介入微弹簧圈栓塞术治疗颅内动脉瘤

目的探讨介入微弹簧圈栓塞治疗颅内动脉瘤技术,评价临床疗效。方法采用介入方法微弹簧圈栓塞术,对114例119枚颅内动脉瘤进行栓塞治疗。临床表现为自发性蛛网膜下腔出血者107例。119枚动脉瘤中宽颈动脉瘤24枚,其中5枚采用支架辅助技术进行栓塞;2枚椎动脉梭形动脉瘤均进行了隔断绝栓塞术。结果119枚动脉瘤中118枚成功栓塞,其中完全致密闭塞72枚(60.5%),接近完全闭塞30枚(25.2%)、大部分闭塞13枚(10.9%),部分闭塞3枚(2.5%),1枚未能栓塞(0.8%)。6例前交通动脉瘤患者出现术中动脉瘤破裂,均继续栓塞后达到了基本致密的填塞,5例基本康复,1例留下残疾。术后1个月内死亡3例(2.5%),均为Hunt-Hess分级Ⅳ～Ⅴ级的患者,死于原先的严重出血或继发的严重脑血管痉挛。结论介入微弹簧圈栓塞治疗颅内动脉瘤是安全、有效的临床技术,积极、及时的栓塞治疗可有效防止动脉瘤再破裂。     

电解可脱式微弹簧圈栓塞治疗颅内动脉瘤

目的：探讨电解可脱式微弹簧圈(GDC)栓塞治疗颅内动脉瘤的方法。方法：采用美国波士顿公司GDC栓塞治疗17例患者18个颅内动脉瘤，其中15例蛛网膜下腔出血患者，术前Hunt和Hess分级：I、Ⅱ级l0例；Ⅲ级3例；Ⅳ级2例。结果：13例痊愈，3例轻度短期神经功能障碍，1例死亡。结论：GDC栓塞是治疗颅内动脉瘤较为理想的方法之一。     

双微导管技术在宽颈颅内动脉瘤栓塞中的初步应用经验

目的　评估采用双微导管技术在宽颈颅内动脉瘤栓塞中的初步经验。方法　 6例宽颈动脉瘤在常规方法应用无效后采用双侧股动脉入路 ,把 2支微导管置入动脉瘤腔内 ,由微导管内同时或先后送入弹簧圈 ,待弹簧圈稳定后解脱 ,随后再送入更多的弹簧圈以达到致密填塞。结果　 6例AN成功地栓塞 ,10 0 %闭塞 2个、闭塞 >90 %的 4个。缺血性并发症 1例 ,导致中残。术后 3月时GOS优良 5例、中残 1例。有 5例进行了造影随访 ,无AN复发和再破裂。结论　双微导管技术对于某些复杂的宽颈动脉瘤是一种可供选择的方法。     

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。     

可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞大型颅内动脉瘤

目的 探讨可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞颅内大型动脉瘤的安全性和有效性。方法 可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞颅内大型动脉瘤4例,动脉瘤直径14～21mm,首先用可解脱弹簧圈在动脉瘤内成篮,然后用游离纤毛铂金弹簧圈进行篮内填塞,最后再用可解脱弹簧圈进行瘤体及瘤颈的致密栓塞。结果 3个动脉瘤获得完全致密栓塞,1个动脉瘤有瘤颈残留。临床随访3～12个月,无出血及脑缺血性事件发生。结论 可解脱弹簧圈结合游离纤毛铂金弹簧圈是一种可选的栓塞颅内大型动脉瘤安全、有效的方法。     

Midterm clinical experience with a complex-shaped detachable platinum coil system for the treatment of cerebral aneurysms: Trufill DCS Orbit detachable coil system registry interim results

PURPOSE: To report an interim analysis of the registry data and evaluate the performance of Trufill DCS Orbit coils in terms of the stability of initial aneurysmal occlusion. MATERIALS AND METHODS: From May 1, 2004, to February 1, 2006, 291 patients with ruptured or unruptured aneurysms were enrolled in a multiple-center global registry from 37 centers in the United States, Europe, and Latin America to be treated via endovascular embolization with Trufill DCS Orbit detachable platinum coils. Acute and long-term anatomic and clinical data were collected and evaluated. RESULTS: Initially, complete obliteration was reported in 187 of 300 treated aneurysms (62.3%) for which data were available; one treated aneurysm had no initial occlusion data. At follow-up (相似文献   

双微导管技术栓塞颅内宽颈不规则动脉瘤

目的评估双微导管技术在栓塞颅内宽颈、不规则动脉瘤的应用价值。方法收集经DSA造影确认的颅内宽颈不规整动脉瘤6例,采用单侧股动脉入路,把2支微导管置入动脉瘤腔内,由微导管内先后交替送入弹簧圈,待弹簧圈稳定后解脱,逐步达到致密填塞。结果 6例动脉瘤均成功栓塞,瘤腔闭塞均>90%。治愈5例,术中出血导致中残1例。随访6个月~2年,动脉瘤无复发。结论双微导管技术对于某些不规则的宽颈动脉瘤是一种较好的方法。     

Use of three-dimensional Guglielmi detachable coils in the treatment of wide-necked cerebral aneurysms

A three-dimensional Guglielmi detachable coil (3D-GDC) has been developed that is designed specifically to bridge the neck of an aneurysm with coil loops, thereby facilitating retention of additional coils placed within the aneurysm. Nine wide-necked cerebral aneurysms were successfully embolized using the 3D-GDC, provided that the dome-to-neck ratio was 1.5 or greater.     

水解可脱弹簧圈栓塞治疗破裂急性期颅内动脉瘤的体会

目的总结水解可脱弹簧圈(Trufill DCS,Trufill DCS Orbit)栓塞治疗破裂急性期颅内动脉瘤的体会。方法对35例颅内破裂动脉瘤,应用DCS或DCS ORBIT方法,在起病72 h内进行栓塞治疗。结果35例栓塞成功,100%栓塞29例,95%栓塞3例,90%栓塞2例,80%栓塞1例。1例并发术中破裂出血,1例并发血栓栓塞,预后较好。1例死于肺部感染。30例获得1~15个月临床随访,无再出血。16例获得3~12个月DSA随访,1例部分再通。结论颅内动脉瘤破裂急性期的患者,应急诊治疗。用DCS或DCS ORBIT栓塞治疗是一种安全、有效、可靠的治疗方法。     

可脱性弹簧圈栓塞治疗脑血管痉挛期颅内动脉瘤

目的　探讨可脱性弹簧圈在脑血管痉挛期 (4～ 14d)栓塞治疗颅内动脉瘤的方法及效果。方法　 2 0 0 4年 3～ 8月共栓塞颅内动脉瘤 14例 ,其中颈内动脉瘤 1例 ,后交通动脉瘤 8例 ,前交通动脉瘤5例 ,所有患者均在 4～ 14d内采用DCS MATRIX材料进行栓塞。结果　 11例栓塞 10 0 % ,2例栓塞 70 %～ 90 % ,1例栓塞 5 0 % ;其中有 6例发现有脑血管痉挛。结论　在脑血管痉挛期 ,血管内栓塞动脉瘤也是一种安全、微创、有效的治疗方法。     

水解脱铂金圈血管内栓塞治疗颅内动脉瘤

目的　介绍水解脱铂金圈 (TrufillDCS)系统栓塞治疗颅内动脉瘤的体会 ;探讨TrufillDCS系统在治疗颅内动脉病中的优、缺点及前景。方法　采用神经介入TrufillDCS系统栓塞治疗 5例 6枚颅内动脉瘤。结果　用水解脱铂金圈TrufillDCS系统成功地对 5例患者 6枚颅内动脉瘤进行了栓塞 ,10 0 %栓塞 2枚 ,95 %栓塞 3枚 ,90 %栓塞 1枚 ,无与栓塞材料有关的手术并发症发生。结论　使用TrufillDCS系统栓塞治疗颅内动脉是一种安全、可靠、有效的治疗方法 ;TrufillDCS具有柔软、贴壁性好、填塞充分、解脱快、可靠等特点。     

电解可解脱弹簧圈栓塞颅内动脉瘤

目的　探讨电解可解脱弹簧圈治疗颅内动脉瘤的手术指征、术前评估方法、技术操作要点、手术时机、并发症防治、治疗效果、存在的问题及临床应用前景。方法　 72例患者 ,80枚颅内动脉瘤中 ,6 8例为破裂动脉瘤 ,4例为未破裂动脉瘤。动脉瘤部位在后交通动脉 2 0枚 ,前交通动脉 32枚 ,大脑中动脉 8枚 ,大脑后动脉 5枚 ,眼动脉 3枚 ,颈内动脉分叉处 3枚 ,基底动脉 5枚 ,小脑后下动脉 2枚 ,脉络膜前动脉 2枚。 72例患者中 ,Hunt Hess分级 :Ⅰ级 2 4例 ,Ⅱ级 2 5例 ,Ⅲ级 10例 ,Ⅳ级 9例 ,Ⅴ级 4例。72例患者分别采用单纯弹簧圈栓塞、血管内支架加弹簧圈栓塞、瘤颈重塑形技术栓塞和双导丝技术栓塞。蛛网膜下腔出血 (SAH)后 1周内治疗的患者 18例 ,2～ 3周内治疗的患者 2 9例 ,4周以后治疗的 2 1例。手术采用全麻并在术中适当控制血压 ,使收缩压不超过 110mmHg ,手术全程在DSA动态监视下完成。根据患者SAH的严重程度 ,采用术前或者术后给予脑室外引流、腰椎蛛网膜下腔引流或单纯腰椎穿刺释放血性脑脊液的方法 ,栓塞术后全部病例给予“3H”治疗。结果　动脉瘤完全闭塞 6 8枚 ,占 85 % ,栓塞程度 95 %～ 99%的 8枚 ,占 10 % ,栓塞程度达 90 %的 4个 ,占 5 %。全组死亡 2例 ,占 2 .78%。术中动脉瘤出血 2例 ,经弹簧     

Safety of endovascular treatment of intracranial aneurysms with a new,complex shaped Guglielmi detachable coil

Introduction The Guglielmi detachable coil (GDC) 360°, a new complex shaped bare platinum coil, became available in Europe for aneurysm treatment in September 2005. The purpose of this study was to assess the feasibility and safety of selective embolization of intracranial aneurysms with the GDC 360° in 52 consecutive patients. Methods All patients included in this study were registered in a prospectively maintained database. We assessed the patient clinical history, aneurysm shape and dimensions, technical details and complications of the procedures, degree of aneurysm occlusion, and clinical findings upon discharge. In all patients, the first coil deployed was a GDC 360°. Results Over a 6-month period, we intended to treat 52 aneurysms with the GDC 360° in 52 patients. Of these 52 patients, 42 (81%) were treated in the context of subarachnoid haemorrhage. In 51 of 52 patients, the underlying aneurysm was successfully treated by coil embolization. Six procedures (11.5%) were complicated by the formation of thrombus in the parent artery during the intervention. One patient suffered a stroke related to the procedure. Angiograms obtained immediately after the procedure showed complete occlusion of the aneurysmal sac in 38 of 51 procedures (74.5%), a neck remnant in 11 (21.6%), and a residual aneurysm in 2 (3.9%). In 43 of 51 patients (84.3%), clinical assessment demonstrated independent clinical status, whereas 7 patients (13.7%) required assistance in the activities of daily living upon hospital discharge. One patient (2.0%) died after development of a severe vasospasm 10 days after the endovascular procedure. Conclusion The GDC 360° can be safely used for the endovascular occlusion of intracranial aneurysms.     

Interlocking detachable coil occlusion in the endovascular treatment of intracranial aneurysms: preliminary results.

PURPOSETo present our preliminary experience with the recently developed interlocking detachable coils in the treatment of intracranial aneurysms.METHODSTwo aneurysms of the basilar tip, two of the internal carotid artery, and one of the posterior inferior cerebellar artery were treated by an endovascular technique using interlocking detachable coils. Three of the patients had undergone unsuccessful surgical clipping. Three-month and 1-year control angiograms were obtained.RESULTSIn all patients but one, who had an aneurysm of the internal carotid artery, the aneurysmal sac was occluded with preservation of the parent artery and did not show recanalization on the follow-up control angiograms. In the other patient who had a wide-necked aneurysm of the internal carotid artery, the sac could not be totally obliterated and showed contrast filling in the neck remnant at 3-month angiography. None of the patients experienced neurologic deficit after treatment.CONCLUSIONBecause they are soft and retrievable, interlocking detachable coils, with their immediate coil release design, may provide an alternative to surgery in the future treatment of endovascular aneurysms.     

颅内动脉瘤电解可脱性弹簧圈栓塞术后随访观察

目的　评价颅内动脉瘤电解可脱性弹簧圈 (GDC)栓塞治疗的中、远期疗效。方法　采用GDC栓塞 131例共 134枚颅内动脉瘤 ,其中前交通动脉瘤 39枚 ,后交通动脉瘤 4 5枚 ,颈内动脉虹吸段动脉瘤 19枚 ,大脑中动脉瘤 14枚 ,大脑前动脉瘤 3枚 ,后循环动脉瘤 9枚 ,其他部位 5枚。宽颈动脉瘤 (瘤颈宽度 >4mm或瘤体颈比率 <2 ) 39枚 ,狭颈动脉瘤 79枚 ,瘤颈显示不清者 16枚。栓塞术后 15个月内随访DSA ,以与栓塞后即时DSA比较其变化。结果　在 39枚宽颈动脉瘤和 79枚狭颈动脉瘤中 ,完全、近完全闭塞者分别为 30枚 (76 92 % )和 75枚 (94 94 % ) ,两者差异有非常显著性意义(χ2 =8 6 4 3,P <0 0 1)。栓塞后即时完全、近完全闭塞的 118枚动脉瘤中 ,术后不同时期随访DSA显示均无变化 ;栓塞后即时部分疏松填塞的 16枚动脉瘤中 ,随访DSA显示动脉瘤缩小者 3枚 ,无变化者4枚 ,再开放扩大者 9枚。结论　GDC致密、完全栓塞颅内动脉瘤的近、中期疗效肯定 ,但定期随访行DSA检查是必要的 ,尤其是部分疏松填塞者 ,对于复发的病例 ,可再行GDC栓塞     

Late rebleeding of ruptured intracranial aneurysms treated with detachable coils

BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of late rebleeding of ruptured intracranial aneurysms treated with detachable coils. PATIENTS AND METHODS: A clinical follow-up study was conducted in 393 consecutive patients with a ruptured aneurysm treated with detachable coils between January 1995 and January 2003. Late rebleeding was defined as recurrent hemorrhage from a coiled aneurysm >1 month after coiling. One patient was lost to follow-up. Total clinical follow-up of the 392 patients who were coiled for ruptured cerebral aneurysms was 18,708 months (1559 patient years; median, 48 months; mean, 47.7 months; range, 0-120 months). RESULTS: Four patients suffered late rebleeding from the coiled aneurysm at 8, 12, 30, and 40 months after coiling, respectively. Two of these patients died. Another patient died of probable rebleeding 4 months after coiling. The incidence of late rebleeding was 1.27% (5/393) and mortality of late rebleeding was 0.76% (3/393). The annual late rebleeding rate was 0.32%, and the annual mortality rate from late rebleeding was 0.19%. During the follow-up period, 53 coiled aneurysms in 53 patients (13%) were additionally treated: 35 aneurysms (8.9%) were additionally treated with coils, 16 aneurysms (4.1%) were additionally clipped, and 2 aneurysms (0.5%) were additionally treated with parent vessel balloon occlusion. CONCLUSION: The late rebleeding rate after coiling of ruptured cerebral aneurysms is very low. Follow-up of patients with a coiled aneurysm is mandatory to identify aneurysms that need additional treatment after reopening.     

电解可脱性弹簧圈栓塞颅内动脉瘤相关问题的探讨

目的　总结使用电解可脱性弹簧圈 (GDC)栓塞颅内动脉瘤时旋转DSA的应用及GDC操作要点。方法　对 38例共 4 0个颅内动脉瘤常规行旋转DSA检查 ,动脉瘤直径 4～ 2 5mm ,平均(12 5 1± 5 37)mm。瘤体直径 <12mm的小动脉瘤 2 9个 ,12～ 2 5mm的大动脉瘤 11个。术前Hunt Hess分级Ⅰ～Ⅳ级分别是 2 6例、8例、3例、1例。随后使用GDC栓塞治疗。结果　 37例 39个颅内动脉瘤栓塞成功 ,1例死亡。完全栓塞 (>95 % ) 2 2个 ,大部分栓塞 (80 %～ 95 % ) 12个 ,部分栓塞(<79% ) 5个。并发动脉瘤破裂 2例 ,治疗后痊愈。并发脑动脉痉挛 6例 ,治疗后 2例遗留轻偏瘫和单瘫。 2例弹簧圈部分遗留于动脉瘤外 ,经抗凝治疗未发生并发症。 2例复发再次栓塞后痊愈。结论GDC栓塞治疗颅内动脉瘤是 1种安全、可靠、有效的治疗方法。合理应用旋转DSA技术、熟练的GDC操作可提高诊断的准确性及治疗的安全性     

Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils--a prospective randomized study

PURPOSE: To compare the use of electrolytically detachable coils versus surgical ligation for the management of acutely ruptured intracranial aneurysm. MATERIALS AND METHODS: A prospective randomized study included 109 patients with acute (< 72 hours) subarachnoid hemorrhage caused by a ruptured aneurysm (Hunt and Hess grade I-II [n = 67], grade III [n = 26], or grade IV-V [n = 16]). All patients were suitable candidates for both endovascular and surgical treatment and were randomly assigned to undergo coil embolization (n = 52) or surgical ligation (n = 57). RESULTS: Significantly better primary angiographic results were achieved after surgery in patients with anterior cerebral artery aneurysm (n = 55, P = .005) and after endovascular treatment in those with posterior circulation aneurysm (n = 11, P = .045). No significant differences were seen in middle cerebral artery (n = 19) or internal carotid artery (n = 24) aneurysms. Early rebleeding occurred in one patient after incomplete coil embolization. The technique-related mortality rate was 4% in the surgical group and 2% in the endovascular group. Clinical outcome (Glasgow Outcome Scale score) at 3 months was not significantly different between treatment groups in terms of intended treatment modality. No late rebleedings had occurred at the time of this writing. CONCLUSION: In selected patients with a recently ruptured intracranial aneurysm, favorable results were achieved by using endovascular treatment. Subsequent acute or late open surgery was sometimes required. The clinical outcome at 3 months was comparable in the endovascular and surgical treatment groups.     

The porous, guidewire-directed, detachable aneurysm liner: a new concept in the endovascular treatment of intracranial aneurysms.

A new device for the endovascular treatment of aneurysms is described. It consists of a guidewire-directed porous liner or bag, detachably mounted on a microcatheter and designed to be inserted into an aneurysm and to be filled with detachable coils or other embolic agents. Several prototypes have been made. Preliminary in vitro and in vivo experiments have demonstrated its behavior in relatively wide-necked aneurysms.