Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience

BACKGROUND AND PURPOSE: Currently available stents for intracranial use usually are balloon-expandable coronary stents that carry the risk of damaging a dysplastic segment of the artery, with potential vessel rupture. We assessed the technical feasibility and efficacy of the combined application of a flexible, self-expanding neurovascular stent and detachable coils in the management of wide-necked intracranial aneurysms in humans. METHODS: Four consecutive patients with a wide-necked intracranial aneurysm were treated with a combined approach that consisted of delivery of a flexible self-expanding neurovascular stent through a microcather to cover the neck of the aneurysm and subsequent filling of the aneurysm with coils through the stent interstices. The aneurysms were located at the internal carotid artery (n=2) and the basilar tip encroaching the P1 segment (n=2). Previous attempts with conventional endosaccular coil packing alone failed in all cases. RESULTS: Stent placement in the desired position with complete or nearly complete occlusion of the aneurysms was feasible in all patients. In one patient, aneurysm perforation with the microcatheter occurred and necessitated ventricular drainage, which led to a large parenchymal and intraventricular hemorrhage because of the strong anticoagulation regimen. Six-month follow-up demonstrated no focal neurologic sequelae in any of the patients, except slight memory dysfunction in the patient with bleeding. CONCLUSION: Preliminary data demonstrate that this extremely flexible stent is technically easy to deploy and can be easily and safely maneuvered through severely tortuous vessels, enabling the treatment of intracranial wide-necked aneurysms. The combination of endovascular reconstruction of the parent vessel with use of a self-expanding stent followed by coil embolization offers a promising therapeutic alternative for wide-necked aneurysms not amenable to coil embolization alone. Although immediate angiographic results are promising, long-term angiographic and clinical follow-up is essential to determine permanent vessel patency and aneurysm occlusion rate.     

Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: a single center experience

Objective

The aim of the present retrospective study is to compare outcome of the endovascular treatment using the Enterprise stent in intracranial wide-necked saccular and dissecting aneurysms.

Methods

Forty-six patients with 50 complex intracranial aneurysms admitted between June 2009 and November 2010 were treated using Enterprise stents. Thirty-one aneurysms were wide-necked saccular, 19 aneurysms dissecting. In 48 cases, aneurysms were occluded by stent-assisted coiling; in 2 cases, by stent alone.

Results

Among the aneurysms treated with the Enterprise stent, patient sex, aneurysm location, hypertension history and the immediate angiographic results differed significantly between the saccular and dissecting aneurysm groups. However, recurrence rate, clinical follow-up outcomes did not differ significantly between the saccular and dissecting groups. There was 1 (2%) procedure-related complication, which caused death in the saccular group. At mean 9.1-month follow-up, the result was good in all dissecting cases and good in 30 saccular cases. There was 1 recurrence in each group.

Conclusions

Enterprise stent is very useful for endovascular embolization of intracranial wide-necked saccular and dissecting aneurysms because it is easy to navigate and place precisely. The overall morbidity and mortality rates were low.     

Early and midterm results of complex cerebral aneurysms treated with Silk stent

Introduction

Endovascular treatment of intracranial aneurysms has been an effective treatment option. In this paper, we report our experience with the Silk stent (SS) for endovascular treatment of complex intracranial aneurysms and present periprocedural events, immediate results, delayed complications, and imaging and clinical follow-up results.

Methods

We retrospectively examined angiographic images and clinical reports of 76 consecutive patients with 87 intracranial aneurysms who were treated with SSs between March 2008 and June 2011.

Results

All aneurysms could be successfully covered technically using implanted SSs, with an overall mortality of 6.6?%. Two transient morbidities (2.6?%) and three permanent morbidities due to embolic events (3.9?%) were observed. Unexpected procedural technical events occurred in 18 procedures (18/78, 23.1?%). Control angiographies were performed in all 71 patients with 82 aneurysms (100?%). Mean angiographic follow-up time was 17.5?±?11.1?months [range 2?C48?months]. Sixteen of the 71 patients with 19 aneurysms had only early angiographic controls in the first 6?months while remaining 55 patients with 63 aneurysms (77.5?%) had late controls after 6?months. Overall control angiographic occlusion rates were as follows: 87.8?% (72/82) total occlusion, 8.5?% residual aneurysm filling, and 3.7?% residual neck filling. The general in-stent stenosis rate in controls was 5.6?% and the stented parent artery occlusion rate was 4.2?%. Five (6.6?%) aneurysms ruptured after stent implantation in our series.

Conclusion

The Silk stent is an effective tool for the treatment of challenging aneurysms, which have previously demonstrated higher re-growth rates and technical problems, despite unexpected higher hemorrhage rates after treatment and deployment difficulties.     

新型颅内支架Enterprise结合水解脱弹簧圈栓塞治疗颅内微小宽颈动脉瘤

目的总结应用新型颅内支架Enterprise结合水解脱弹簧圈栓塞治疗颅内微小宽颈动脉瘤的技术及疗效。方法6例颅内微小宽颈动脉瘤(直径<3mm,体/颈比<1.5)采用Enterprise支架结合水解脱弹簧圈栓塞,其中5例采用先放置支架覆盖动脉瘤颈再将微导管经支架网孔放入动脉瘤腔填塞弹簧圈进行栓塞,1例将微导管进入瘤腔后再释放支架进行弹簧圈栓塞。术后3～6个月进行临床随访。结果6例全部技术成功,支架均满意到位,载瘤动脉通畅,无手术并发症;动脉瘤完全闭塞4例,闭塞95%以上2例。术后患者均恢复良好,3～6个月临床随访无再出血及脑血栓形成。结论联合使用Enterprise支架和水解弹簧圈栓塞治疗颅内微小宽颈动脉瘤是一种安全有效的方法,但其长期疗效仍需进一步观察。     

Enterprise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤的临床研究

目的初步探讨和总结应用EnterPrise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤的技术及疗效。方法收治8例前交通宽颈动脉瘤(体/颈比<1.5)患者,均采用Enterprise支架辅助水解脱弹簧圈栓塞,其中6例先放置支架覆盖动脉瘤颈再将微导管经支架网孔放入动脉瘤腔填塞弹簧圈进行栓塞,2例在微导管进入瘤腔后再释放支架进行弹簧圈栓塞。术后6～12个月进行临床和DSA随访。结果 8例全部技术成功,支架到位满意,载瘤动脉通畅,无手术并发症;其中动脉瘤完全闭塞7例,闭塞95%以上1例,患者术后均恢复良好,临床随访6～12个月无再出血及脑血栓形成,其中DSA随访6例无支架狭窄及动脉瘤再通。结论 Enterprise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤是一种安全、可靠、有效的治疗方法,但其长期疗效仍需进一步观察。     

Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience

BACKGROUND AND PURPOSE: Endovascular treatment of wide-necked aneurysms remains a therapeutic challenge. We conducted this study to evaluate the angiographic results and clinical outcome of patients treated with stent-assisted coiling by using a recently available self-expandable intracranial stent. METHODS: A retrospective review of all patients treated with self-expandable stent-assisted coiling between September 2002 and December 2003 was done. Treatment was attempted in 32 patients with 35 aneurysms. Four of the aneurysms were ruptured. All had either a dome-to-neck ratio less than 2 and/or a neck diameter of 5 mm or larger. Following stent placement, coiling was attempted in 33 of 34 aneurysms. The technical success of the procedure, procedure related complications, and the angiographic results were documented. RESULTS: In 34 of 35 aneurysms, stent deployment across the neck of the aneurysm was successful. Coiling was performed successfully in 30 of 33 aneurysms. In 20 aneurysms, immediate posttreatment angiography showed either total (17%) or satisfactory (50%) occlusion. Procedure-related mortality occurred in one patient (3.1%). Adverse events occurred in eight patients (25%); in three of them permanent neurologic deficit resulted (9.3%). In six patients, thrombus formation occurred within the stented segments during the procedure and reopro infusion was used. Follow-up angiography was available in 12 (40%) of 30 treated aneurysms. CONCLUSION: In our practice use of the self-expandable stent seemed to facilitate endovascular treatment of wide-necked intracranial aneurysms. Difficulty of deployment and stent thrombogenicity are the main drawbacks of the system.     

Neuroform颅内支架辅助栓塞宽颈颅内动脉瘤的初步经验

目的　报道我科使用Neuroform支架辅助可脱式弹簧圈栓塞宽颈脑动脉瘤的初步经验。方法　 2 2例 2 4枚宽颈颅内动脉瘤采用Neuroform支架和弹簧圈进行栓塞 ,其中急性破裂动脉瘤 19枚、未破裂动脉瘤 5枚。结果　支架均成功地释放 ,支架置入后的造影未发现有瘤内造影剂滞留的血流动力学改变。 10 0 %闭塞动脉瘤 18枚 ,90 %以上闭塞 5枚 ,1枚伴发的未破裂小型宽颈动脉瘤在支架置入后微导管无法超选 ,载瘤动脉均通畅。有 2枚动脉瘤虽有支架阻挡 ,但仍有部分弹簧圈畔进入载瘤动脉。所有患者没有出现与支架置入有关的症状性缺血性并发症。 17例造影随访中 ,有 1例在 3个月复查时发现再通 ,进行 2次栓塞完全闭塞动脉瘤 ,其余未见复发 ,结论　Neuroform颅内支架使用安全有效 ,适合于宽颈颅内动脉瘤的支架辅助弹簧圈栓塞 ,特别适合于迂曲的脑血管 ;其径向支撑力较差 ,在输送微导管时应防止其移位 ;其支架网眼较大 ,对血流动力学改变不明显 ,致密填塞是重要的 ,在输送弹簧圈时仍应防止弹簧圈畔进入载瘤动脉 ;术前、术后抗血小板药物的应用以及术后严格的系列造影随访是必要的。     

支架结合弹簧圈治疗颅内宽颈动脉瘤急性破裂的可行性和安全性

目的　总结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急性破裂的临床体会 ,对其可行性和安全性进行初步探讨。方法　 5 7例急性破裂宽颈动脉瘤 ,均先植入冠脉支架覆盖动脉瘤颈 ,再将微导管通过支架网孔超选进入动脉瘤腔内填塞GDC。结果　 1例因血管扭曲不能植入支架 ,5 6例成功 ,均达到 90 %以上栓塞 ,载瘤动脉通畅 ,所有患者无神经功能障碍出现。结论　血管内支架植入结合GDC填塞是治疗急性破裂宽颈动脉瘤的安全、可行的方法     

Horizontal stent-assisted coil embolisation of wide-necked intracranial aneurysms with the Enterprise stent—a case series with early angiographic follow-up

Introduction  The purpose of the study is to describe our experience in eight cases of horizontal stenting across the circle of Willis in patients with terminal aneurysms. Methods  Eight patients were treated with horizontal stent placement and aneurysm coiling. All aneurysms had highly unfavourable dome to neck ratios. All patients were followed up with digital subtraction angiography at 3–12 months following treatment. Results  The Enterprise stent was successfully deployed horizontally in vessels of less than 2-mm diameter with no stent occlusion. Neurological complications occurred in one patient. Immediate and follow-up angiographic results were encouraging with six stable occlusions at 6 months. There was one asymptomatic case of in-stent stenosis and one case of late organised in-stent thrombus. Conclusions  Horizontal deployment of the Enterprise stent to assist coil embolisation of wide-necked terminal aneurysms is feasible. This device can be navigated via relatively small communicating arteries, in cases with favourable anatomy. Early angiographic results were favourable; however, longer-term follow-up will be required.     

Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results

BACKGROUND AND PURPOSE: We present our preliminary experience, including mid-term angiographic and clinical follow-up results, with an alternative technique for the endovascular treatment of intracranial aneurysms in a series of patients. This new method, previously described in anecdotal case reports, consists of endovascular deployment of an artificial vessel graft (stent graft or covered stent) in the parent vessel to exclude the intracranial aneurysm sac from circulation. METHODS: Twenty-five internal carotid artery (ICA) aneurysms in 24 patients were successfully treated by using a Jostent coronary stent graft deployed in the parent artery across the aneurysm neck. All except four aneurysms were extradural, located in the petrous or cavernous portion of the ICA. The four intradural aneurysms were located in the carotico-ophthalmic region. Seventeen aneurysms in 16 patients occurred posttraumatically, secondary to motor vehicle accidents or surgical injury. RESULTS: Twenty-three aneurysms were immediately excluded from circulation after stent graft placement. In two aneurysms, a slow contrast material filling (endoleak) into the aneurysm cavity was observed immediately after treatment. One was thrombosed, as shown by late control angiography; in the other one, a second larger bare stent was used to appose the stent graft's distal end to the ICA wall, thus sealing the endoleak into the distal graft. No technical adverse event, including vessel dissection, vessel perforation, or thromboembolism, occurred with or without clinical consequence. No mortality or morbidity developed during or after the procedure, including the follow-up period. Two-year control angiography in one patient, 1.5-year control angiography in two patients, 1-year control angiography in six patients, and 6-month control angiography in 12 patients were performed, revealing reconstruction of the ICA with no aneurysm recanalization. All symptoms resolved after treatment in the patients who had initially presented with mass effect. CONCLUSION: Initial anatomic, clinical and mid-term follow-up results in this small series of patients are encouraging. This technique has been proved to have potential in the reconstructive treatment of intracranial aneurysms. Further research and development are needed to optimize the stent graft technology for the cerebrovascular system.     

支架技术在颅内复杂动脉瘤治疗中的应用

目的探讨支架在颅内复杂动脉瘤中的治疗技术及应用价值。方法回顾性分析应用支架技术辅助栓塞治疗的31例颅内动脉瘤患者（宽颈动脉瘤28例,梭形动脉瘤3例）的临床资料。术中将支架引至动脉瘤处释放支架覆盖动脉瘤颈,并结合弹簧圈栓塞术。结果 31例共置入支架32枚,其中Enterprise支架24枚,LEO支架5枚,Solitaire AB支架3枚。采用单纯支架置入技术2例,此2例微小动脉瘤术后见瘤腔内造影剂滞留。支架结合弹簧圈治疗29例,其中支架先释放技术7例,支架后释放技术22例,支架结合弹簧圈治疗组取得满意疗效。术后即刻栓塞结果按改良的Raymond分级：动脉瘤体完全栓塞20例（Ⅰ级）,瘤颈残留7例（Ⅱ级）,瘤体显影2例（Ⅲ级）。随访1～6个月未发生再出血及缺血并发症。结论支架辅助栓塞技术是治疗颅内动脉瘤安全有效的方法,可提高动脉瘤栓塞的致密程度,采用支架后释放技术使绝大多数颅内复杂动脉瘤的介入治疗成为可能。     

LVIS支架辅助栓塞颅内破裂动脉瘤的有效性和安全性

目的：分析Lvis支架辅助栓塞颅内破裂动脉瘤的有效性及安全性。 方法：回顾性分析2014年4月至2018年2月在郑州大学第一附属医院神经介入科接受Lvis支架辅助栓塞颅内破裂动脉瘤的230例患者的临床资料,分析患者术后即刻的疗效及随访疗效,收集围手术期并发症发生情况,分析其出血事件发生率、缺血事件发生率、致死率和残疾率。 结果：230例患者术后即刻手术效果：Raymond Ⅰ级205例（89.1%）,Raymond Ⅱ级25例（10.9%）。术后12个月,180例患者获得随访,临床效果：Raymond Ⅰ级162例（90%）,Raymond Ⅱ级17例（9.6%）,Raymond Ⅲ级1例（0.4%）。230例患者发生并发症共计24例（14.0%）,1例（0.4%）术中动脉瘤破裂再出血,1例（0.4%）术后出现再出血,12例（5.2%）术中或术后支架内血栓,支架内血栓患者中3例（1.2%）出现缺血并发症,术后未发现支架内血栓或闭塞患者出现缺血并发症患者10例（4.3%）,所有并发症患者中出现8例致残（3.5%）,致死2例（0.8%）。 结论：Lvis支架辅助栓塞颅内破裂动脉瘤安全有效。     

GDC 360° for the endovascular treatment of intracranial aneurysms: a matched-pair study analysing angiographic outcomes with GDC 3D Coils in 38 patients

Introduction  The purpose of this study was to determine whether coil embolisation with a new complex-shaped Guglielmi Detachable Coil (GDC 360°; Boston Scientific Neurovascular, Fremont, CA, USA) has any effect on the stability of aneurysm occlusion. Materials and methods  Fifty-one consecutive patients with intracranial aneurysms treated with GDC 360° were included. Angiographic results and adverse neurological events during the follow-up period were recorded. For 38 patients treated with GDC 360° with available follow-up data, a corresponding patient treated with GDC 3D was identified from our database. Matches were sought for rupture status, location, aneurysmal size, and neck size. The angiographic outcome of these matched controls at 6 months was compared to aneurysms treated with GDC 360°. Results  Initial angiographic controls for 38 patients treated with GDC 360° showed complete occlusion in 32 aneurysms, and a neck remnant in six. At 6-month follow-up, complete occlusion was found in 29, a neck remnant in eight, and a residual aneurysm in one. One patient treated with GDC 360° needed retreatment for a major recanalisation. In 38 matched patients treated with GDC 3D, initial angiographic controls found complete aneurysmal occlusion in 30 aneurysms and a residual neck in 8. At 6-month follow-up, 24 aneurysms were completely occluded, ten showed a neck remnant, and residual aneurysms were seen in four. Four patients, treated with GDC 3D, were retreated for major aneurysm recanalisations. Conclusion  Our data suggests that endovascular coil embolisation with GDC 360° might improve long-term stability of coiled aneurysms when compared to GDC 3D.     

Endovascular treatment of giant or very large intracranial aneurysms with different modalities: an analysis of 20 cases

Introduction The aim of this retrospective study was to evaluate the clinical efficacy and limitations of different endovascular modalities in the treatment of very large and giant intracranial aneurysms. Methods A group of 20 patients with very large and giant intracranial aneurysms treated by endovascular approaches were retrospectively analyzed. Of the 20 patients, 9 had been treated by parent artery occlusion, 8 by coil embolization, and 3 with an intracranial covered stent. Two recurrent aneurysms initially treated with coil embolization were retreated with an intracranial covered stent. Patients were followed for 9–83 months after the procedure. Results Endovascular treatment was technically feasible in all 20 patients. One patient died 7 days after the procedure from rebleeding caused by incomplete aneurysmal occlusion. Immediate postprocedural angiograms showed that complete occlusion was achieved in 11 aneurysms, subtotal occlusion in 7, and incomplete occlusion in 2. The final angiographic results in the other 19 surviving patients confirmed complete occlusion of 15 aneurysms, subtotal occlusion in 3, and incomplete occlusion in 1. Clinical evaluations performed at the final follow-up visit showed an excellent outcome in 11 patients and a good outcome in 8. Conclusion Endovascular treatment of giant intracranial aneurysms with coil embolization is often associated with a low complete occlusion rate and a high recanalization rate, and parent artery occlusion remains a practical option in selected patients. Based on our limited experience, the use of an intracranial covered stent appears to be a relatively simple and safe procedure for occluding very large and giant aneurysms while still maintaining the patency of the parent artery.     

支架辅助弹簧圈介入栓塞颅内宽颈动脉瘤

目的探讨支架辅助弹簧圈介入栓塞治疗颅内宽颈动脉瘤的方法和疗效。方法回顾性分析16例患者的临床资料,应用支架包括Neuroform 6枚和Fnterprise 10枚。结果所有支架均成功释放并行弹簧圈栓塞,即刻造影动脉瘤获得完全及大部分栓塞13例,瘤颈残留1例,部分栓塞2例.14例患者术后3～12个月复查,13例完全及大部分栓塞中11例复查未见复发,瘤颈残留1例6个月后复查复发,再次行支架植入完全栓塞.部分栓塞2例复查时瘤腔消失。结论通过支架辅助对宽颈动脉瘤瘤颈重塑及弹簧圈的介入栓塞作用,使动脉瘤栓塞疗效满意。     

支架治疗颈内动脉分叉部宽颈动脉瘤

目的初步评价支架治疗颈内动脉分叉部宽颈动脉瘤的可行性、安全性和有效性。方法收集2004年1月至2010年12月11例颅内动脉瘤患者,共检出16枚颅内动脉瘤。其中位于颈内动脉分叉部的11枚动脉瘤均为宽颈动脉瘤,动脉瘤直径2.5～18 mm。所有患者采用不同类型支架及支架技术治疗,并于术后1、3、6、12个月进行随访。结果治疗中采用不同类型支架11枚,其中球扩支架1枚,自膨胀支架10枚。动脉瘤即刻栓塞结果按Raymond分级.Ⅰ级4枚,Ⅱ级2枚,Ⅲ级5枚。未发生手术相关并发症,出院时改良Rankin评分0～1分11例。11例患者随访1～108个月,均病情稳定,无新发的神经功能障碍。影像学随访7例,随访时间1～48个月,动脉瘤不显影4例,改善2例,稳定1例。结论对于颈内动脉分叉部宽颈动脉瘤,支架治疗技术可行,且安全有效,长期疗效有待于进一步研究。     

Endovascular treatment of renal aneurysms: A series of 18 cases

Purpose

To retrospectively analyze the results and complications of the endovascular treatment of 18 renal aneurysms.

Methods

From 2002 to 2011, 15 patients (aged 31–76), with 18 renal aneurysms, were admitted in our institution for treatment by embolization. Except one, all were wide-necked aneurysms. One aneurysm was treated by occluding the parent artery considering its distal location; a small-necked aneurysm was treated by simple coiling, and the remaining 16 were embolized utilizing adjunctive techniques to protect the parent artery. We analyzed the rates of technical success, complication and clinical consequence, post-operative occlusion and recurrence.

Results

There was a 100% technical success rate. 15 aneurysms showed a total occlusion on the post-treatment angiogram. 2 aneurysms demonstrated neck remnants, and one had an intrasaccular residual in-flow. Two minor post-operative complications were encountered but resolved over time. No delayed clinical complications were observed and the long-term angiographic follow-up demonstrated stability of the occlusion of the target renal aneurysm with no major recurrence.

Conclusion

Complications of the embolization of renal aneurysms are rare. Endovascular treatment should therefore be considered at first for the treatment of renal aneurysms.     

Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils

BACKGROUND AND PURPOSE: Intravascular treatment of intracranial aneurysms is a relatively new therapeutic technique and long-term controlled angiographic trials are needed to assess persistence of aneurysm occlusion. Our purpose was to evaluate the effectiveness of 3D time-of-flight (3D-TOF) MR angiography as a noninvasive screening tool in the follow-up of cerebral aneurysms treated with Guglielmi detachable coils (GDCs). METHODS: Forty-nine patients with 50 intracranial aneurysms previously treated with GDCs were studied with both DSA and 3D-TOF MR angiography. In 14 cases, a second follow-up examination was performed, for a total of 64 aneurysms evaluated. In 25 aneurysms, both pre- and postcontrast MR angiographic studies were obtained. RESULTS: In seven of 64 aneurysms, the MR angiographic studies were considered to be unreliable owing to the presence of artifacts that obscured part of the parent artery and did not allow an accurate evaluation of the aneurysm neck. These seven aneurysms, however, all were shown to be completely occluded at digital subtraction angiography (DSA). In the remaining 57 aneurysms, DSA revealed complete occlusion in 39 and the presence of residual patency in 18, whereas MR angiography showed complete occlusion in 38 and residual patency in 19. Enhanced MR angiography proved to be useful in evaluating residual patency in large and giant aneurysms and in better depicting the distal branch arteries. CONCLUSION: Although artifacts related to the presence of coils are evident on a considerable number of imaging studies, our findings indicate that MR angiography is useful in the evaluation of residual patency of cerebral aneurysms treated with GDCs and may eventually prove valuable in the follow-up of those cases in which a good initial correlation with DSA was demonstrated.     

Treatment and follow-up of 22 unruptured wide-necked intracranial aneurysms of the internal carotid artery with Onyx HD 500

BACKGROUND AND PURPOSE: The purpose of this study was to demonstrate endovascular treatment of wide-necked aneurysms of the internal carotid artery with the liquid embolic agent Onyx HD 500. METHODS: Twenty-two wide-necked, large or giant aneurysms of the internal carotid artery (ICA) were treated in 22 patients with Onyx HD 500 (15 ophthalmic, 1 clinoid, and 6 cavernous aneurysms). Sixteen patients were asymptomatic, and mass effect of the aneuryms caused cranial nerve palsy in 6. Seven aneurysms showed regrowth after prior endovascular coiling. RESULTS: Postinterventional angiography demonstrated total occlusion in 18 aneurysms, and a small remnant was left in 4. Clinical and angiographic follow-up data are available in 19 patients (average follow-up, 13 months; range, 5-36 months). Total occlusion was demonstrated in 17 aneurysms (91%), and a partial recanalization was seen in 2. There were 2 ICA occlusions and 1 ICA stenosis. Clinical follow-up demonstrated a transient ischemic attack in 1 patient; 2 with cranial nerve palsy were unchanged, and 2 showed improved symptoms compared with the findings before treatment. The remaining 14 patients were clinically asymptomatic. There was no permanent severe morbidity and no mortality at follow-up. CONCLUSION: The endovascular treatment of wide-necked, large or giant ICA aneurysms with Onyx HD 500 is a treatment option in these selected cases. The benefit is a primary high and stable occlusion rate and good clinical outcome. ICA occlusion caused by Onyx migration in the parent artery is a typical problem, with a benign clinical course in this series.     

血管内支架结合电解可脱弹簧圈治疗颅内动脉瘤

目的 初步总结使用血管内支架结合电解可脱卸弹簧圈（GDC）治疗颅内梭形及宽颈动脉瘤的体会,探讨其适应证、方法、疗效及并发症。方法 5例颅内梭形动脉瘤及12例宽颈动脉瘤,首先将冠脉支架跨动脉瘤颈放置,通过支架的网孔将微导管送入动脉瘤腔,继续填塞GDC。结果 13例动脉瘤致密填塞,3例大部分填塞,1例支架未能送入颅内而单用弹簧圈部分栓塞,载瘤动脉通畅,临床效果优良。结论 联合使用支架及微弹簧圈是治疗颅内梭形及宽颈动脉瘤的有效方法,远期疗效需进一步随访。