可脱性弹簧圈栓塞治疗颅内动脉瘤

目的总结AXIUM可脱性弹簧圈栓塞治疗颅内动脉瘤的经验。方法回顾性分析经AXIUM微弹簧圈栓塞、Solitaire支架辅助弹簧圈栓塞治疗的62例颅内动脉瘤（共63个动脉瘤）的临床资料。结果动脉瘤腔完全致密栓塞53个,非完全致密栓塞8个,动脉瘤颈部有残留2个。58例破裂动脉瘤中,治愈57例;死亡1例,为术前Hunt—HessⅢ级,左前交通动脉窄颈动脉瘤和后交通动脉宽颈动脉瘤并存的患者,在支架辅助下进行了致密栓塞,术后90min因颅内再出血死亡。4例未破裂动脉瘤均临床治愈。结论针对不同部位、不同类型的颅内动脉瘤,应用AXIUM微弹簧圈进行合理的血管内栓塞治疗可获得满意疗效。     

颅内多发动脉瘤的电解可脱弹簧圈栓塞治疗

自１９９８年７月至２０００年３月我院采用电解可脱弹簧圈（GDC）栓塞治疗颅内动脉瘤９３例,其中多发动脉瘤２３例,报告如下：１对象与方法１．１一般资料２３例多发动脉瘤中,男８例,女１５例,年龄３２～６４岁。１．２临床表现１例以一侧动眼神经麻痹入院,余２２例病人临床表现为蛛网膜下腔出血,３例伴发颅内血肿。破裂动脉瘤临床分级依据Hunt和Hess分级标准,其中Ⅰ级５例;Ⅱ级１２例,Ⅲ级４例,Ⅳ级１例。１．３影像学检a查DSA检查２３例,同时作栓塞治疗。本组２３例动脉瘤病人共荷瘤４８个,其中２１例病人荷瘤２个,２…     

机械可脱式弹簧圈栓塞治疗颅内动脉瘤的评价

目的 :评价机械可脱式弹簧圈 (MechanicalDetachableSpiral,MDS)栓塞治疗颅内动脉瘤。方法 :对 1995年 3月～ 1998年 7月利用MDS栓塞的 64例 66个颅内动脉瘤进行回顾性分析。结果 :66个动脉瘤中 ,10 0 %栓塞的 2 5个 ,占 3 7 9% (2 5 /66) ;95 %的 19个 ,占 2 8 8% ;90 %的 11个 ,占 16 7% ;80 %的 6个 ,占 9 1% ;<80 %的 5个 ,占 7 6%。 5 5个 (83 3 % )动脉瘤达 90 %以上栓塞。死亡 2例 (3 1% ) ,永久并发症 3例 (4 7% )。结论 :应用MDS进行囊内栓塞 ,是治疗颅内动脉瘤安全有效的方法之一     

可脱性弹簧圈栓塞治疗颅内破裂动脉瘤(附141例报告)

目的讨论可脱性弹簧圈血管内栓塞治疗颅内破裂动脉瘤的技术要点、疗效及并发症的防治。方法对141例颅内破裂动脉瘤采用单纯弹簧圈栓塞86例,球囊辅助弹簧圈栓塞24例,支架辅助弹簧圈栓塞31例。结果动脉瘤完全栓塞93例,栓塞95%31例,栓塞90%10例,栓塞90%5例,栓塞不成功2例。出院时恢复良好无神经功能障碍107例,轻度神经功能障碍24例,重度障碍7例,死亡3例。127例随访1~33个月,无再出血患者,9例再通。结论对颅内破裂动脉瘤采用可脱性弹簧圈血管内栓塞疗效可靠、微创、术后恢复快,是一种较为理想的治疗方法,早期栓塞及积极的术后处理可以降低其死亡率和致残率。     

可脱性弹簧圈血管内栓塞颅内动脉瘤(附126例分析)

目的　探讨可脱性弹簧圈血管内栓塞治疗颅内动脉瘤的效果及技术要点。方法　对 1 2 6例颅内动脉瘤应用微导管技术 ,在数字减影血管造影 (DSA)监视下行血管内栓塞治疗 ,其中 85例 90个动脉瘤用机械式可脱性弹簧圈 (MDS)栓塞 ,41例 42个动脉瘤用电解式可脱性弹簧圈 (GDC)栓塞。结果　成功栓塞 1 2 6例 1 3 2个动脉瘤 ,1 2 3例痊愈 ,3例死亡。1 0 0 %栓塞 1 2 4个 ,95%栓塞 6个 ,90 %栓塞 2个。并发动脉瘤破裂 4例 ,并发脑梗死 2例 ,其中 1例痊愈 ,1例死亡 ;1例微弹簧末端逸出并顽固性脑血管痉挛致死亡。 2例复发者再予GDC栓塞而治愈。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 ,但动脉硬化明显 ,导管到位困难者及术前呼吸、循环功能衰竭者不宜行血管内治疗。动脉瘤较大者 ,术后复发率高 ;术前反复蛛网膜下腔出血者 ,术中动脉瘤破裂的可能性较大。     

电解可脱弹簧圈栓塞治疗颅内动脉瘤的并发症及处理

目的 探讨颅内动脉瘤电解可脱弹簧圈（GDC）栓塞治疗的常见并发症,确立有效的处理方法。方法 采用GDC栓塞颅内动脉瘤71个。结果 发生并发症4例次,经过对症处理后好转。所有病人均获临床治愈。结论 GDC栓塞治疗颅内动脉瘤安全有效,并发症少。     

MDS血管内栓塞颅内动脉瘤

我院自1995年9月至2000年3月共行可脱性弹簧圈血管内栓塞243例254个动脉瘤,其中应用机械可脱性弹簧圈（MDS）栓塞85例90个动脉瘤,电解可脱性弹簧圈（GDC）栓塞158例164个动脉瘤。由于MDS栓塞颅内动脉瘤较经济,易于掌握。目前为我国大部分地区,尤其是经济落后地区血管内治疗     

机械可脱性螺旋圈栓塞治疗颅内动脉瘤

目的:探讨机械可脱性螺旋圈栓塞颅内动脉瘤的优越性以及相关的栓塞技术。方法:在神经镇定镇痛麻醉及全身肝素化的条件下,对10例不同部位、大小的动脉瘤进行栓塞。其中男性7例,女性3例。平均年龄46(31～63)岁。结果:7例动脉瘤达到100％栓塞,1例达到95％栓塞,1例因材料不足仅栓塞45％,1例因栓塞术中出血而放弃栓塞。全部保留载瘤动脉通畅,仪1例发生与栓塞技术有关的并发症。结论:机械可脱性螺旋圈安全可靠。但手法必须轻柔,一次性准确到位及螺旋圈在动脉瘤腔内良好盘曲是栓塞成功的关键。远期效果尚需长期随访。     

电解可脱性微弹簧圈栓塞治疗颅内动脉瘤

目的总结电解式可脱性微弹簧圈（ＧＤＣ）栓塞治疗颅内动脉瘤的经验。方法１９９８年２月至１９９８年８月用ＧＤＣ栓塞治疗颅内动脉瘤５６例,其中蛛网膜下腔出血（ＳＡＨ）急性期病例１３例。术前Ｈｕｎｔ氏分级;７例为Ⅳ级,１４例为Ⅲ级,３５例为Ⅰ－Ⅱ级。采用美国ＢｏｓｔｏｎＳｃｉｅｎｔｉｆｉｃＣｏ．的ＧＤＣ进行栓塞治疗。结果５６例栓塞后无死亡及永久并发症,有２例前交通动脉瘤栓塞后出现一过性偏瘫,经内科治疗１周,症状、体征消失。５６例中４４例造影证实为完全闭塞,有８例为大部分闭塞。本组由于治疗时间均在半年内,无随访资料。结论ＧＤＣ栓塞治疗动脉瘤,是目前比较理想的治疗方法,但其远期疗效有待随访观察。     

颅内动脉瘤电解可脱弹簧圈栓塞治疗

目的:探讨颅内动脉瘤电解可脱弹簧圈(Guglielmi detachable coil,GDC)栓塞治疗术.方法:经股动脉Seldinger's穿刺,将微导管插入动脉瘤腔用DGC栓塞动脉瘤.结果:11例患者7例完全康复,2例偏瘫,1例自动出院,2例死亡.6例随访头颅平片GDC均在瘤腔,1例患者7个月后复查DSA,无复发.结论:颅内动脉瘤栓塞术是微创有效安全的方法.     

应用电解可脱性弹簧圈栓塞颅内动脉瘤临床体会

目的:讨论电解可脱性弹簧圈血管内栓塞治疗颅内动脉瘤的治疗要点、并发症及疗效的体会。方法:对43例破裂颅内动脉瘤患者采用电解可脱性弹簧圈进行颅内动脉瘤囊内栓塞。术后早期处理出血并进行有效的对症治疗。结果:43例患者发现47个动脉瘤,栓塞导致出血的43个。其中38个100%闭塞,4个95%闭塞,1个90%闭塞。术中出血2例,血管痉挛5例,术后血管痉挛3例。术后39例临床痊愈,2例因合并脑积水行脑室腹腔引流术,2例死亡,随访期间均无再出血。结论:作者体会对颅内动脉瘤可应用脱性弹簧圈进行血管内栓塞疗效可靠,早期栓塞及有效的术后处理可减少并发症,提高治愈率。     

The Merits of Endovascular Coil Surgery for Patients with Unruptured Intracranial Aneurysms

Objective

The purpose of this study was to report the morbidity, mortality, angiographic results, and merits of elective coiling of unruptured intracranial aneurysms.

Methods

Ninety-six unruptured aneurysms in 92 patients were electively treated with detachable coils. Eighty-one of these aneurysms were located in the anterior circulation, and 15 were located in the posterior circulation. Thirty-six aneurysms were treated in the presence of previously ruptured aneurysms that had already undergone operation. Nine unruptured aneurysms presented with symptoms of mass effect. The remaining 51 aneurysms were incidentally discovered in patients with other cerebral diseases and in individuals undergoing routine health maintenance. Angiographic and clinical outcomes and procedure-related complications were analyzed.

Results

Eight procedure-related untoward events (8.3%) occurred during surgery or within procedure-related hospitalization, including thromboembolism, sac perforation, and coil migration. Permanent procedural morbidity was 2.2% ; there was no mortality. Complete occlusion was achieved in 73 (76%) aneurysms, neck remnant occlusion in 18 (18.7%) aneurysms, and incomplete occlusion in five (5.2%) aneurysms. Recanalization occurred in 8 (15.4%) of 52 coiled aneurysms that were available for follow-up conventional angiography or magnetic resonance angiography over a mean period of 13.3 months. No ruptures occurred during the follow-up period (12-79 months).

Conclusion

Endovascular coil surgery for patients with unruptured intracranial aneurysms is characterized by low procedural mortality and morbidity and has advantages in patients with poor general health, cerebral infarction, posterior circulation aneurysms, aneurysms of the proximal internal cerebral artery, and unruptured aneurysms associated with ruptured aneurysm. For the management of unruptured aneurysms, endovascular coil surgery is considered an attractive alterative option.     

血管内栓塞治疗破裂的前交通动脉瘤

目的探讨血管内栓塞治疗破裂的前交通动脉瘤的方法及并发症的防治。方法60例前交通动脉瘤采用水解、电解可脱性弹簧圈进行血管内栓塞。结果59例患者栓塞成功，1例因栓塞失败行手术夹闭。按GOS评分进行疗效评价，Ⅳ-Ⅴ级55例，Ⅲ级3例，Ⅰ级（死亡）2例。58例随访3～12个月均无再出血症状。55例行DSA或MRA检查，50例均未见动脉瘤再通，5例动脉瘤残腔未见增大。结论破裂的前交通动脉瘤栓塞术前应对动脉瘤进行充分评估。选择适当的弹簧圈进行填塞，术中适时造影，了解动脉瘤填塞情况及载瘤动脉的循环情况可避免血栓形成、动脉瘤再破裂等术中并发症的发生。血管内栓塞前交通动脉瘤的近、中期疗效是肯定的，但远期疗效还有待进一步观察。     

血管内栓塞治疗多发性颅内动脉瘤

目的评价血管内栓塞治疗多发性颅内动脉瘤的安全性与有效性。方法回顾性分析经血管内栓塞治疗16例多发性颅内动脉瘤（共38个动脉瘤）患者的临床资料。36个动脉瘤在前循环,2例病人分别有1个动脉瘤在后循环。根据Hunt—Hess评分,Ⅰ级5例,Ⅱ级6例,Ⅲ级3例,Ⅳ级2例。结果15例病人一次性将所有动脉瘤栓塞,1例仅栓塞责任动脉瘤,未能栓塞的动脉瘤二期手术夹闭。无死亡病例,临床随访6个月以上,所有病例无再出血;预后按GOS评分,良好11例,轻残3例,重残1例,植物生存1例。结论血管内栓塞治疗多发性颅内动脉瘤是安全有效的。诊断明确后应尽早治疗责任动脉瘤;然后再根据未破裂动脉瘤的处理原则,选择性栓塞其它未破裂动脉瘤。     

颅内动脉瘤血管内栓塞治疗的临床分析

目的总结颅内动脉瘤血管内栓塞治疗技巧及结果。方法采用血管内栓塞治疗76例80个颅内动脉瘤。对23个宽颈动脉瘤采用瘤颈成形辅助技术栓塞治疗,其中球囊辅助成形术治疗动脉瘤4个,微导丝辅助瘤颈成形技术治疗5个,支架结合弹簧圈栓塞治疗14个。6个巨大动脉瘤5个用可脱性球囊闭塞载瘤动脉,1个用电解可脱性弹簧圈闭塞载瘤动脉。结果栓塞程度:致密栓塞48个(64.9%。48/74),90%以上栓塞11个(14.9%,11/74),疏松(90%以下)栓塞15个(20.3%,15/74)。术中动脉瘤破裂出血4例(5.3%,4/76),2例死亡。结论电解可脱性弹簧圈栓塞颅内动脉瘤具有微创、安全、效果可靠等优点。采用微导丝辅助瘤颈成形技术、瘤颈重塑形技术、血管内支架等方法,可以明显提高宽颈动脉瘤的致密栓塞率和减少脑梗死并发症发生。     

电解可脱弹簧圈栓塞治疗颅内宽颈动脉瘤

目的 总结电解可脱弹簧圈栓塞治疗60例67个颅内宽颈动脉瘤的体会,探讨颅内宽颈动脉瘤介入治疗方法、技术操作要点、存在问题及临床应用前景。方法 60例颅内动脉瘤患者中54例为破裂动脉瘤。采用双弯塑形、横向成篮、分部填塞及篮外填塞等方法治疗55例,瘤颈重塑形技术2例,血管内支架结合GDC 3例。结果 栓塞程度:颅内动脉瘤完全栓塞54个(54/67),栓塞90％以上9个(9/67),栓塞90％以下4个(4/67)。术中出血2例(2/60),死亡2例(2/60)。结论 GDC栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。改进栓塞技巧及瘤颈塑形技术等方法,可以明显提高宽颈动脉瘤的完全栓塞率,血管内支架结合GDC可能成为治疗颅内梭形及宽颈动脉瘤的有效方法。     

Matrix弹簧圈栓塞治疗颅内破裂动脉瘤的并发症

目的评价Matrix弹簧圈栓塞颅内破裂动脉瘤的安全性。方法回顾性分析应用Matrix弹簧圈栓塞的102枚颅内破裂动脉瘤的临床表现、影像学资料、治疗过程、并发症和临床结果,分析与治疗相关并发症的发生、类型、频率、相关因素和后果。结果发生并发症的有16例,其中术中动脉瘤破裂9例,血栓形成3例,弹簧圈脱出1例,载瘤动脉闭塞3例,并发症发生率为15.69%。6例患者无神经功能异常,3例患者具有暂时性神经功能异常,6例患者具有持久性神经功能障碍,1例患者死亡。与治疗相关性持久性神经功能障碍发生率和死亡率分别为5.88%和0.98%。结论应用Matrix弹簧圈栓塞颅内破裂动脉瘤和应用裸金属圈栓塞一样安全,生物活性物质不增加血栓形成的风险,但应用Matix弹簧圈栓塞远段、较小动脉瘤应慎重。     

支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤

目的 分析支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤的安全性和有效性.方法 该回顾性研究纳入昆明医科大学第二附属医院脑血管病科2016年7月-2020年7月经DSA诊断的应用支架辅助栓塞治疗的前交通动脉宽颈动脉瘤患者.收集所有患者的临床相关资料,评价支架辅助栓塞治疗的疗效和安全性.治疗技术指标采用术后即刻DSA Ray...     

Clinical and Radiogical Outcomes of Endovascular Detachable Coil Embolization in Paraclinoid Aneurysms : A 10-Year Experience

Objective

Direct surgical clipping of paraclinoid aneurysms poses technical challenges to even very experienced neurosurgeons, making endovascular treatment an alternative treatment modality in many centers. We have therefore retrospectively evaluated the safety and efficacy of endovascular detachable coil embolization of paraclinoid aneurysms.

Methods

From June 1997 to June 2007, 65 patients underwent endovascular detachable coiling for 67 paraclinoid aneurysms (of which 9 were ruptured and 58 were unruptured) in our institute. Their medical records, radiological images and readings, and operation records were reviewed retrospectively.

Results

After the initial embolization procedure, complete occlusion was achieved in 29 (43.3%) of the aneurysms treated by endovascular detachable coiling. Six aneurysms required retreatment, with two each requiring one, two, or three additional endovascular procedures. Fifty-five (82.1%) aneurysms were measured by three-dimensional time of flight (TOF) magnetic resonance images (MRI) or transfemoral cerebral angiography (TFCA) at a mean follow-up of 29.7 months (range from 4 to 94 months), with 39 aneurysms (70.9%) showing complete occlusion. Thromboembolic events (3.8%) were the most frequent complication. Rupture did not occur during or after any of the procedures. According to the Glasgow Outcome Scale (GOS), 98.4% of the patients treated by coil embolization had a score of 4 or 5.

Conclusion

Our results indicate that endovascular detachable coiling is a safe and effective treatment modality in paraclinoid aneurysms.