧圈栓塞颅内宽颈动脉瘤的临床疗效

【目的】4g讨LEO支架结合弹簧圈治疗颅内宽颈动脉瘤的适应证、技术要点、并发症防治,评估该技术的安全性及疗效。【方法】16例颅内宽颈动脉瘤采用LEO支架结合电解可脱卸弹簧圈栓塞,术后3、6及12个月随访临床症状,6～12个月造影随访。【结果】13例宽颈动脉瘤致密填塞,3例不全填塞,所有患者载瘤动脉通畅,支架均到位;15例临床症状随访,均无再出血及血栓形成;14例造影随访,13例动脉瘤不显影,1例有轻度血管狭窄。【结论】LEO支架结合弹簧圈治疗颅内宽颈动脉瘤是一种微创、安全、有效的方法,但远期疗效有待于进一步观察。     

Solitaire支架辅助弹簧圈栓塞颅内宽颈动脉瘤26例分析

目的 探讨Solitaire支架辅助弹簧圈栓塞颅内宽颈动脉瘤的经验及栓塞效果.方法 2009年6月至2011年12月,我们对26例颅内宽颈动脉瘤患者应用Solitaire支架辅助微弹簧圈栓塞,围术期给予抗凝及抗血小板治疗,术后3个月复查脑血管造影评价栓塞效果.结果 26例患者共使用27枚Solitaire支架,其中1例患者使用2枚支架.术中支架均顺利到位,放置位置满意,即刻血管造影致密栓塞24例,次全栓塞2例,支架释放位置满意,载瘤血管通畅,3个月后,23例患者获得数字减影血管造影随访,无动脉瘤复发迹象.结论 Solitaire支架辅助弹簧圈栓塞颅内宽颈动脉瘤,操作简单,栓塞率高,复发率低.     

血管内支架结合弹簧圈栓塞治疗颅内宽颈动脉瘤的护理

目的探讨血管内支架结合电解可脱卸弹簧圈（GDC）治疗颅内宽颈动脉瘤的护理要点、并发症的防治及疗效。方法对10例宽颈动脉瘤病人围术期做好心理护理，术后加强病情观察，精心护理，预防并发症发生。结果10例病人全部治愈出院。9例致密栓塞，1例大部填塞。血管造影检查，动脉瘤不显影，载瘤动脉及邻近主要血管分支通畅，均无再出血或血栓栓塞等相关并发症。结论血管内支架结合弹簧圈是治疗颅内宽颈动脉瘤安全、有效的方法，短期治疗效果肯定，正确的护理，可以提高手术的成功率，减少并发症。     

Stent-assisted coiling for the treatment of ruptured micro-intracranial wide-necked aneurysms

The stent-assisted coil embolization technique has been increasingly used in the clinic, but its efficacy and safety have yet to be assessed. This study aimed to evaluate the efficacy and safety of stent-assisted coiling in the treatment of micro-intracranial wide-necked aneurysms.Between May 2007 and November 2011, a total of 35 micro-intracranial wide-necked ruptured aneurysms were occluded with Enterprise stent-assisted coils. The patients were followed up for two years.Stent-assisted coiling was performed successfully in all cases, and stent placement was satisfactory without any complications. Of 35 aneurysms, 13 (37.1%) were completely occluded, ten (28.5%) had residual necks, and 12 (34.2%) had residual aneurysms. In the two-year follow-up, no aneurysm rupture occurred and no patients had nerve dysfunction. All patients were reviewed by digital subtraction angiography or computed tomography angiography. One patient had a residual neck (2.8%), and no patients experienced stent restenosis or thromboembolic events.In general, stent-assisted coiling is effective and safe for the treatment of micro-intracranial wide-necked aneurysms.     

颅内支架辅助栓塞宽颈动脉瘤初步经验

目的 探讨颅内宽颈动脉瘤新的血管内治疗技术,初步评价该技术和新栓塞材料的安全性和有效性.方法 回顾我们治疗中心近9个月内收治的11例宽颈动脉瘤病人的临床资料.对颅内Neuroform 支架辅助生物活性Matrix弹簧圈栓塞宽颈动脉瘤技术特点进行探讨,并通过对部分获得血管造影随访病人的疗效观察,评价该技术的临床应用价值.结果 联合颅内Neuroform支架和生物活性Matrix弹簧圈血管内治疗的11例宽颈动脉瘤病人中,除1例死于并发症外,其余病人均得到满意疗效,其中6例病人术后半年行数字减影血管成像(DSA)随访,未见动脉瘤复发,但仍需长期观察.结论 联合颅内支架和生物活性弹簧圈是一有效的血管内治疗颅内宽颈动脉瘤技术,颅内支架理想的大小选择和恰当的植入位置是成功治疗的重要一环,生物活性Matrix弹簧圈栓入瘤腔后可有效促进血栓和结体组织形成.     

Solitaire AB支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤

目的：探讨Solitaire AB支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤的有效性和安全性。方法对2011年1月～2013年10月33例患者34个前循环宽颈动脉瘤采用Solitaire AB支架辅助弹簧圈栓塞,回顾性分析其临床资料和疗效。结果所有患者均采用支架半释放技术,33例患者共应用Solitaire AB支架34个,均成功到位并准确释放。1个支架内血栓形成,其余无手术相关并发症。动脉瘤完全栓塞26个,瘤颈残留6个,部分栓塞2个。载瘤动脉通畅。除1例后交通动脉瘤病人术后3 d并发颅内出血死亡外,余32例临床随访6～12个月无临床症状加重,未发生再出血及缺血并发症。22例术后6～12个月行DSA随访,2个动脉瘤瘤颈有残留,未见支架内狭窄和闭塞。结论 Solitaire AB支架操作简便,采用支架半释放技术结合弹簧圈栓塞治疗前循环宽颈动脉瘤是安全的和有效的。     

Hybrid,Y-configured,dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms

In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms.We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts.In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one.Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.     

Evaluation of the safety and efficacy of a Pipeline Flex embolization device for treatment of large,wide-necked intracranial aneurysms

Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device (PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery (ICA).Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southern Hospital of Southern Medical University from February 2017 to June 2018 were retrospectively analyzed.Results: A total of 66 cases were treated with a Pipeline Flex embolization device, 10 with a pipeline flex embolization device, and 2 with a double tubride stent (10 patients were treated with a pipeline stent-assisted coil embolization in; and 2 patients were treated with two pipeline stents). The patients were followed up for 3 to 18 months (average, 9.25 months). Among them, 63 cases had complete occlusion of the neck of the aneurysm (Raymondl Class I; MRS score 0; 80.8%). Aneurysms recurred in 12 cases (Raymondl Class II; MRS score 1; 15.4%). Delayed ischemic complications were observed in 1 case (MRS score >2; 0.13%). There was 1 case of poor release of stent and 1 case of stent stenosis (0.13%).Conclusion: The treatment of large, wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization, but the placement of PFED still has some neurological complications.     

双LVIS支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的安全性和有效性

目的探讨双LVIS支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的安全性和有效性。方法将我院实施单支LVIS支架辅助弹簧圈栓塞治疗的40例颅内宽颈动脉瘤患者设为对照组,同期实施双LVIS支架辅助弹簧圈栓塞治疗的40例颅内宽颈动脉瘤患者设为观察组。比较两组的治疗效果。结果两组患者的手术时间、术中出血量、住院时间及术后并发症发生率比较,差异均无统计学意义(P>0.05)。两组治疗后24 h的C反应蛋白水平高于治疗前(P<0.05);两组治疗前及治疗后24 h、5 d、10 d的C反应蛋白水平比较,差异无统计学意义(P>0.05)。治疗后5、10 d,两组的NIHSS评分显著低于治疗前,BI指数显著高于治疗前,且观察组优于对照组(P<0.05)。术后随访3个月,观察组的预后分级优于对照组(P<0.05)。术后3个月,观察组的WHOQOL-BREF各维度评分均高于对照组(P<0.05)。结论双LVIS支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的近期效果显著,可有效减轻神经功能损伤,促进日常生活能力的恢复,改善患者的预后及生存质量。