支架辅助微弹簧圈栓塞颅内动脉瘤的应用价值

 目的 探讨应用颅内专用支架结合微弹簧圈栓塞治疗颅内动脉技术的临床应用价值。方法44例中,男性20 例,女性24例,通过微导管放置颅内专用支架,支架覆盖动脉瘤瘤颈,同时以另一微导管进入动脉瘤腔微弹簧圈栓塞动脉瘤。结果全部病例采用颅内专用 支架辅助微弹簧圈栓塞,其中38 例致密栓塞,6 例部分栓塞。术中、术后未发生颅内出血及支架内血栓形成,患者均恢复良好。36例术后3～6个月脑血管造影随访：其中35 例致密栓塞的动脉瘤均未显影,载瘤动脉通畅;1例动脉瘤颈有残留,未见动脉瘤复发;6例患者术后3个月内,未随访;2例失访。结论支架结合弹簧圈栓塞颅内动脉瘤有较好的疗效。     

以Neuroform支架辅助弹簧圈栓塞颅内复杂动脉瘤

目的　 探讨复杂颅内动脉瘤的介入治疗方法 ,探讨支架辅助弹簧圈栓塞动脉瘤的适应证 ,急诊期使用支架术中、术后的安全性。方法　采用Neuroform支架 ,弹簧圈主要采用Matrix。以 1枚支架覆盖 2枚动脉瘤并同时栓塞 2例 ;以支架辅助栓塞巨大宽颈动脉瘤 1例 ,急诊常规栓塞时瘤颈残留 ,择期再以支架植入辅助弹簧圈栓塞瘤颈 1例 ;动脉瘤常规弹簧圈栓塞后 3年复发 ,再以支架辅助栓塞 1例 ;急诊期支架辅助栓塞宽颈动脉瘤 4例。择期栓塞患者术前 3d予强抗血小板聚集药物 ,所有患者术后予强抗血小板聚集药物及 5d抗凝治疗。术后 3～ 6个月复查 4例。结果　所有病例栓塞操作均顺利完成 ,无手术并发症 ;除 1例巨大动脉瘤为次全栓塞外 ,其他均致密栓塞 ;复查 4例中 ,除次全栓塞的巨大动脉瘤出现动脉瘤腔部分显影外 ,其余 3例均未见动脉瘤显影。结论　以支架辅助弹簧圈栓塞提高了颅内宽颈动脉瘤、复杂性动脉瘤的治疗效果 ;既使用Matrix也要求致密栓塞 ;使用支架对抗血小板聚集药物的要求与蛛网膜下腔出血后可能需要的外科手术处理存在矛盾 ;未行抗血小板聚集药物准备情况下 ,急诊栓塞时使用支架的安全性尚有待探讨。     

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。     

Onyx联合支架辅助弹簧圈治疗复杂性颅内破裂动脉瘤

目的 探讨应用Onyx联合支架辅助弹簧圈治疗颅内复杂破裂动脉瘤的可行性和疗效.方法 回顾性分析2例应用Onyx联合支架辅助弹簧圈技术方法,进行治疗的颅内复杂破裂动脉瘤.并对Onyx栓塞治疗颅内动脉瘤相关文献进行回顾.结果 应用该技术栓塞治疗2例复杂性颅内动脉瘤(1例为右侧颈内动脉分叉部动脉瘤,1例为颈内动脉前壁复发动脉...     

单纯弹簧圈栓塞治疗颅内微小动脉瘤

目的总结单纯弹簧圈栓塞治疗颅内微小动脉瘤的可行性和安全性。 方法回顾分析42例患者接受单纯弹簧圈栓塞治疗颅内微小动脉瘤,综合应用选择合适患者、良好的微导管塑形、"回撤式"微导管进入颅内微小动脉瘤的方式、柔软弹簧圈等方法。 结果手术成功率100%,动脉瘤完全栓塞35例（占83.6%）,近全栓塞4例（占9.5%）,不完全栓塞3例（占7.1%）。术中动脉瘤破裂出血两例,术中出血率为4.8%（2/42）。 结论选择合适的患者,单纯弹簧圈栓塞治疗颅内微小动脉瘤是可行性,通过综合多种技术手段,能明显降低术中动脉瘤破裂率。     

弹簧圈血管内栓塞颅内动脉瘤危急事件中支架的应用

目的 探讨在血管内弹簧圈栓塞颅内动脉瘤过程中出现弹簧圈移位、突出或脱出和解旋等危急事件的原因及支架应用的价值.方法 回顾性分析12例弹簧圈栓塞颅内动脉瘤出现危急事件的病例,其中9例为宽颈动脉瘤;10例出现动脉瘤破裂出血;2例动脉瘤最大径为5 ～ 12 mm,7例为3 ～ 5 mm,3例＜ 3 mm;造影和临床随访超过1...     

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。     

球囊辅助弹簧圈在血管内栓塞颅内动脉瘤中的应用和中长期随访

目的 探讨球囊辅助弹簧圈栓塞(balloon-assisted coiling embolization,BACE)颅内动脉瘤的应用价值和中长期随访结果.方法 回顾性分析2006年至2011年48例使用新一代BACE治疗的颅内动脉瘤患者,其中38例破裂出血.42例宽颈动脉瘤,7例瘤颈＞ 4 mm,37例体颈比≤ 1.5...     

支架辅助下弹簧圈栓塞颅内宽颈动脉瘤长期随访分析

目的 观察使用支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤患者术后3年以上的复发率、支架内狭窄率、动脉瘤再破裂发生率.方法 47例支架辅助弹簧圈栓塞颅内宽颈动脉瘤患者,术后3年以上接受DSA下全颈脑血管造影检查.结果 出现不同程度的支架内狭窄3例,其中1例出现载瘤动脉慢性闭塞.复发5例,其中1例为小型前交通动脉瘤,患者动脉瘤体可见部分显影;4例为超过1.5 cm的颈内动脉虹吸段的大型动脉瘤,栓塞后半年随访发现,动脉瘤内弹簧圈压缩,瘤体再度显影,该4例中有3例经过2次栓塞后即时显影消失,但仍有2例3年随访动脉瘤体再度显影,另1例拒绝2次栓塞,继续随访中.3年随访期内无一例患者栓塞后动脉瘤再破裂.结论 支架辅助弹簧圈栓塞颅内宽颈动脉瘤术式有效、可行,复发率低,支架内狭窄发生率不高,长期效果良好.     

The Stent-Assisted Coil-Jailing Technique Facilitates Efficient Embolization of Tiny Cerebral Aneurysms

Objective

Tiny cerebral aneurysms are difficult to embolize because the aneurysm''s sac is too small for a single small coil, and coils within the aneurysm may escape from the confinement of a stent. This study was performed to introduce the stent-assisted coil-jailing technique and to investigate its effect on the coil embolization of tiny intracranial aneurysms.

Materials and Methods

Sixteen patients with tiny intracranial aneurysms treated with the stent-assisted coil-jailing technique between January 2011 and December 2013 were retrospectively reviewed and followed-up.

Results

All aneurysms were successfully treated with the coil-jailing technique, and at the end of embolization, complete occlusion of the aneurysm was achieved in 9 cases (56.3%), incomplete occlusion in 6 (37.5%), and partial occlusion in 1 (6.3%). Intraprocedural complications included acute thrombosis in one case (6.3%) and re-rupture in another (6.3%). Both complications were managed appropriately with no sequela. Follow-up was performed in all patients for 3-24 months (mean, 7.7 months) after embolization. Complete occlusion was sustained in the 9 aneurysms with initial complete occlusion, progressive thrombosis to complete occlusion occurred in the 6 aneurysms with initial near-complete occlusion, and one aneurysm resulted in progressive thrombosis to complete occlusion after initial partial occlusion. No migration of stents or coils occurred at follow-up as compared with their positions immediately after embolization. At follow-up, all patients had recovered with no sequela.

Conclusion

The stent-assisted coil-jailing technique can be an efficient approach for tiny intracranial aneurysms, even though no definite conclusion regarding its safety can be drawn from the current data.     

微弹簧圈血管内介入治疗颅内动脉瘤

目的总结颅内动脉瘤血管内介入治疗的经验,探讨微弹簧圈栓塞颅内动脉瘤的技巧、效果及相关并发症的防治。方法回顾性分析我院介入治疗颅内动脉瘤31例,32个动脉瘤的临床资料,其中单纯用弹簧圈栓塞25例,宽颈动脉瘤球囊辅助弹簧圈栓塞4例,支架结合弹簧圈栓塞1例,载瘤动脉闭塞1例。结果栓塞程度:致密栓塞27例,疏松栓塞3例,闭塞载瘤动脉1例;术中动脉瘤破裂3例,术后完全康复22例,不同程度神经功能障碍8例,死亡1例。结论电解脱弹簧圈栓塞颅内动脉瘤,具有微创、安全、效果可靠等优点。选择合适的技术和方法,对提高栓塞率,减少并发症具有重要的意义。     

Endovascular Coil Embolization of Very Small Intracranial Aneurysms

Objective

We aimed to evaluate the results of endovascular coil embolization for very small aneurysms (≤ 3 mm).

Materials and Methods

Between March 2005 and December 2008, a total of 31 very small aneurysms in 30 patients were treated by coil embolization. Of the 31 aneurysms, five (16%) were ruptured, as opposed to 26 (84%) that were not. We assessed the procedural complications, immediate angiographic outcome after coiling, clinical outcome, and follow-up MR angiography (MRA).

Results

Two thromboembolic complications occurred during the procedure, but did not lead to any persistent neurologic deficit. No procedural aneurysmal rupture was observed and procedure-related morbidity and mortality were both 0%. Occlusion was adequate in 25 aneurysms (81%) and incomplete in six aneurysms (19%). The clinical outcomes of five patients with ruptured aneurysms were good (Glasgow outcome scale ≥ 4), with no bleeding of the treated aneurysms during a mean follow-up period of 13.3 months. On 27 follow-up MRA, there was no recurrence, and the five incompletely occluded aneurysms showed a spontaneous amelioration resulting in an adequate occlusion.

Conclusion

Coil embolization of very small aneurysms is technically feasible with good results. The long-term efficacy and the potential as a standard treatment strategy remain to be determined by randomized large trials.     

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

ObjectiveDescribed herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy.ResultsThrough this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping.ConclusionThis microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.     

颅内巨大动脉瘤的MR影像学分析

目的　分析颅内巨大动脉瘤的MR影像学表现。方法　搜集 40例经手术病理证实的颅内巨大动脉瘤。结果　颅内巨大动脉瘤的MR信号表现多样 ,主要与动脉瘤内是否出现血栓 ,血栓的大小和形成时间的长短 ,和动脉瘤引起的继发改变等因素有关。瘤腔信号 :绝大部分巨大动脉瘤表现出典型的流空现象或流动信号。瘤腔水平可见的血管流动伪影 ,注药后明显强化。血栓信号 :大部分动脉瘤中出现了血栓 ,血栓信号差异很大 ,多呈层状或涡状的混杂信号 ,增强扫描无强化。无血管流空伪影。DSA和MRA可显示动脉瘤瘤腔 ,不能显示动脉瘤内是否存在血栓或闭塞 ,低估动脉瘤的大小。绝大部分动脉瘤可在MRA中证实。结论　MR可清楚显示颅内巨大动脉瘤的全貌 ,包括瘤腔和血栓形成情况 ,是DSA检查的必要补充。     

颅内动脉瘤在栓塞治疗中不全栓塞的原因和预防措施

目的探讨颅内动脉瘤不全栓塞的原因及预防措施。方法采用经股动脉插管行全脑血管造影,应用电解脱微弹簧圈进行动脉瘤栓塞。共45例47个动脉瘤,其中前交通动脉瘤19个,大脑中动脉分叉处动脉瘤7个,后交通动脉瘤16个,颈内动脉动脉瘤5个,2例同时存在2个动脉瘤。结果完全致密填塞(动脉瘤体积100%不显影)35个;不全栓塞动脉瘤12个,其中95%不显影9个,90%不显影2个,80%不显影1个。结论颅内宽颈动脉瘤、大动脉瘤以及蛇形、不规则分叶状动脉瘤不全栓塞率较高,采用筐篮技术,球囊辅助技术,血管重建术和蚕食样分步栓塞术以及应用新型栓塞材料GDC-M atrix可降低不全栓塞率。     

支架精显技术在支架辅助动脉瘤栓塞复查患者中的应用

目的:探讨DSA的支架精显技术在支架辅助动脉瘤栓塞患者复查中的应用价值。方法:我院2017年6月至2018年6月收治的支架辅助动脉瘤栓塞复查患者32例,其中5例复发患者,27例未复发患者。所有患者均行超选择性脑血管动脉造影及支架精显技术进行对照评估。结果:支架精显技术评估动脉瘤的形态及支架局部形态、是否移位与超选择性脑血管造影技术一致,但能显著减少患者的创伤,减低对比剂的使用量,减轻X线的照射剂量。结论:支架精显技术可以很好地显示动脉瘤的形态及支架情况,具有非常高的临床实用价值。     

Resolved Abdominal Aortic Aneurysms Following Stent Graft Treatment: A Report of Five Cases

Complete aneurysm resolution is the hallmark of successful endoluminal stent-graft treatment. We describe 5 patients in whom an abdominal aortic aneurysm (AAA) disappeared completely at mid-term follow-up after endovascular stent-graft placement. We reviewed 45 patients (43 men and 2 women) who underwent AAA repair using an endovascular technique, from April 1997 to December 2001. Mean AAA diameter was 58.3 mm. On 48-month follow-up, 12 aneurysms had not changed in size, 4 had grown, 16 had shrunk, and 5 had resolved completely. We describe these 5 patients in detail. The 5 patients were all men, mean age 68 years; their mean aneurysmal sac diameter was 54 mm. The only common finding in all of them was patency of lumbar and inferior mesenteric arteries at pre-procedure evaluation as well as at follow-up. Mean time to complete resolution was 18 months. No major complications were encountered. AAA may resolve completely after endovascular stent-graft implantation. Patent side branches may perhaps contribute to AAA disappearance by antegrade flow. A larger patient population should be reviewed, however, before any statistical conclusion can be drawn.     

Coil-Protected Embolization Technique for a Branch-Incorporated Aneurysm

Objective

A small branch-incorporated aneurysm is an aneurysm with a small branch incorporated into the sac or the neck. It is one of the most difficult aneurysms to treat with coil embolization. The aim of this study was to evaluate the safety and effectiveness of the coil-protected embolization technique for small-branch incorporated aneurysm.

Materials and Methods

Fourteen aneurysms (2 ruptured and 12 unruptured) in 12 patients (mean age, 56 years, range, 40-73 years; 6 men and 6 women) were treated with the coil-protected embolization technique during the period between February 2007 and October 2011. Clinical and angiographic outcomes were retrospectively evaluated.

Results

All aneurysms were successfully treated without any complications during the procedure. Immediate post-treatment angiographies demonstrated complete or near complete occlusion in 12 and incomplete occlusion in 2 patients. Two patients had a delayed small embolic infarction in the relevant posterior circulation territory and middle cerebral artery territory 10 days and 14 days later, respectively, but both recovered completely or almost completely (modified Rankin scale score [mRS score], 0 and 1, respectively). During the clinical follow-up period (mean, 21 months; range: 2-58 months), all patients reported an mRS score of 0 (n = 10) or 1 (n = 2). Vascular imaging follow-up (catheter angiography: n = 3 and MR angiography: n = 8) was available in 11 aneurysms at 6-12 months. All 11 aneurysms showed complete occlusion except for 1 minor neck recurrence that did not require further treatment.

Conclusion

In this series of cases, the coil-protected embolization technique seems to be feasible and effective in the treatment of small-branch incorporated aneurysms.     

脑动脉瘤的MR血管造影与IA—DSA的对照研究

对经手术证实的２０例脑动脉瘤的ＭＲＡ和ＩＡ－ＤＳＡ的影像进行了对照分析研究，经ＭＲＡ检出１９例（９５％）动脉瘤，１０ｍｍ以下的动脉瘤９例，最小的为４ｍｍ，与ＤＳＡ检出率（１９／２０）相仿。ＭＲＡ的定位符合率为８４％，低于ＤＳＡ（９５％）。１３／１９例（６８％）在ＭＲＡ图象上能显示动脉瘤的瘤颈。作者认为ＭＲＡ是一种新的非侵入性的血管影像方法，可作为脑动脉瘤高危病例的筛选检查，随着ＭＲＡ技术的进一步完善，ＭＲＡ有望在神经外科领域替代部分侵入性血管造影检查。