Embolisation with Guglielmi detachable coils during the period of increased risk for cerebral vasospasm: early outcome

In a retrospective study, we investigated whether embolisation of intracranial aneurysms during the spasm period (days 3–14) after subarachnoid haemorrhage carries an increased risk. A comparison was made with patients embolised during the same period but in the first 2 days after the haemorrhage. The two groups compared well except for a higher incidence of posterior circulation aneurysm in the group with delayed treatment. There seems to be no difference in the short-term outcome between the two. Received: 30 April 1999 Accepted: 3 March 2000     

Magnetic resonance signal intensity and volume changes after endovascular treatment of intracranial aneurysms causing mass effect

To determine when and how intracranial aneurysms causing mass effect change following endovascular treatment, we used MRI to assess patients for 2–3 years after the interventional procedure. Nine patients who had aneurysms compressing the surrounding structures underwent endovascular treatment. Proximal occlusion of the parent artery was performed in seven cases, and in two the aneurysm was embolised with microcoils. After embolisation, signal intensity within aneurysms tended to be high on both T1- and T2-weighted images. When there was rapid reduction in size high-signal zones within aneurysms became isointense or gave low signal on T1-weighted images. On T2-weighted images, isointense or low-signal foci appeared within high-signal areas in the aneurysm, giving mixed intensity. In typical cases, the mean volume of the aneurysm fell to approximately 30 % of its initial value 2–12 months after treatment. After this, no additional reduction was observed. The aneurysms which showed little signal intensity change tended to shrink more slowly and to a lesser degree than the more typical cases. Aneurysms which gave high signal on both T1- and T2-weighted images early following embolisation shrank more quickly than those showing little signal change. Received: 24 February 1997 Accepted: 19 June 1997     

Coil embolisation for ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery

Although many surgical or endovascular treatments for ruptured vertebral artery dissection have been reported, the best treatment is controversial. We treated five cases of ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery (PICA), using retrievable platinum coils packed in the dissection site and the immediately proximal vertebral artery. All patients had a contralateral vertebral artery of the same calibre or larger. All dissections were occluded completely, together with the portion of the vertebral artery distal to the PICA origin. No complications related to the procedure were seen. The purpose of the treatment is to isolate the dissection from the cerebral circulation. Occlusion of the rupture site, preserving perforating arteries arising from the vertebral artery, would be ideal. Short-segment occlusion by retrievable platinum coils is close to the ideal. Received: 21 December 1998/Accepted: 21 July 1999     

“De novo” formation of intracranial aneurysms: who is at risk?

Although aneurysms are widely considered to be of congenital origin there is still debate as to whether some at least might be formed de novo during life. A review of all 49 reported cases plus one previously unpublished case reveals common clinical features and might aid in the management of this group of patients. Statistical analysis of all 50 cases of de novo aneurysms discloses a more frequent history of smoking (P = 0.0007) and arterial hypertension (P = 0.0026) than in a control cohort. Patients with de novo aneurysms are younger (P < 0.0001); the proportion with multiple aneurysms was 28 %. Of de novo aneurysms 44 % became symptomatic 3–6 years after the first subarachnoid haemorrhage (SAH), and the interval was significantly shorter in hypertensive patients. We suggest that young patients with a history of SAH and arterial hypertension and nicotine abuse should therefore be considered for conventional angiography after a 5-year interval. MRA might not be useful due to clip artefacts from even nonferromagnetic clips. Close control of blood pressure is essential in these patients. Received: 10 October 1998 Accepted: 27 January 1999     

Comparison of operative and endovascular treatment of anterior circulation aneurysms in patients in poor grades

We assessed the outcome of surgical and endovascular treatment in patients in poor (Hunt & Hess IV or V) grade following subarachnoid haemorrhage due to anterior circulation aneurysm (ACA). There were 41 patients, treated surgically (20), by the endovascular route (20) or both (1). The aneurysms were clipped in 20 patients, wrapped in one; 19 were treated with Guglielmi detachable coils (GDC), one by parent vessel occlusion using detachable balloons. One GDC treatment was interrupted and the aneurysm was surgically clipped instead. We treated five patients surgically to evacuate accompanying intracerebral clots. We treated 14 (66 %) patients by the endovascular route and 15 (71 %) surgically within 72 h of the haemorrhage. The frequency of delayed ischaemic neurological deficit and/or cerebral infarct due to vasospasm did not differ significantly between the endovascular and surgical groups. We had one surgical and three endovascular procedure-related complications with clinical manifestations. Outcome was evaluated after 6 months. After GDC treatment, angiographic follow-up was carried out between 8 and 26 months (mean 17 months). Good outcomes were achieved in six (29 %) of the surgically treated patients (40 % of the survivors) and six (30 %) of the endovascular treatment patients (60 % of the survivors). Outcome was similar after surgical and endovascular approaches. The decision as to which treatment to chosen is influenced mainly by clinical factors such as cerebral haematoma or age. Received: 27 September 2000/Accepted: 10 January 2001     

Operative or endovascular treatment of ruptured intracranial vertebral artery aneurysms?

Our purpose was to evaluate the surgical and endovascular treatment outcomes of ruptured intracranial vertebral artery aneurysms (RIVAA). The outcomes of 44 patients with RIVAA treated between 1983 and 1998 surgically (26), endovascularly (20) or both (2) were evaluated. The aneurysms were clipped in 24 patients, and clipped and wrapped in two. We treated 20 by the endovascular approach, 12 with Guglielmi detachable coils (GDC), and eight by parent-vessel occlusion using detachable balloons. Three patients had endovascular treatment after a failed or inadequate surgical attempt. Post-treatment follow-up was 17–183 months (mean 101 months) for surgically treated patients. For the GDC-treated group angiographic follow-up was carried at 8–49 months (mean 19 months). The condition of seven (27 %) of the surgically treated patients worsened due to procedure-related complications, compared with 10 % in the endovascular treatment group. Of the patients initially presenting with Hunt and Hess grade IV or V, three of five (60 %) died who were treated surgically and two of eight (25 %) who were treated endovascularly. A good outcome was achieved in 17 surgically treated patients (85 % of the survivors) and in 16 of the endovascular group (89 % of the survivors). This present “same-site” report on treatment of a specific abnormality, RIVAA, treated surgically or by an endovascular approach indicates that especially in poorer Hunt and Hess grade patients, the latter may offer a clinical outcome as good as that of surgery, although long-term efficacy of GDC treatment is still to be determined. Received: 4 April 1999/Accepted: 25 January 2000     

Neuroform3支架在急诊血管内栓塞破裂性颅内宽颈动脉瘤中的应用

目的 评价急诊血管内Neuroform3支架辅助下可解脱弹簧圈栓塞破裂的颅内宽颈动脉瘤的疗效和中期随访.方法 回顾性分析最近18个月急诊介入栓塞治疗的破裂出血性颅内动脉瘤48例,其中26例在72 h内实施Neuroform3支架辅助下弹簧圈栓塞术.其中3例动脉瘤位于大脑前动脉A1段,3例位于大脑中动脉M1和M2段,13例位于后交通,2例位于颈内动脉眼动脉段,2例位于基底动脉顶端,2例位于椎动脉V2和V4段,1例位于小脑后下动脉;3例在第1枚弹簧圈释放后植入支架,1例在第2枚弹簧圈释放后植入支架,2例在第4枚弹簧圈释放后植入支架,10例在第1枚弹簧圈无法在瘤腔内成篮后植入支架,其余10例先植入支架再进行弹簧圈栓塞,所有微导管均通过支架网眼进入动脉瘤.结果 所有病例均成功释放支架(100%),覆盖了瘤颈,同期行弹簧圈填塞动脉瘤.术后即刻造影显示动脉瘤完全栓塞23例(88.5%),次全栓塞3例(11.5%);术中1例支架轻度回撤,无血栓事件和动脉瘤再破裂出血发生,所有患者均恢复良好出院.栓塞术后随访到23例,至少复查1次脑血管造影,最多复查3次;完全致密栓塞14例(60.8%)动脉瘤均末显影,6例瘤颈少许显影病例中3例(11.5%)存在血栓形成,次全栓塞1例(3.3%)瘤体再通,另外2例始终稳定,所有病例载瘤动脉通畅,狭窄2例(7.7%),临床上无任何症状,术后所有患者均无再出血.结论 急症血管内应用Neuroform3支架辅助弹簧圈栓塞破裂出血的颅内宽颈动脉瘤足方便的、安全的和有效的.     

颅内动脉瘤破裂早期的血管内栓塞治疗

目的探讨颅内动脉瘤破裂早期血管内栓塞治疗的效果。方法２０例破裂的颅内动脉瘤采取早期血管内治疗技术，用自制的多形钨丝弹簧圈栓塞动脉瘤囊。动脉瘤的位置：前交通动脉（ＡＣｏＡ）７例，后交通动脉（ＰＣｏＡ）６例，中动脉（ＭＣＡ）２例，眼动脉１例，后循环４例。病人分级：ＨｕｎｔＨｅｓＩＩ级３例，ＩＩ级及ＩＶ级各７例，Ｖ级３例。１６例于３天内治疗，其余４例于６天内治疗。结果１８例闭塞９０％以上，其中８例动脉瘤完全闭塞（４０％），２例死亡。术后观察３个月～２年，１５例效果良好，３例残留轻～中度瘫痪，术后随访无一例发生蛛网膜下腔出血（ＳＡＨ）。结论血管内栓塞是治疗颅内动脉瘤急性期破裂的较好方法。     

The Amplatzer vascular plug for large vessel occlusion in the endovascular management of aneurysms

The Amplatzer vascular plug (AVP) is derived from the Amplatzer device used in correction of cardiac septal defects. We present a large series of the use of the AVP in the endovascular management of aneurysms. Three patients with a combination of aortic and peripheral aneurysms underwent embolisation with the AVP. Plugs with 10–16 mm diameter were used and delivered using introducer/guiding sheaths. A total of 16 internal iliac arteries, 2 common iliac arteries (CIA), 4 subclavian (SCA) arteries, 1 superior mesenteric (SMA) and 1 popliteal artery were embolised. Successful occlusion with the AVP was achieved in 21 out of 24 vessels (87.5%), of which 18 (75%) occluded immediately and 3 (12.5%) were delayed occlusions. The three patients who are considered to have failed to occlude with the AVP required the use of additional embolic agents. At the end of the 17-month follow-up all 24 target vessels had occluded. Two patients developed persistent buttock claudication, and one had a left hemiparesis. The AVP is useful as an adjunctive device in the management of aneurysms. It has a particular role in embolisation of large-diameter vessels with a short implantation zone. The device is safe and easy to use.     

破裂出血动脉瘤的早期栓塞治疗与脑血管痉挛

目的　分析血管内栓塞治疗急性破裂出血动脉瘤脑血管痉挛的发生及治疗。方法　Hunt HessⅠ～Ⅲ级并在发病后 72h内进行介入治疗的动脉瘤患者 32 9例 ,症状性血管痉挛的诊断根据迟发性神经功能损害 ,并有TCD和 (或 )脑血管造影的证据。结果　共发生症状性血管痉挛 6 2例 (18.2 % ) ,血管痉挛的发生率和Hunt Hess分级及Fisher分级有显著的相关关系 ,6 2例发生症状性脑血管痉挛患者中恢复良好 4 1例 ,中度致残 13例 ,重度致残 6例 ,死亡 2例。结论　GDC栓塞治疗动脉瘤后症状性血管痉挛的发生率并不高于常规手术治疗 ;放置腰椎蛛网膜下腔持续引流可能对降低症状性脑血管痉挛的发生有积极意义。     

A computerised relational database for auditing endovascular treatment of patients with intracranial aneurysms

We describe the development and design of a database for auditing patients with intracranial aneurysms and their endovascular treatment. The database has been used since 1992. Our department's version now contains records of over 800 patients and well over 1000 aneurysms. The advantages of a relational database for this type of audit are discussed. Copies of the software can be obtained free of charge from the authors. Received: 16 November 1999/Accepted: 28 February 2000     

联合血管内外神经介入技术治疗急性期破裂颅内动脉瘤

目的　评估联合血管内外神经介入技术治疗急性期破裂颅内动脉瘤 (aneurysm ,AN)的疗效。方法　对 4 0例急性破裂期AN采用电解脱弹簧圈栓塞 ,随后穿刺腰蛛网膜下腔 ,导丝导向的微导管在透视下插管至枕大池 ,2h后注入 10万U尿激酶 (UK)溶解血块并经微导管持续引流血性脑脊液。根据CT复查结果决定是否继续注射UK。结果　AN栓塞及枕大池插管均获成功 ,无技术相关并发症 ,术后 3～ 7d时的CT见所有患者脑池内的出血消失。除 1例有一过性症状性脑血管痉挛 (CVS)外 ,其余患者无症状性CVS、所有患者无AN再出血。结论　联合血管内外神经介入技术既闭塞了AN ,又清除了蛛网膜下腔积血 ,可防止再出血和继发性CVS的发生 ,达到了对因、对症治疗的双重目的。     

Anatomical and morphological factors correlating with rupture of intracranial aneurysms in patients referred for endovascular treatment

The size of intracranial aneurysms is the only characteristic shown to correlate with their rupture. However, the critical size for rupture has varied considerably among previous accounts and remains a point of controversy. Our goal was to identify statistically significant clinical and morphological factors predictive of the occurrence of rupture and aneurysm size in patients referred for endovascular treatment. We retrospectively recorded the following factors from 74 patients who presented with ruptured (40) or unruptured (34) aneurysms: aneurysm morphology (uni/multilobulated), location (anterior/posterior), maximum diameter, diameter of the neck, and the patient's age and sex. We performed stepwise discriminant, and stepwise and logistic regression analysis to identify factors predicting rupture and the size of the aneurysm at rupture. The mean diameter of the ruptured aneurysms was 11.9 ± 6.3 mm, range 3.0–33.0 mm, and that of the unruptured aneurysm 13.5 ± 5.8 mm, range 5.0–30 mm. Stepwise discriminant analysis identified aneurysm morphology (P < 0.001) and location in the intracranial circulation (P < 0.001) as statistically significant factors in predicting rupture. Stepwise regression analysis revealed that aneurysm morphology and the size of the neck were predictors of aneurysm size at rupture. Received: 30 December 1997 Accepted: 28 April 1998     

Post-procedure migration of Guglielmi detachable coils and Mechanical detachable spirals

We describe a previously unreported complication of the use of Guglielmi detachable coils and Mechanical detachable spirals in endovascular treatment of intracranial aneurysms. We document four cases in which migration of part of a coil into the parent artery occurred after completion of the procedure. Possible mechanisms are discussed. Received: 18 August 1998 Accepted: 26 October 1998     

Stent-assisted coil embolization of intracranial wide-necked aneurysms

The endovascular treatment of cerebral aneurysms with coils poses significant technical challenges, particularly with respect to wide-necked aneurysms. We present the results of our initial experiences in using a stent for endovascular treatment of aneurysms, with an emphasis on potential applications, technical aspects, and associated complications. Twenty-three wide-necked aneurysms from 22 patients were treated during the 13-month study period. Seven patients presented with subarachnoid hemorrhage. Aneurysms were located at the internal carotid artery (n=14), the vertebral artery (n=3), the basilar artery (n=5), and the middle cerebral artery (n=1). A Neuroform stent² was used for stent-assisted procedures. Premedication with antithrombotic agents was available for unruptured cases. Postprocedural antithrombotic medication was prescribed for all patients. Nineteen aneurysms were primarily stented, followed by coil placement. For five of these aneurysms, stenting was performed subsequent to failure of an attempt to frame with an initial coil. Stenting for the remaining four aneurysms was performed as a rescue procedure to prevent the migration of previously placed coils. Complete occlusion was obtained in ten aneurysms, nearly complete occlusion (95% or more occluded) in 11 aneurysms, and partial occlusion (less than 95% occluded) in one aneurysm. In one aneurysm, we failed to navigate the microcatheter into the aneurysmal sac through the interstices of the stent. Stent thrombosis was noted during the procedure in one patient. Hemorrhagic complication on the 25th day after the procedure was noted in one patient. No procedure-related complications were observed during the procedure or during follow-up in the remaining 20 patients, including seven patients who did not receive antithrombotic agents prior to endovascular treatment owing to recent subarachnoid hemorrhage. To overcome the technical limitation in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, even though longer periods of follow-up are required.     

以突发截瘫为临床表现的前交通动脉瘤破裂临床观察

目的 探讨以截瘫为临床表现的破裂前交通动脉瘤的发病原因,总结诊断要点和治疗方法.方法 回顾性分析2012年1月-2015年3月山西省人民医院神经外科收治的6例以截瘫为临床表现的破裂前交通动脉瘤患者的CT、MR、数字减影血管造影(DSA)资料及出现截瘫的原因,根据原因进行动脉瘤栓塞及抗血管痉挛治疗.结果 6例破裂前交通动脉瘤患者除头痛及颈部不适症状外,5例伴有双下肢截瘫,1例为四肢瘫,经动脉瘤血管内栓塞及抗血管痉挛对症治疗,截瘫肢体肌力由发病时的0-Ⅰ级恢复至Ⅳ-Ⅴ级,基本可正常生活,其中2例肌力恢复所需时间较短,约2周,余4例患者3个月内恢复.术后半年及1年随访患者肢体肌力完全恢复.结论 以截瘫为临床表现的破裂前交通动脉瘤,其发病原因倾向于动脉瘤破裂出血致大脑初级运动区及辅助运动前区供血不足,出现截瘫甚至四肢瘫.采用介入栓塞动脉瘤防止动脉瘤再次出血,术后辅以抗血管痉挛及改善神经功能的对症治疗,截瘫症状可逐渐恢复.     

脑血管痉挛高峰期栓塞破裂脑动脉瘤

目的 分析脑血管痉挛(cerebral vasospasm，CVS)高峰期栓塞破裂脑动脉瘤的经验。方法 回顾分析37例在CVS期(破裂后4～14d)进行的血管内治疗病例资料，分析其特点。A组14例在脑血管造影上可见CVS；B组23例无CVS。除2例外，余均为破裂第4天起入院。均在治疗后3个月时进行格拉斯哥后果评分(Glasgow outcome score，GOS)。结果 A组中有2例因微导管无法通过载瘤动脉而放弃，余12例成功地进行了动脉瘤栓塞和动脉内罂粟碱注射，并有3例行球囊成形术，该12例患者3个月时GOS评分优良7例、中残2例、重残1例、死亡2例。B组患者均成功地接受了栓塞术，GOS优良18例、中残2例、重残2例、死亡1例。结论 CVS期并不都伴发CVS，在CVS期进行血管内治疗并不增加危险，可同时治疗动脉瘤和伴发的CVS，可降低因等待手术而发生的院内再出血和改善CVS患者的预后。     

电解铂金圈栓塞治疗颅内动脉瘤

目的　评估颅内动脉瘤电解脱铂金圈 (EDPC)栓塞治疗的临床疗效 ,探讨手术时机及术中操作注意事项。方法　 1999年 2月至 2 0 0 4年 7月用EDPC栓塞治疗颅内动脉瘤 5 8例。其中 5 6例为蛛网膜下腔出血 (SAH)病例 ,术前Hunt&Hess氏分级 :Ⅰ级 36例 ,Ⅱ级 12例 ,Ⅳ～Ⅴ级 8例。本组 5 8例 6 0个动脉瘤 ,均采用EDPC治疗。放置铂金圈过程中及解脱后及时行数字减影血管造影 ,以了解动脉瘤腔栓塞情况。结果　 5 8例中 ,前循环动脉瘤 5 1例 ,后循环动脉瘤 7例。多发性动脉瘤 3例。 5 8例颅内动脉瘤患者 6 0枚动脉瘤 ,5 8枚动脉瘤栓塞成功 ,2枚因载瘤动脉严重痉挛失败 ,手术成功率为 96 .6 %。按动脉瘤的填塞程度分为 :完全填塞 4 4 (75 .9% )例 ;不完全填塞 12 (2 0 .7% )例。本组非血栓性并发症发生率 6 .9% ,1例因EDPC疝入载瘤动脉发生偏瘫。无血栓形成及血栓性栓塞并发症 ,本组无死亡病例。本组 4 1例患者经 1～ 4年随访 ,无SAH再复发病例。结论　EDPC栓塞治疗动脉瘤是目前比较理想的治疗方法 ,其疗效确切、创伤小、恢复快。     

经颅多普勒在前循环动脉瘤破裂致脑血管痉挛中的应用价值

目的 探讨经颅多普勒(TCD)在前循环动脉瘤破裂致症状性脑血管痉挛中的应用价值.方法 回顾性分析我院神经外科2010年4月～2020年4月收治的前循环动脉瘤性蛛网膜下腔出血,诊断为症状性脑血管痉挛的患者62例,所有患者在发病后连续每天行TCD检查,连续观察大脑中动脉血流速度,诊断为症状性脑血管痉挛后行脑血管造影检查(D...     

脑血管痉挛高峰期栓塞破裂颅内动脉瘤

目的　分析脑血管痉挛 (CVS)高峰期栓塞破裂颅内动脉瘤的经验。方法　回顾 37例在CVS期 (破裂后 4～ 14d)进行的血管内治疗 ,A组 14例在脑血管造影上可见CVS ;B组 2 3例无CVS。除 2例外 ,余均为破裂第 4天起入院。结果　A组中有 2例因微导管芜法通过载瘤动脉而放弃 ,余 12例成功地进行了动脉瘤栓塞和动脉内罂粟碱注射 ,并有 3例行球囊成形术 ,该 12例患者病后 3个月时格拉斯哥后果评分 (GOS)优良 7例、中残 2例、重残 1例、死亡 2例。B组患者均成功地接受了栓塞术 ,GOS优良 18例、中残 2例、重残 2例、死亡 1例。结论　所谓的CVS期并不都伴发CVS ,在CVS期进行血管内治疗并不增加危险 ,可同时治疗动脉瘤和伴发的CVS ,可降低因等待手术而发生的院内再出血和改善CVS患者的预后。