胚胎型大脑后动脉伴发型颈内动脉后交通动脉瘤血管内治疗——单中心经验

【摘要】 目的 探讨胚胎型大脑后动脉（fPCA）伴发型颈内动脉后交通动脉瘤血管内治疗的安全性和有效性。方法 回顾性分析2010 年 12 月至 2018 年 12 月采用血管内弹簧圈栓塞治疗的25 例fPCA伴发型颈内动脉后交通动脉瘤患者临床资料。采用改良Raymond-Roy分类（MRRC）评估动脉瘤即刻治疗和随访结果,改良Rankin量表（mRS）评分评估患者预后。 结果 25 例共25枚fPCA伴发型颈内动脉后交通动脉瘤患者中女22例,破裂出血23例。术后即刻造影显示充分栓塞15例（MRRCⅠ级7例,Ⅱ级8例）,不全栓塞10例（Ⅲa级6例,Ⅲb级4例）。DSA随访平均（20.7±20.6）（3～73）个月,除二期支架辅助弹簧圈栓塞治疗3例外,复发4例,其中2例接受支架辅助弹簧圈栓塞再治疗;随访终点显示MRRCⅠ级10例,Ⅱ级10 例,Ⅲb级 4例。临床随访平均（40.1±30.5）（3～117）个月,患者预后均良好（mRS评分0分23例,1分1例）。 结论 血管内弹簧圈栓塞治疗fPCA伴发型颈内动脉后交通动脉瘤安全有效,很多情况下需要支架辅助,且需要长期密切随访。     

Neuroform EZ支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤中远期安全性和有效性分析

【摘要】 目的 评价Neuroform EZ支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的中远期安全性和有效性。方法 回顾性分析2015年4月至2018年12月在南京医科大学第一附属医院接受Neuroform EZ支架辅助弹簧圈栓塞治疗的连续104例颈内动脉眼动脉段动脉瘤患者临床和影像学资料。重点分析动脉瘤特征、术后即刻和进展性闭塞率、围手术期并发症及临床随访结果。 结果 共104例患者116枚眼动脉段动脉瘤接受治疗,其中16例动脉瘤性蛛网膜下腔出血。根据眼动脉段动脉瘤Krisht分型,上侧型36枚,后侧型32枚,内侧型41枚,外侧型7枚。支架辅助弹簧圈填塞治疗均获成功。手术并发症发生率为2.9%,均为小血栓栓塞事件。术后即刻造影显示动脉瘤完全闭塞60枚（51.7%）,近全闭塞54枚（46.6%）,部分闭塞2枚（1.7%）。89例患者93枚动脉瘤接受平均（7.6±5.4）个月造影随访,首次随访造影显示完全闭塞率进展至92.5%（86枚）,未见迟发性支架内狭窄。动脉瘤复发3枚（3.2%）,均再次接受弹簧圈栓塞后达到完全闭塞。96例（92.3%）患者临床随访平均（18.5±11.2）个月,其中95例（99.0%）改良Rankin量表（mRS）评分为0～2分,远期预后良好。 结论 Neuroform EZ支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤安全有效,中远期随访中可提供更稳定闭塞率,且未见支架内再狭窄。     

颅内多发动脉瘤的介入诊治分析

目的：探讨血管内介入诊治颅内多发动脉瘤的临床效果。 方法：选取我院神经外科2016年1月至2018年6月收治的29例颅内多发动脉瘤患者,均行脑血管造影后确诊接受血管内单纯或支架辅助的弹簧圈填塞治疗。采用Raymond分级评价患者动脉瘤填塞的程度,格拉斯哥预后评分（GOS）评价治疗效果。 结果：对29例患者的40枚动脉瘤实施了介入治疗,按照Raymond分级,Ⅰ级（完全填塞）30枚,Ⅱ级（近全栓塞）4枚,Ⅲ级（部分栓塞）2枚,Pipeline密网支架覆盖瘤颈4枚。术后患者的GOS评分为5分18例,4分8例,3分2例,2分1例。 结论：采用血管内介入方式治疗颅内多发动脉瘤可以取得较高的动脉瘤填塞程度及较好的临床效果和预后。     

颅内宽颈动脉瘤的血管内介入治疗

目的：探讨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的疗效、治疗护理要点、安全性及并发症的防治。方法：对明确诊断为颅内宽颈动脉瘤的20例患者行血管内支架结合电解可脱卸弹簧圈介入治疗。动脉瘤位置：前交通动脉瘤8例。后交通动脉瘤4例,颈内动脉海绵窦段动脉瘤3例．大脑中动脉瘤2例．基底动脉瘤2例．颈内动脉海绵窦段合并前交通动脉瘤1例。结果：20例患者均成功释放支架,患者全部治愈出院。其中17例致密栓塞。3例大部填塞。血管造影检查：动脉瘤不显影,载瘤动脉及邻近主要血管分支通畅．均无再出血或血栓栓塞等相关并发症。结论：血管内支架结合弹簧圈是治疗颅内宽颈动脉瘤安全、有效的方法．短期治疗效果肯定,正确的围手术期处理,可以提高手术的成功率,减少并发症。     

颈内动脉-后交通动脉瘤常规支架辅助弹簧圈栓塞治疗临床结果及复发因素分析

【摘要】 目的 分析常规支架辅助弹簧圈栓塞治疗颈内动脉（ICA）-后交通动脉（PComA）动脉瘤的效果及复发的危险因素。 方法 收集2013年1月至2019年12月在郑州大学第一附属医院接受常规支架辅助弹簧圈栓塞术治疗的ICA-PComA动脉瘤患者临床资料。采用单因素和多因素logistics回归分析确定常规支架辅助弹簧圈栓塞术后动脉瘤复发的危险因素。结果 共入组患者199例（224枚动脉瘤）,平均年龄为57岁,女性168例（84.4%）。平均随访时间12个月,20例患者20枚（8.9%）动脉瘤复发。单因素分析结果显示,术后动脉瘤复发和未复发患者伴高血压、动脉瘤位于大弯侧、破裂动脉瘤、动脉瘤直径、瘤颈宽、瘤颈口有优势PComA、流入道未致密栓塞、第1枚弹簧圈成篮即刻造影差异均有统计学意义（均P＜0.05）。多因素logistics回归分析显示,伴高血压、动脉瘤破裂、动脉瘤直径≥5 mm、瘤颈口有优势PComA、流入道未致密填塞、第1枚弹簧圈成篮未覆盖瘤颈口是术后动脉瘤复发的危险因素。 结论 伴高血压、动脉瘤破裂、动脉瘤直径≥5 mm、瘤颈口有优势PComA、流入道未致密填塞、第1枚弹簧圈成篮未覆盖瘤颈口的ICA-PComA动脉瘤患者,常规支架辅助弹簧圈栓塞术后复发风险较高。     

球囊联合支架辅助弹簧圈栓塞颅内分叉部宽颈动脉瘤

目的：分析球囊联合支架辅助弹簧圈栓塞术治疗颅内分叉部宽颈动脉瘤的优势。方法回顾性分析2014年1月至4月昆明医科大学第一附属医院采用球囊联合支架辅助弹簧圈栓塞术治疗20例共25枚颅内分叉部宽颈动脉瘤患者的临床资料。20例患者中曾患蛛网膜下腔出血12例,无出血史8例;25枚颅内分叉部宽颈动脉瘤中位于基部动脉未端分叉部14枚,大脑中动脉分叉部8枚,颈内动脉末端分叉部3枚。根据Raymond分级评价介入治疗术后即刻和3个月后三维DSA检查结果,根据改良Rankin 量表（mRS）评分评价术后3个月临床疗效。结果球囊联合支架辅助弹簧圈栓塞术后即刻三维DSA检查显示25枚颅内分叉部宽颈动脉瘤中RaymondⅠ级21枚,Ⅱ级2枚,Ⅲ级2枚;术后3个月DSA随访显示RaymondⅠ级20枚,Ⅱ级3枚,Ⅲ级2枚。术后3个月mRS评分显示17例患者0分,1例患者1分,均预后良好;2例患者4～6分,预后不良。结论球囊联合支架辅助弹簧圈栓塞术在颅内分叉部宽颈动脉瘤介入治疗术中具有明显优势。     

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。     

支架辅助弹簧圈栓塞术治疗颈内动脉血泡样动脉瘤

目的 评估支架辅助弹簧圈栓塞在血泡样动脉瘤治疗中的作用.方法 回顾性分析8例采用支架辅助弹簧圈栓塞治疗的颈内动脉血泡样动脉瘤的临床特点、治疗过程及脑血管造影结果及随访结果.本组8例中,成功实施支架辅助弹簧圈栓塞术5例.2例因动脉瘤体积过小无法进一步实施弹簧圈栓塞,以单纯支架治疗.1例患者在成功释放支架后填塞弹簧圈过程中发生动脉瘤破裂,改行颈内动脉闭塞术.结果 患者出院时改良 Rankin 评分为1分4例,2分1例,3分1例,2例患者因术后再出血死亡.术后9～36个月(平均21.5个月)的临床随访结果提示4例患者改良Rankin评分为0分,1例1分,1例2分.所有患者均接受影像学随访,证实动脉瘤影像学复发3例,均接受再次血管内栓塞治疗.结论 支架辅助的弹簧圈栓塞术是治疗颈内动脉血泡样动脉瘤血泡样动脉瘤的町行方法之一.此方法用于急性期治疗有较高的安全性,可降低急性期病死率,应用多支架技术或使用新型低孔率支架辅助栓塞可能会进一步降低再出血和复发的风险.     

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.     

Solitaire AB支架辅助栓塞颅内动脉瘤临床随访研究

目的观察Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤初中期效果。方法回顾性分析2009年至2012年期间采用Solitaire AB支架辅助弹簧圈栓塞治疗的49例颅内宽颈动脉瘤患者49个动脉瘤,其中41例患者41个动脉瘤（26个破裂出血,15个未破裂）术后随访12～48个月,根据改良Rankin评分、DSA、CTA或MRA检查评价颅内动脉瘤影像学及临床结果。结果栓塞术后有2例动脉瘤再次破裂出血,3例脑梗死,1例载瘤动脉闭塞,死亡1例,并发症发生率为14.2%。栓塞术后12个月DSA、MRA或CTA检查显示,32个动脉瘤（32/41,78.0%）完全栓塞,明显高于术后即刻（21个,42.9%）（P＝0.02）;瘤颈残留7个（17.1%）,部分栓塞2个（4.9%）,均较术后即刻有改善。24个动脉瘤（58.5%）稳定而无变化,复发4个（9.7%）。末次随访时改良Rankin评分显示0分18例（43.9%）,1分10例（24.4%）,2分5例（12.2%）,3分4例（9.8%）,4分2例（4.85%）,5分2例（4.85%）。患者日常活动能力自理率为80.5%,预后良好。结论 Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤安全有效,有助于提高完全栓塞率,降低操作相关并发症。     

Quadrature detection surface coil

A surface coil assembly consisting of two interleaved coplanar resonators that are intrinsically decoupled from each other is described for imaging at 1.5 T. Vector reception fields on-axis at 3 cm depth are orthogonal and of equal magnitude. Both components of magnetization were received and combined resulting in a 2 1/2 improvement in signal-to-noise for temporomandibular joint images.     

Effect of body coil electric field distribution on receive-only surface coil heating

Although in the design of transmit RF coils, B(1) homogeneity is crucial for good image quality, discussion of electric field (E-field) distribution in the literature has been mostly limited to specific absorption rate (SAR) and patient loading (dielectric) effects. In this work, we report on a different aspect of E-field: the receive-only surface coil heating resulting from the voltage drop across the blocking (decoupling) networks and cable traps that are used to minimize the transmit field distortion. The results show that the z-component (parallel to the coil cable) of the E-field has a significant effect on the temperature rise in the surface coil. Therefore, in the receive-only coil designs, it is not sufficient to consider only the induced voltage on the coil loop due to the B(1) field, as is generally done in blocking network analysis calculations. The body coil E-field distribution must be considered as well.     

Modular gradient coil: A new concept in high-performance whole-body gradient coil design.

A new concept in high-performance MR gradient coil design is presented which we have called the Modular Gradient Coil (MGC). This novel design approach results in an actively shielded whole-body gradient coil containing multiple and independent elements, integrated onto a single former, for generating gradient fields along each of the three axes (x, y, and z). These elements can be energized in a number of configurations, using a single gradient power supply unit (PSU), to generate a whole range of gradient performance levels. The design criteria for the MGC also include a requirement to prohibit peripheral nerve stimulation in all of its modes of operation. This requirement is achieved, while simultaneously providing high performance, by specifying different volumes of gradient linearity for each of the operating modes. Magn Reson Med 42:561-570, 1999.     

Surface coil holder for Signa

A surface coil holder is described for the General Electric Signa spectrometer. This allows for accurate positioning of the 31P coil relative to that of the 1H coil used for tissue slice localization.     

MR gradient coil heat dissipation

The temperature responses of five different gradient coil designs were modeled using simplified engineering equations and measured. The model predicts that the coil temperature approaches a maximum as an inverse exponential, where the maximum temperature is governed by two parameters: a local power density and a cooling term. The power density term is a function of position and is highest where the current paths have minimum widths and are closely packed. The cooling parameter consists of convective, conductive, and radiative components which can be controlled by (1) providing forced cooling, (2) having a coil former with high thermal conductivity and thin walls, and (3) varying the emissivity of the coil surfaces. For a given gradient strength, the average temperature rise is minimized by designing a coil with a small radius and thick copper. The model predicted the local temperature rise, which is also dependent on the current density, to within 5°C of measured values.     

Simultaneous reception from a whole-volume coil and a surface coil on a clinical MR system

Simultaneous acquisition of signals from the same anatomic region with use of both the head or body coil and a surface coil was demonstrated on healthy volunteers with a commercial magnetic resonance imaging system and a hybrid combiner. An improvement in the signal-to-noise ratio (S/N) over that which is obtained with the surface coil alone was demonstrated at depths of 3-4 cm and greater from the surface of the body. The practical necessity of use of the hybrid combiner to add the signals created several problems, such as the inability to obtain the predicted increase in S/N in certain areas and an actual decrease in S/N close to the surface coil. These problems would have been avoided with the use of two separate data channels. The only problem intrinsic to the method is a "wraparound" of structures and motion artifacts onto the field of view.