可降解镁合金覆膜支架治疗兔颈总动脉侧壁型动脉瘤可行性研究

目的 评价可降解镁合金覆膜支架治疗兔颈总动脉侧壁型动脉瘤的可行性.方法 20只新西兰大白兔饲养1周后采用间断式外翻缝合法将右侧颈总动脉与静脉囊吻合,构建20枚颈总动脉侧壁型动脉瘤.72 h内分别实施可降解镁合金覆膜支架植入术和Willis覆膜支架植入术.术前、术后即刻、术后3、6、12个月作DSA造影检查,对比动脉瘤闭塞、内漏、血管痉挛、血管损伤、血栓事件、血管闭塞和狭窄等情况.结果 可降解镁合金覆膜支架和Willis覆膜支架各植入10枚,技术成功率为100％.支架植入术后即刻造影显示所有动脉瘤腔完全闭塞,载瘤动脉通畅,可降解镁合金覆膜支架组血管痉挛3例,Willis覆膜支架组血管痉挛1例;术后3、6、12个月复查造影显示动脉瘤完全消失,载瘤动脉通畅.结论 可降解镁合金覆膜支架治疗兔颈总动脉侧壁型动脉瘤是可行的.     

应用Willis覆膜支架治疗脑池段动脉瘤的临床对照研究和长期随访结果

目的复杂性颈内动脉脑池段动脉瘤(ICA-CSA)治疗难度很高。本研究通过与弹簧圈填塞治疗疗效比较,探讨Willis覆膜支架治疗ICA-CSA的可行性。方法19枚和17枚ICA-CSA分别使用Willis覆膜支架植入(A组)和弹簧圈(B组)填塞治疗。即刻和随访血管造影评价动脉瘤复发,内漏和载瘤动脉狭窄情况。Kaplan-Meier生存分析曲线比较两组治疗动脉瘤的无复发率和载瘤动脉无再狭窄率。结果A组中,13枚ICA-CSA植入支架,即刻造影完全闭塞,有5枚ICA-CSA存在少量内漏;B组中,7枚ICA-CSA弹簧圈填塞即刻达到完全和次完全闭塞,8枚达到大部填塞,2枚部分填塞。在两组中各发生1例急性血栓形成,1例弹簧圈填塞后发生再出血。A组随访造影显示16枚ICA-CSA完全闭塞,2支载瘤动脉有轻度狭窄。Kaplan-Meier曲线分析表明术后18个月两组病例中分别有93.3%和50%动脉瘤治疗后无复发,分别有87.5%和100%载瘤动脉无狭窄。临床症状随访研究表明A组和B组病例中神经症状完全恢复分别为9例和9例,明显改善分别为3例和5例,无改变分别为2例和2例,恶化进展分别为1例和0例。结论应用Willis覆膜...     

Willis覆膜支架治疗颅内段颈内动脉病变临床应用

目的 评价Willis覆膜支架治疗颅内段颈内动脉病变的效果.方法 回顾性分析2013年4月至2015年4月采用Willis覆膜支架治疗的201例颅内段颈内动脉病变患者.术后3～6个月随访复查DSA和临床观察结果.结果 Willis覆膜支架成功治疗198例颅内段颈内动脉病变,其中囊性动脉瘤88例,外伤性动脉瘤19例,假性动脉瘤35例,外伤性颈动脉海绵窦瘘56例,技术成功率达到98.5％.Willis覆膜支架释放部位依次为颈内动脉C7段9例,C6段28例,C5段32例,C4段110例,C3段19例;支架释放后即刻DSA显示病变完全不显影163例,内漏35例,经球囊后扩或再植入支架治疗后病变完全不显影33例(其中2例闭塞载瘤动脉),2例仍存在内漏.术中发生支架源性血管破裂出血5例,术中成功止血4例;术后再出血1例,死亡2例.术后3～6个月随访复查DSA显示载瘤动脉通畅189例,轻度狭窄5例;病变完全不显影196例.临床随访3～20个月,存活患者无新发神经系统体征.结论 Willis覆膜支架能够安全有效地治疗颅内段颈内动脉病变,但需要更远期随访.     

颅内动脉瘤用纳米电纺覆膜支架初步实验研究

目的 动物实验研究评价新型颅内动脉瘤用纳米电纺覆膜支架的力学性能和生物相容性.方法 10只健康成年比格犬中共植入20枚纳米电纺覆膜支架,其中10枚0.10 mm丝径支架植入左侧锁骨下动脉(A组),10枚0.15 mm丝径支架植入右侧锁骨下动脉(B组).支架植入术后即刻和术后2、4、6周分别作血管造影随访.支架段血管作组织学病理检查,评价支架内皮化和内膜增生情况.结果 A组支架植入后即刻造影示7枚支架内漏,随访期间2枚支架内漏消失,5枚仍残留内漏;B组支架植入后即刻造影示1枚支架内漏,随访期间内漏消失,3枚支架发生轻度狭窄(狭窄程度＜50％).组织病理学检查显示,B组术后2周血管壁呈慢性炎性反应,术后4周支架内表面部分血管内皮化,术后6周支架内表面基本实现血管内皮化.结论 本实验研究初步证明纳米电纺覆膜支架治疗颅内动脉瘤的有效性和可行性,具有重要临床应用价值.但该支架尚处于初始研究阶段,有待进一步远期观察和研究.     

Willis覆膜支架治疗外伤性颈内动脉假性动脉瘤的中期随访

目的评价Willis覆膜支架治疗外伤性颈内动脉假性动脉瘤的疗效和中期预后。方法在38例头颈部外伤患者的脑血管造影中发现了13例、14枚延迟性颈内动脉假性动脉瘤,所有假性动脉瘤使用Willis覆膜支架治疗,术后1、3、6和12个月随访脑血管造影,分为完全闭塞和不完全闭塞;临床症状随访分为完全恢复、明显改善、无明显改善和恶化。结果所有病例成功植入Willis覆膜支架,术中无一例出现并发症。最初9例假性动脉瘤完全闭塞,4例不完全闭塞;3～12个月随访造影显示12例假性动脉瘤完全闭塞,所有病例颈内动脉通畅,无明显支架内狭窄。临床随访11例完全恢复,1例改善,1例无明显改善;无致残和致死病例。结论Willis覆膜支架治疗外伤性颈内动脉假性动脉瘤是切实可行的,能够很好地保留载瘤动脉。     

三种覆膜支架治疗犬颈动脉囊状动脉瘤的实验研究

目的 探讨颅内覆膜支架治疗犬颈动脉囊状动脉瘤的可行性、安全性和疗效。方法 采用外科手术方法在20只犬中建立犬颈动脉囊状动脉瘤模型36枚，应用血管内技术放置聚氨酯膜支架(PUM-SSS)、可膨胀聚四氟乙烯膜支架(ePTFEM-SSS)、生物膜支架(BM-SSS)各12枚，支架置人后即刻及术后2、4和12周分别进行血管造影随访，并进行组织病理学检查及统计学分析。结果PUM-SSS、ePTFE-SSS和BM-SSS的完全开放率分别为25．O％、41．7％和91．7％，PuM-SSS、ePTFE-SSS分别和BM-SSS比较有非常显著的差异。组织学分析表明，支架置放后2周BM-SSS内皮化开始，12周3种支架内皮化基本完成；所有治疗的动脉瘤瘤腔内均见血栓形成，载瘤动脉内膜增厚；支架附着处血管见不同程度的细胞变性；金属支架未见到腐蚀。结论 覆膜支架是一种新的简单、安全、有效的治疗犬颈动脉囊状动脉瘤的方法。生物膜支架具有更好的血液相容性和血管开通率，是一种较理想的覆膜支架。     

两种覆膜支架治疗犬颈部囊状动脉瘤的对比研究

目的探讨2种覆膜支架即聚氨酯膜支架（PUM—SSS）和生物膜支架（BM—SSS）治疗颅颈部囊状动脉瘤的可行性。方法16条健康杂种犬共成功建立颈部囊状侧壁动脉瘤模型29个，其中26个应用血管内技术成功放置14枚BM—SSS（BM—SSS组）和12枚PUM—SSS（PUM—SSS组），另外3个不予任何处理作为对照组。支架置入后即刻及术后2、4、12周分别进行血管造影随访，不同随访时间结束后，进行组织病理学检查，最后进行统计学分析。结果血管造影显示，支架置入后即刻所有动脉瘤瘤腔全部消失，载瘤动脉保持通畅。对照组在直至1年的随访中动脉瘤瘤腔及载瘤动脉均显影良好。在置放的14枚生物膜支架及12枚聚氨酯膜支架中，分别有13枚和3枚开放良好，两者完全开放率比较差异有统计学意义（采用Fisher确切概率计算法，P=0．0008）。组织学分析表明，支架置放后12周2种支架的内皮化基本完成，所有治疗的动脉瘤瘤腔内均见血栓及纤维组织充填，支架深嵌于载瘤动脉血管壁内，表面被新生的内膜所覆盖。2种支架所在处血管均有不同程度的细胞变性。结论覆膜支架是1种新的简单、安全、有效的治疗颅颈部动脉瘤的方法。生物膜支架是1种较理想的覆膜支架，而聚氨酯膜支架在应用于临床前尚需做进一步的研究。     

血管内治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血

目的探讨鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血的血管内治疗方式、疗效及安全性。方法 回顾性分析福建医科大学附属协和医院收治的21例鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血患者的临床资料,其中8例行覆膜支架植入,6例行支架辅助弹簧圈栓塞,7例直接行载瘤动脉闭塞治疗。分析手术策略、治疗结果以及临床与影像学随访结果。结果 21例患者均成功接受血管内治疗。术后即刻止血效果均良好,瘤颈残留2例,瘤体残留1例。术后出血复发5例,其中4例再次行载瘤动脉闭塞后出血停止,1例为覆膜支架植入后发生内漏,予球囊扩张后血止,但1个月后不明原因死亡;1例覆膜支架植入术后出现昏迷,CT示蛛网膜下腔出血、脑肿胀,治疗后未好转自动出院;3例在随访中发现颈内动脉闭塞;2例术后未随访。随访的19例患者中mRS评分0分9例,1分6例,2分2例,5分1例,6分1例。结论 针对鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血,血管内治疗效果确切,安全性较高。覆膜支架短期疗效好,但也存在着动脉瘤复发、内漏等问题,载瘤动脉闭塞可能远期疗效更可靠。     

一种新型的脑动脉瘤血管内治疗技术——脑血管覆膜支架术的问世

虽然传统的动脉瘤腔内栓塞治疗颅内动脉瘤方法在临床应用广泛,但有其自身的缺陷。专为颅内血管设计的Willis覆膜支架技术其治疗行为发生在载瘤动脉,其机制是使动脉瘤与体循环隔绝,直至动脉瘤内自愈性血栓形成。Willis覆膜支架柔顺性好,在选择病例容易进入颈内动脉远端。采用覆膜支架治疗C5段以下假性、外伤性动脉瘤方法简单、效果肯定。在其他部位以及其他类型动脉瘤,如颈内动脉和椎动脉巨大动脉瘤、夹层或夹层动脉瘤、弹簧圈栓塞后复发之动脉瘤,也可选择覆膜支架治疗。载瘤动脉过度迂曲应视为Willis覆膜支架的禁忌证。分支动脉开口,特别是脉络膜前动脉、眼动脉,应尽量避免。Willis覆膜支架的应用,彻底改变了颅内动脉瘤血管内治疗的传统理念,由于其操作简单,效果满意,为颅内动脉瘤的血管内治疗技术的发展提供了新的方向。增加临床病例的积累以完整评价Willis覆膜支架的长期临床效果是需要的。     

犬实验性颈总动脉动脉瘤的血管内支架治疗系列研究之二：载瘤动脉内置入支架后血流动力学研究

目的: 探讨将血管内支架置于动脉瘤附近载瘤动脉后发生的血流动力学改变,为动脉瘤的载瘤动脉内支架治疗提供实验依据。材料与方法: 向6 只犬7 个颈总动脉侧壁动脉瘤附近载瘤动脉内置入血管内支架,而后作血管造影,比较支架置入前后瘤腔闭塞及载瘤动脉通畅情况。结果: 7 个动脉瘤载瘤动脉内支架置入后3 天瘤腔均发生闭塞,载瘤动脉保持通畅;3 周后瘤腔仍见闭塞且载瘤动脉保持通畅。结论: 向动脉瘤附近载瘤动脉内置入血管内支架,可有效地闭塞动脉瘤,且载瘤动脉保持通畅     

Treatment of carotid siphon aneurysms by use of the Willis stent graft: an angiographic and histopathological study

Objective

We designed a carotid siphon (CS) aneurysm model in dogs to test a new stent graft (the Willis covered stent) and compared tissue reaction over 12-month follow-up versus a comparison group with stents implanted in straight vessels.

Methods

Twenty-four saccular sidewall aneurysms (group A) and 12 CS aneurysms (group B) were created surgically. A Willis stent graft was implanted in each aneurysm. Angiography was performed immediately and at 1-, 3-, 6- and 12-month post-implantation to investigate aneurysm isolation, endoleak, stent angulation, parent artery (PA) patency and restenosis. Light and scanning electron microscopy were used to identify aneurysmal sac thrombi, intima hyperplasia and endothelial progress.

Results

Immediate angiography demonstrated mild endoleak in two aneurysms and three stent angulations in group B. Follow-up at 12 months revealed resolved endoleaks, occlusion in one PA and mild stenosis in three in group B. In group A, occlusion occurred in one PA and mild stenosis in two. Light microscopy revealed new intima, and all aneurysm sacs were filled with thrombi. In group B, endothelial progress was complete at 12 months, and closely correlated with haemodynamic changes.

Conclusions

Application of a Willis stent graft is a feasible method of treating CS aneurysms, and it exhibits a prolonged endothelial progress compared with that in straight vessels.     

Curved planar reformatted CT angiography: usefulness for the evaluation of aneurysms at the carotid siphon.

BACKGROUND AND PURPOSE: Three-dimensional CT angiography uses the data obtained on a contrast-enhanced CT brain scan to generate 3D images of the intracranial vasculature. We describe the methodology of curved planar reformatting (CPR) for CT angiography and characterize its usefulness in the evaluation of aneurysms at the carotid siphon, comparing it with the shaded surface display technique (SSD). METHODS: Eighty-seven patients with suspected intracranial aneurysms at CT angiography were examined by conventional cerebral angiography, and the patients with aneurysm(s) at the carotid siphon were selected for study. For these patients, the visibility of the neck and fundus of the aneurysms on CT angiograms was compared for those obtained with SSD and those with CPR, and observer reproducibility was evaluated with the kappa statistic. RESULTS: Eighteen patients were confirmed to have an aneurysm at the carotid siphon on conventional angiograms. Seventeen aneurysms were depicted at CT angiography with SSD; 18 aneurysms with CPR. The number of visible aneurysmal necks and fundi was nine and 12, respectively, with SSD; 18 and 18, respectively, with CPR. CONCLUSION: CPR allows better demonstration of the body and neck of an aneurysm at the carotid siphon, which has a tortuous course and is surrounded by complex bony structures. CPR may be a useful adjunct for the evaluation of aneurysms in this region.     

Magnetic resonance angiography compared to intra-arterial digital subtraction angiography in patients with subarachnoid haemorrhage

Summary In order to evaluate the sensitivity and specificity of magnetic resonance angiography (MRA) in spontaneous subarachnoid haemorrhage, 14 patients with recent haemorrhage verified by CT or lumbar puncture were investigated with both selective intra-arterial digital subtraction angiography (IA-DSA) and MRA by two independent teams, each having the same preangiographic information. The results were compared with each other and whenever possible (all positive cases except one) with those of surgical intervention. Seven patients were identified by MRA and IA-DSA as having a single aneurysm on the circle of Willis, 1 an aneurysm of the posterior inferior cerebellar artery 1 an aneurysm of the internal carotid artery (siphon) and 2 patients with two aneurysms on the circle of Willis. MRA and IA-DSA both failed to demonstrate aneurysms in 2 cases. Three patients had negative results on both methods and no surgical intervention was attempted. The aneurysms ranged from 0.3 to 1.5 cm in size. In most cases there was agreement between MRA and DSA, leading us to believe that, if the proper protocols are followed, MRA is a powerful alternative to other established methods in the detection of intracranial aneurysms. At this stage it will not replace IA-DSA prior to surgery, but the ability to obtain various projections using 3D MRA may improve surgical planning.     

Aortic and arterial aneurysms in behçet disease: management with stent-grafts--initial experience

PURPOSE: To assess the application of stent-grafts in the management of aortic and arterial aneurysms in patients with Beh?et disease. MATERIALS AND METHODS: Nine aneurysms in seven patients were managed with various types of stent-grafts. Diagnoses were based on clinical findings. The aortic aneurysms (n = 3) were thoracic (n = 1), suprarenal (n = 1), or infrarenal (n = 1). The arterial aneurysms (n = 6) were in the right and left subclavian (n = 2), right common carotid (n = 2), right brachiocephalic (n = 1), or left common iliac arteries (n = 1). A tandem connection of Gianturco stent covered with polytetrafluorethylene was placed in three aneurysms, and a balloon-expandable stent was placed in six. RESULTS: The stent-graft was successfully placed in all patients. Immediate follow-up angiography revealed complete exclusion of the aneurysm in all cases. Follow-up computed tomography performed 3 days to 2 weeks later revealed complete exclusion and thrombosis of the aneurysm and patency of the stent-graft in six patients. In one patient, total occlusion of the artery with a stent occurred due to flow disturbance caused by double lesions. During follow-up (range, 6-59 months; mean, 28 months), the aneurysm resolved and completely regressed in four patients. A recurrent aneurysm at the distal margin of previously inserted stent-graft was successfully managed with an additional stent-graft. CONCLUSION: The findings in this initial experience suggest that stent-graft insertion may be a safe and effective alternative to surgical treatment of aortic and arterial aneurysms in patients with Beh?et disease.     

Role of the endothelial lining in endoleak formation and persistence after endovascular repair of aneurysm

PURPOSE: To evaluate whether ablation of the endothelial lining of an aneurysm can prevent endoleak persistence after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: Bilateral aneurysms were constructed in common iliac arteries in three different experimental groups. In group 1 (six dogs), 12 aneurysms without collateral outflow were created, the endothelial layer was removed on one side, and stent-grafts were implanted immediately after surgery with endovascular creation of a type I endoleak. In group 2 (six dogs), the same experiment was performed in aneurysms with collateral outflow. In group 3 (three dogs), six aneurysms with collateral outflow were denuded, but stent-grafts were implanted 3 months later. Follow-up imaging was performed with Doppler ultrasonography (US) and angiography until animal sacrifice 3 months after EVAR. Leak persistence and healing were also evaluated with macroscopic and histopathologic examination. RESULTS: Type I endoleaks persisted in all endothelialized group 1 aneurysms (six of six), but in none that were denuded before stent-graft implantation (P = .03). The ratio between the maximum diameter of the aneurysm measured before sacrifice and at baseline was significantly lower in denuded aneurysms than in aneurysms with an intact endothelial layer (74% vs 92%, P = .003). Endoleaks were observed in all aneurysms of groups 2 (denuded and intact endothelium) and 3. All endoleak areas were surrounded by endothelial lining. CONCLUSIONS: In this animal model of EVAR, ablation of the endothelial lining promotes long-term endoleak thrombosis after EVAR. The presence of collateral flow can promote re-endothelialization and endoleak persistence.     

Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.     

Clinico-radiological spectrum of giant supraclinoid internal carotid artery aneurysms

Summary A review of a series of 312 giant intracranial aneurysms treated at University Hospital in London, Ontario, Showed that 93 of those aneurysms were located between the intracavernous portion and the bifurcation of the internal carotid artery. Sixty-five of those aneurysms were carotid ophthalmic, 12 were located in the internal carotid-posterior communicating-anterior choroidal artery regions and 16 involved the internal carotid artery bifurcation. For the majority, clinical presentation was related to the mass of the aneurysms and compression of surrounding structures such as visual pathways, ocular motor cranial nerves, the fifth nerve, and hypothalamic-pituitary axis. Fourteen patients presented with subarachnoid hemorrhage. Cerebral angiography, computed tomography and xenon inhalation studies of cerebral blood flow were the tools used to study the morphology of the aneurysm and dynamics of the circle of Willis.     

颅内动脉瘤的CTA术前诊断

评价CT血管造影(CTA)在颅内动脉瘤的术前诊断价值及对最大密度投影(MIP)、表面遮盖显示(SSD)和容积显示技术(VRT)作用的比较.材料和方法:对36例CT平扫怀疑患有颅内动脉瘤的患者进行CTA检查,初选27例动脉瘤患者分别进行MIP、SSD及VRT成像,观察动脉瘤的部位、形态、生长方向及载瘤动脉;进行瘤体大小及瘤颈宽度的测量,部分病例与术中结果比较.结果:27例动脉瘤患者中,动脉瘤大小:5～60mm.瘤颈呈蒂状(颈宽＜10mm)18例、宽颈(颈宽≥10mm)9例.载瘤动脉分别为:大脑中动脉(12例)、大脑前交通动脉(7例)、颈内动脉虹吸部(6例)、基底动脉(2例).蒂状窄颈动脉瘤均行手术治疗,术后恢复良好;1例瘤颈宽为10mm手术后患者所在中动脉闭塞,脑组织缺血性梗死,9例均放弃手术.结论:CTA可作为动脉瘤的有效术前筛选诊断,可作为神经外科医师手术前的重要指导方法之一.     

A failure of matrix metalloproteinase inhibition in the prevention of rat intracranial aneurysm formation

We tested the hypothesis that nonspecific matrix metalloproteinase (MMP) inhibition with doxycycline would decrease the incidence of intracranial aneurysm formation in a rat aneurysm model. We performed common carotid artery ligation on 96 Long-Evans rats. A treatment group of 48 animals was chosen at random to receive oral doxycycline (3 mg/kg) in addition to standard rat chow, and the control group of 48 animals received standard rat chow only. The major circle of Willis arteries was dissected at 1 year following carotid ligation, and the proportions of animals with aneurysms were compared between groups using Fisher’s exact test. Four animals given oral doxycycline and ten control animals expired before 1 year. Of the examined animals, eight saccular intracranial aneurysms were found in 8 of 45 animals which had received doxycycline (17.8%) and seven saccular intracranial aneurysms were found in 7 of 37 control animals (18.9%). There was no significant difference in aneurysm formation between the doxycycline-treated and control groups (P=0.894). Nonspecific MMP inhibition with doxycycline is not effective in preventing intracranial aneurysm formation in a rat model. The authors have no personal or institutional financial interest in drugs, materials or devices described in this submission