超早期血管内栓塞治疗破裂颅内动脉瘤

目的探讨颅内动脉瘤破裂超早期血管内栓塞治疗方案的临床意义.方法回顾性总结27例破裂出血动脉瘤患者在48h内进行血管内栓塞治疗的效果.结果随访4月～3年,27例病人格拉斯哥预后评分:恢复良好23例,中度残疾2例,重度残疾0例,持续性植物生存0例,死亡2例.无再出血病例.结论超早期血管内栓塞治疗能及时防止破裂动脉瘤再出血,并为后续积极的抗血管痉挛治疗提供条件,可明显改善患者的预后.     

超早期血管内栓塞治疗破裂颅内动脉瘤

目的 探讨颅内动脉瘤破裂超早期血管内栓塞治疗方案的临床意义．方法 回顾性总结27例破裂出血动脉瘤患者在48h内进行血管内栓塞治疗的效果．结 果随访4月．3年，27例病人格拉斯哥预后评分：恢复良好23例，中度残疾2例，重度残疾0例，持续性植物生存0例，死亡2例．无再出血病例．结论 超早期血管内栓塞治疗能及时防止破裂动脉瘤再出血，并为后续积极的抗血管痉挛治疗提供条件，可明显改善患者的预后．     

GDC栓塞治疗颅内动脉瘤的护理

目的 探讨电解可脱性微弹簧圈（GDC）栓塞术治疗颅内动脉痛的护理特点。方法选择近两年我科研E栓塞治疗的颅内动脉瘤的病人12例，探讨其围手术期护理方法。结果 经我们周到的术前、术后护理，包括术前心理护理，消除紧张情绪，认真宣教，精心的术前准备，术后详细的记录各种症状和体征的变化，针对GDC栓塞术的特点，术后易出现的问题和并发症制定特定的护理方案，12位患者均获得了较好的疗效。结论 针对GDC拴塞术的特点，实施特定的护理方法，配合医师治疗，有助于病人术后的恢复。     

单纯弹簧圈栓塞治疗颅内破裂宽颈动脉瘤的安全性和有效性

目的:探讨颅内宽颈动脉瘤破裂后急性期使用单纯弹簧圈栓塞治疗的安全性和有效性。方法:前瞻性研究。纳入2017年6月—2018年5月首都医科大学宣武医院神经外科符合要求的颅内破裂宽颈动脉瘤60例,其中男22例、女38例,年龄38～85(57±11)岁。术前Hunt-Hess分级Ⅰ级16例,Ⅱ级23例,Ⅲ级16例,Ⅳ级4例,...     

血管内栓塞治疗颅内动脉瘤的观察与护理对策

颅内动脉瘤是常见的脑血管疾病之一，死亡率25％～60％。血管内栓塞是目前治疗该疾病最有效的方法之一，与开颅手术治疗相比，创伤小、预后好，并发症少，但血管内栓塞具有一定的特殊性，需要精心的护理。我院自2001年1月至2005年3月共进行血管内栓塞治疗颅内动脉瘤64例。现将护理体会报告如下。     

Lvis支架辅助弹簧圈血管内栓塞治疗颅内破裂动脉瘤的临床效果和安全性

目的:探讨Lvis支架辅助弹簧圈血管内栓塞治疗颅内破裂动脉瘤中的临床效果和安全性。方法:选取84例颅内破裂动脉瘤患者作为观察对象,随机分为A、B两组,每组42例患者。A组采用Lvis支架辅助弹簧圈血管内栓塞方式进行治疗,B组采用Solitaire支架辅助弹簧圈血管内栓塞方式进行治疗。采用RS评分、Raymond评分和GOS评分对临床效果进行评价,并对治疗后的不良反应发生率及复发率进行分析。结果:RS评分方面,A组为（0.23±0.57）分,B组为（2.48±0.96）分,A组低于B组（P<0.05）;Raymond评分方面,A组Ⅰ级发生率为92.24%,B组为78.57%,A组高于B组（P<0.05）;GOS评分方面,A组5分的发生率为92.86%,B组为73.81%,A组高于B组（P<0.05）。不良反应发生率方面,A组为2.38%,B组为21.43%,A组低于B组（P<0.05）。复发率方面,A组无一例复发,B组复发率为4.76%,A组低于B组（P<0.05）。结论:Lvis支架辅助弹簧圈血管内栓塞治疗颅内破裂动脉瘤,临床效果好且具有一定安全性。 【关键词】颅内破裂动脉瘤;Lvis支架;弹簧圈血管内栓塞     

颅内栓塞术后复发动脉瘤不同干预方式疗效分析

目的 对比不同的二次干预方式对栓塞术后复发动脉瘤的疗效。方法 采用回顾性队列研究方法。纳入2010年1月—2016年12月北京市大兴区人民医院神经外科栓塞术后动脉瘤复发患者共101 例,其中男36例,女65例;首次发病年龄15~69(45±11)岁,复发年龄16~76(48±11)岁。根据二次干预方式不同分为手术组(24例)、栓塞组(39例)、栓塞+支架组(30例)、保守组(8例),分析患者治疗前后改良Rankin量表(mRS)评分变化、干预后是否存在并发症、干预后是否再复发,判断不同干预方式的治疗效果。结果 4组复发动脉瘤患者的二次干预时年龄、合并高血压或糖尿病、吸烟、动脉瘤破裂发生率、动脉瘤直径及瘤颈宽度、mRS评分变化及并发症发生率比较差异均无统计学意义(P值均＞0.05);各组间动脉瘤部位存在统计学差异(χ²=37.485, P＜0.05);二次干预前后mRS比较各组间差异无统计学意义;二次干预后手术组复发0例(0%)、栓塞组10例(25.6%,10/39)、栓塞+支架组3例(10%,3/30)、保守组2例复发进展(2/8),4组间动脉瘤再复发率比较差异有统计学意义(χ²=8.986, P＜0.05)。结论 对于复发动脉瘤,开颅夹闭、介入栓塞及支架辅助等均为有效的治疗方式,其中,开颅夹闭较介入治疗具有更低的再复发率;对于保守治疗的复发动脉瘤患者,需要严密随访观察。     

颅内动脉瘤介入栓塞术后二次复发的影响因素分析

目的 探讨颅内栓塞术后复发动脉瘤介入治疗后再复发的影响因素。方法 采用回顾性队列研究方法。纳入2010年1月—2016年12月北京市大兴区人民医院神经外科二次介入栓塞术治疗的复发动脉瘤患者69 例,其中男27例、女42 例,年龄25~76(48±10)岁;二次介入手术后再复发13例,再复发率为18.8%(13/69)。采用单因素分析及Logistic回归分析方法, 分析复发颅内动脉瘤介入治疗后再复发的影响因素。结果 单因素分析显示,复发组与非复发组患者性别、年龄、合并高血压、合并糖尿病、吸烟、 动脉瘤瘤颈宽度、动脉瘤部位、是否支架辅助比较,差异均无统计学意义(P值均＞0.05);而两组患者动脉瘤大小、手术前后改良RANKIN量表(mRS)评分变化情况、术后Raymond分级比较,差异均有统计学意义(Z=-3.396、-5.955、-5.825, P值均＜0.05)。Logistic回归分析显示:以RaymondⅠ级为参照,RaymondⅡ级(OR=0.116,95%CI 0.025~0.546, P＜0.01)和Raymond Ⅲ级(OR=0.052, 95%CI 0.008~0.350, P＜0.01)为二次介入栓塞术后动脉瘤再复发的独立危险因素。结论 栓塞不完全(RaymondⅡ级和Ⅲ级)是二次介入栓塞术后动脉瘤再复发的独立危险因素;对于再复发的颅内动脉瘤,二次介入术中选择合适的弹簧圈,尽可能栓塞完全无残留,意味着更低的再复发率。     

颅内动脉瘤行介入栓塞术的围手术期护理

目的总结颅内动脉瘤行介入栓塞术的围手术期护理经验。方法23例颅内动脉瘤行全脑血管造影及介入栓塞的患者,做好术前、术中、术后的围手术期护理。结果23例患者行介入栓塞术后,均未出现不良症状,3~6个月随访均恢复良好。结论做好介入栓塞术的围手术期护理是保证患者尽快康复,减少并发症的关键。     

电解可脱性弹簧圈栓塞治疗95例颅内动脉瘤

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效果.方法:回顾性分析2002年10月～2010年8月收治的95例颅内动脉瘤患者行电解可脱弹簧圈栓塞治疗的临床资料.本组患者均在全脑血管造影的同时或择日在静脉复合全身麻醉下经导引导管引入微导管和与之相匹配的微导丝.头端经过塑形的微导管在微导丝配合下置入瘤腔并固定于距瘤颈1/3处,选择大小适合的GDC进行栓塞治疗,依次将GDC填入瘤腔.结果:95例中,84例动脉瘤100%栓塞,8例95%栓塞,2例90%栓塞,1例基底动脉顶端动脉瘤患者微导管无法到位放弃治疗.94例术后随访3～12个月,均无再出血.3例术中出现并发症,其中2例后交通动脉瘤术中发生破裂出血,治疗后痊愈; 1例前交通动脉瘤治疗过程中见同侧大脑前动脉未显示,立即经引导管罂粟碱推注、40万尿激酶溶栓后再通,无并发症.结论:血管内栓塞治疗颅内动脉瘤是一种比较安全、可靠、有效的治疗手段.     

Transcatheter Embolization of a Ruptured Internal Pudendal Artery Pseudoaneurysm in a Patient with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder. Pseudoaneurysms formation and rupture is an unusual complication of neurofibromatosis. To date, pseudoaneurysm of the internal pudendal artery associated with NF-1 has not been reported. In this article, we present a 62-yr-old man with NF-1 suffering from spontaneous hematoma of the perinea and scrotum. A digital substraction angiography disclosed a ruptured pseudoaneurysm of the right internal pudendal artery, which was successfully managed with transcatheter embolization.     

Risk Factors for Intraprocedural Rerupture during Embolization of Ruptured Intracranial Aneurysms

BackgroundIntraprocedural rupture (IPR) is a devastating complication in endovascular treatment of ruptured intracranial aneurysms, but its risk factors have not been fully assessed. This study was performed to explore the risk factors for IPR during embolization of ruptured cerebral aneurysms.MethodsA total of 1,494 patients with ruptured intracranial aneurysms who underwent endovascular interventional embolization were enrolled. Clinical characteristics were collected for each patient. Univariate and multivariate logistic regression analysis was employed to identify the factors independently associated with IPR. A receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of continuous variables predicting IPR.ResultsForty-one patients suffered from IPR (2.7%). Multivariate logistic regression analysis indicated that aneurysm size (odds ratio [OR], 0.819; 95% confidence interval [CI], 0.732–0.916), aneurysms with irregular morphology (OR, 2.162; 95% CI, 1.143–4.091), time from symptom onset to intervention (OR, 1.615; 95% CI, 1.207–2.161), and vasospasm during embolization (OR, 2.021; 95% CI, 1.038–3.934) were the independent risk factors of IPR. ROC curve analysis showed that the area under the curve for aneurysm size and time from onset to intervention were 0.697 (cutoff value, 3.4 mm; sensitivity, 78.8%; and specificity, 53.7%) and 0.659 (cutoff value, 2 days; sensitivity, 78.0%; and specificity, 45.2%), respectively.ConclusionAneurysms with irregular morphology, aneurysms ≤ 3.4 mm in diameter, time from onset to intervention > 2 days and cerebral vasospasm during embolization are independent risk factors for IPR during coil embolization of ruptured aneurysms. More attention should be paid to the factors increasing the risk of IPR in patients with ruptured aneurysms so as to minimize this complication.     

血管内介入治疗脑动静脉畸形

目的 探讨血管内栓塞治疗脑动静脉畸形(AVM)的临床效果和安全性．方法 应用血管内栓塞治疗脑AVMll例，栓塞剂为NBCA，栓塞后3例行手术切除，3例行γ-刀治疗．结果 1例完全栓塞，5例栓塞70％—90％，3例栓塞50％—70％，2例栓塞小于50％．生活、工作完全正常治愈5例，症状明显改善4例，症状无改善2例．结论 血管内栓塞治疗脑AVM的方法是相对安全的，可治愈部分脑AVM，对于大型、重要功能区的脑AVM，血管内栓塞联合手术或放疗可提高治愈率，降低致残率和死亡率．     

Ultra-Early Surgery for Poor-Grade Intracranial Aneurysmal Subarachnoid Hemorrhage: A Preliminary Study

Purpose

To describe the therapeutic effect and possibility of the ultra-early surgery for poor-grade aneurysmal subarachnoid hemorrhage (Hunt-Hess grades IV - V).

Materials and Methods

Nine cases with intracranial aneurysms, demonstrated by computed tomographic angiography (CTA), were treated by ultra-early surgery under general anesthesia within 24 hours from subarachnoid hemorrhage (SAH), 5 cases were treated within 6 hours and 4 cases in 6 - 24 hours. Preoperative Hunt-Hess grade: 6 cases were IV and 3 cases were V. The clinical outcome was evaluated by Glasgow Outcome Scores (GOS).

Results

In operation, difficult dissection occurred in 5 cases (55.6%), and rupture of aneurysm occurred and temporary obstructions were performed in 4 cases (44.4%). After clipping of aneurysm, 2 cases underwent V-P shunt because of hydrocephalus, pulmonary infection occurred in 3 cases, hypothalamus reaction accompanied with upper gastrointestinal hemorrhage in 2 cases. The clinical outcome were favorable (GOS 4 - 5) in 4 cases (44.4%), dissatisfied (GOS 2 - 3) in 3 cases (33.3%), and dead (GOS 1) in 2 cases (22.2%) when patients departed from our hospital.

Conclusion

The ultra-early surgery can avoid early rebleeding of intracranial aneurysm, therefore, should be considered in the treatment of Hunt-Hess grade IV-V intracranial aneurysms. The appliance of CTA can make it possible to use of ultra-early surgery and improve the therapeutic effect.     

动脉瘤性蛛网膜下腔出血后认知功能检查及损害特点

目的：检测动脉瘤性蛛网膜下腔出血后认知功能损害的发生率及损害程度。分析SAH对认知功能的影响。方法：对37例动脉瘤性蛛网膜下腔出血病人手术前进行了认知功能检查。检查内容包括算术、数字广度、数字符号、图画填充、视觉再生、词语流畅性测验、连线测验、简易精神状态检查等内容。结果：表现有认知功能损害者26人，总的发生率为70．3％。有一项损害者14人(37．8％)，二项损害及以上者12人(32．4％)。在所测验项目中．算术发生损害率为2．7％、数字广度为5．4％、数字符号为2．7％、填图项目为2．7％、视觉再生为48．6％、词语流畅性测验为(食品名称)27％和(日用品)18．9％、连线测验为(A)18．9％和(B)21．6％、MMSE为18．9％。结论：动脉瘤性蛛网膜下腔出血本身可引起认知功能损害，以图形记忆力、注意力、额叶功能损害为主。     

Effect of Renal Embolization with Trisacryl and PAVc

OBJECTIVES

Evaluate the degree of vascular occlusion, vascular recanalization, and necrosis of the vascular wall caused by polyvinyl alcohol-covered polyvinyl acetate (PVAc) particles compared to trisacryl particles after renal embolization.

METHODS

Seventy-nine female albino New Zealand rabbits underwent arterial catheterization of the right kidney. Thirty-three animals were embolized with trisacryl particles, thirty-one with PVAc particles, and fifteen were kept as controls. Four animals were excluded (three trisacryl and one PVAc) due to early death. Five subgroups of six animals were created. The animals in the different groups were sacrificed either 48 hours, 5 days, 10 days, 30 days, or 90 days after embolization. The control group was divided into subgroups of three animals each and kept for the same periods of time. The kidneys were dyed with hematoxylin-eosin and Masson’s trichrome and then examined using optical microscopy.

RESULTS

There were significant differences in the degree of vascular occlusion caused by the trisacryl and the PVAc particles between the five-day and the ten-day groups. Additional differences were noted between the five-day and 48-hour groups in regard to the amount of necrosis. For both findings, the PVAc group members showed adequate tissue reaction (ischemia and volumetric reduction) and less recanalization than those treated with trisacryl.

CONCLUSION

The use of PVAc as an embolization material exhibited an adequate tissue reaction (ischemia and volumetric reduction), more expressive vascular occlusion and necrosis, and less recanalization than the trisacryl material.     

Characteristics of circulating monocytes at baseline and after activation in patients with intracranial aneurysm

Intracranial aneurysm (IA) is a bulging of blood vessels around the brain that is often asymptomatic but may cause severe complications and death if ruptured. Macrophage-mediated immune responses can contribute to the development of IA. During homeostasis and inflammation, circulating monocytes can infiltrate the vasculature, where they develop into macrophages, and modulate immune responses. Based on the expression of CD14 and CD16, total circulating monocytes can be distinguished into three main subsets, including the CD14⁺CD16⁻ classical monocytes, the CD14⁺CD16⁺ intermediate monocytes, and the CD14^loCD16⁺⁺ non-classical monocytes. In this study, we found that frequencies of CD14⁺CD16⁻ classical monocytes were significantly lower in IA patients than in healthy controls, while the frequencies of CD14⁺CD16⁺ intermediate monocytes and CD14^loCD16⁺⁺ non-classical monocytes were significantly higher in IA patients than in healthy controls. The frequencies of CD14⁺CD16⁺ intermediate monocytes were further elevated in IA-ruptured patients compared to those in IA-unruptured patients. Compared to classical monocytes, intermediate monocytes and non-classical monocytes presented higher TNF-α and IL-1β expression. When cocultured with autologous naive CD4 T cells, intermediate and non-classical monocytes preferentially promoted the expression of TBX21 and RORC over the expression of FOXP3 in CD4 T cells. Inhibition of TNF-α and IL-1β slightly reduced TBX21 expression and markedly reduced RORC expression, and at the same time significantly increased FOXP3 expression in CD4 T cells. Overall, this study demonstrated that the monocytes were dysregulated in IA patients in a manner that favored the development of proinflammatory responses.     

Novel ELN mutation in a family with supravalvular aortic stenosis and intracranial aneurysm

Pathogenic germline mutations in ELN can be detected in patients with supravalvular aortic stenosis. The mutation might occur de novo or be inherited following an autosomal dominant pattern of inheritance. In this report we describe a three-generation family suffering from supravalvular aortic stenosis, various other arterial stenoses, sudden death, and intracranial aneurysms. A frameshift mutation in exon 12, not described before, was detected in the affected family members. This report emphasises the importance of family history, genetic counselling, and demonstrates the great variability in the phenotype within a single SVAS family.