应用GDC治疗颅内宽颈动脉瘤

电解可脱卸弹簧圈（guglielmi datachable coil,GDC)治疗颅内动脉瘤在临床治疗中取得了较好的成绩。但GDC治疗宽颈的动脉瘤（瘤颈直径＜4mm者）存在困难。为了解决这一难题，学者们提出各种不同的改进方法。讨论了较成熟的球囊辅助GDC释放技术的优缺点，也对病例数较少的其他方法作了初步分析，以期更好地将这项技术用于临床治疗。     

颅内宽颈动脉瘤的介入治疗

介入治疗已成为颅内动脉瘤治疗的重要手段。电解可脱卸弹簧圈（GDC）栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。但宽颈动脉瘤的致密栓塞率低，复发率高，如何提高颅内动脉瘤的致密栓塞是该技术的要点和难点。动脉瘤微导管的双弯塑型、横向成篮、篮外填塞、分部填塞及瘤颈重塑型技术可明显提高动脉瘤的致密栓塞率。常见的并发症有术中出血、血栓栓塞、血管痉挛等，迅速继续填塞动脉瘤是处理术中出血最有效的措施；实施腰蛛网膜下腔持续引流，释放血性脑脊液，辅以抗凝及“3H”治疗是防治脑血管痉挛和血栓栓塞的关键。对于特别宽颈及梭形动脉瘤，无法单纯采用GDC治疗，血管内支架结合GDC是治疗颅内梭形及宽颈动脉瘤的有效方法。正确的支架选择，防止支架移位，是手术成功的关键，但确切疗效需进一步长期随访。     

运用介入法检查治疗颅内宽颈动脉瘤的分析

目的：研究探讨血管内水解可脱卸弹簧圈结合球囊封堵治疗颅内宽颈动脉瘤的技术操作要点，适应症及临床应用前景。方法：本组共10例患者采用水解可脱卸弹簧圈结合封堵球囊栓塞治疗颅内宽颈动脉瘤，直径在5mm-10mm。先用大弹簧圈使其在瘤内成篮，然后再用小弹簧圈进行填塞，根据瘤体的大小，可用数个由大到小的水解可脱弹簧圈直至把瘤体腔填塞完全，结果：10例颅内动脉瘤获得完全致密栓塞均获得成功，术后不定期随访，载瘤动脉保持通畅，无再出血及脑缺血性事件发生，动脉瘤无复发，效果良好。结论：水解可脱卸弹簧圈结合球囊封堵法栓塞治疗颅内宽颈动脉瘤效果良好，是首选的治疗颅内宽颈动脉瘤的完全、有效的方法，在临床上有广阔的应用前景。     

血管内支架治疗颅内动脉瘤

目的：探索使用血管内支架及血管内支架结合电解可脱卸弹簧圈（Guglielmi detachable coil,GDC)治疗颅内梭形及宽颈动脉瘤的可能性。方法：3例椎动脉颅内段梭形动脉瘤及6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,填入GDC。结果：7例动脉瘤致密堵塞,2例大部堵塞,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可选择的有效方法之一。     

血管内支架结合GDC栓塞治疗基底动脉顶端宽颈动脉瘤

目的 报道应用血管内支架结合电解可脱卸弹簧圈栓塞治疗1例未破裂的基底动脉顶端宽颈动脉瘤的经验及结果。方法 将球囊膨胀型血管内支架跨动脉瘤瘤颈部位置入并准确释放后，微导管超选进入动脉瘤内填塞弹簧圈。结果 支架成功的置入，支架近端在基底动脉，远端在大脑后动脉近段，动脉瘤得到次全栓塞(90％以上)，载瘤动脉及毗邻的侧支血管保持通畅，患者恢复满意。结论 血管内支架结合弹簧圈栓塞治疗基底动脉顶端宽颈动脉瘤是可行的，支架植入对侧支血管血流无明显影响。     

支架辅助GDC治疗颅内动脉瘤术中并发症的防治

目的 回顾总结血管内支架治疗颅内动脉瘤术中并发症，以提高使用血管内支架结合电解可脱卸弹簧圈(GDC)治疗颅内夹层及宽颈动脉瘤的安全性。方法 105例难治性动脉瘤，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，填入GDC。结果 6例患者术中出现支架移位，1例发生动脉瘤破裂出血，1例发生大脑中动脉穿支出血，1例发生支架塌陷，1例发生颈内动脉夹层动脉瘤，1例弹簧圈突入小脑后下动脉(PICA)起始部，10例发生血管痉挛，经对症处理，预后良好。结论 在支架植入过程中，联合采用多种措施可减少并发症的发生；支架和GDC联合应用治疗颅内夹层及宽颈动脉瘤安全、有效。     

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     

血管内支架结合GDC治疗颅内宽颈动脉瘤的介入护理配合

颅内动脉瘤血管内介入治疗经历了球囊、游离弹簧圈、机械可脱卸弹簧圈(MDS)的发展,特别近10年来电解可脱卸弹簧圈(GDC)的应用,使之成为一种安全、有效的微创治疗方法。但是对于梭形及体／颈大于1／2的宽颈动脉瘤,则无法使弹簧圈稳定在动脉瘤内,容易发生载瘤动脉阻塞。随着安全有效的支架输送系统的研制成功,血管内支架在宽颈动脉瘤的治疗中可作为血管腔内隔绝物,防止弹簧圈突入载瘤动脉,使弹簧圈在瘤内达到致密填塞,     

应用GDC治疗颅内宽颈动脉瘤

电解可脱卸弹簧圈(guglielmi detachable coil，GDC)治疗颅内动脉瘤在临床治疗中取得了较好的成绩。但GDC治疗宽颈的动脉瘤(瘤颈直径＞4mm者)存在困难。为了解决这一难题，学者们提出各种不同的改进方法。讨论了较成熟的球囊辅助GDC释放技术的优缺点，也对病例数较少的其他方法作了初步分析，以期更好地将这项技术用于临床治疗。     

血管重建治疗颅内宽颈动脉瘤1例

颅内动脉瘤的血管内治疗有了很大的发展,特别是电解可脱卸弹簧圈（GDC）的运用,使介入治疗成为动脉瘤除夹闭手术之外的一项可靠治疗手段。但对于宽颈动脉瘤仍然无能为力,而血管内支架的运用使这种动脉瘤的介入治疗成为可能。本文报道联合应用颅内专用支架和弹簧圈,成功对1例宽颈颈内动脉海绵窦段动脉瘤患者实施介入栓塞治疗。     

前交通动脉瘤的栓塞治疗

目的　总结 2 62例前交通动脉瘤栓塞治疗的经验。方法　均采用电解可脱卸弹簧圈(guglielmidetachablecoil,GDC)作动脉瘤内栓塞治疗。对双侧A1正常者应用双侧颈动脉置管技术监测栓塞术中载瘤动脉通畅情况 ,对瘤颈累及双侧A2者采用微导管微导丝辅助技术保持载瘤动脉通畅。发生术中出血者予弹簧圈继续栓塞 ,发生术中血栓形成者予尿激酶溶栓。 3 4例颅内多发动脉瘤均同次手术治愈。结果　动脉瘤完全闭塞 160例 ,>90 %闭塞 5 6例 ,<90 %闭塞 4 6例。术中因过度栓塞造成载瘤动脉闭塞 10例 ,术后脑梗死 16例。术中发生血栓形成 3例 ,经溶栓后恢复通畅。术后死于肺部并发症 1例 ,植物生存 1例。随访 190例 ,3～ 6个月行DSA/MRA复查 ,动脉瘤复发行 2次栓塞 8例 ,复发经手术治愈 1例 ,其余治疗结果稳定。结论　GDC栓塞治疗前交通动脉瘤效果好。采用微导管 /微导丝辅助技术可提高致密栓塞率和减少脑梗死并发症发生     

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     

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。     

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。     

Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils

The aim of this study was to evaluate endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils GDC. To obtain long-term follow-up, we selected patients treated between October 1992 and March 1994. Among the 251 berry aneurysms treated by detachable coils at our institution, 36 were located at the anterior communicating artery and treated with GDC. The most frequent clinical presentation in this group (86 %) was subarachnoid haemorrhage (30 cases). There were 23 aneurysms which were completely and 6 were partially occluded. We did not treat 7 aneurysms. In 3 cases, no endovascular treatment was attempted either because the aneurysmal neck was not clearly distinct from the adjacent, or parent vessels (2 cases), or because the aneurysm sac was too small (1 case). In 4 cases, treatment failed because of atheroma of the cervical and intracranial vessels. Complications were, in the majority of cases, related to clotting (3 cases) with a good outcome in 2 cases and neurological sequelae in 1. In 1 case rupture of the aneurysm occurred during treatment. Endovascular packing was continued until complete occlusion of the aneurysm was achieved and no clinical complication was observed after the treatment. Two patients died as a result of complications of subarachnoid haemorrhage (vasospasm in one case, pulmonary complications in the other). Endovascular treatment using GDC is an efficient technique for treating anterior communicating artery aneurysms even in the acute phase of bleeding. Received: 6 June 1995 Accepted: 25 August 1995     

GDC血管内栓塞治疗颅内动脉瘤

目的 探讨电解可脱性弹簧圈（GDC）血管内栓塞治疗颅内动脉瘤的疗效和技术要点。方法 对31例动脉瘤患者应用微导管技术,通过数字减影全脑血管造影,采用GDC作动脉瘤囊内填塞治疗。结果 31例31枚动脉瘤中28枚瘤腔完全闭塞,3枚95％闭塞。术后30例临床痊愈;1例死亡;病死率3．2％。术中并发动脉瘤再破裂出血1例;术后弹簧圈末端逸出1例。术后随访0．5～3年均无再出血。结论 GDC血管内栓塞治疗颅内动脉瘤疗效可靠,早期栓塞及有效的术后处理是提高治愈率的重要方法。     

Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation: A case report

Embolization of collateral veins is often treated with rigid coils(Gianturco and interlocking detachable coils type).However,when dealing with tortuous and dilated collateral veins,there is a high risk for technical failure and coil migration due to inflexibility of the coils.To safely and successfully solve this problem,Guglielmi detachable coils(GDC) can be used for embolization.Their flexibility allows for easy navigation in tortuous veins,low risk of unintended coil release or coil migration,and safe deployment.A 12-year-old girl with a single ventricle had severe cyanosis and a low exercise tolerance 5 years after Fontan procedure.The symp-toms were caused by a tortuous and dilated collateral from the left phrenic vein into the left pulmonary vein,forming a right-to-left shunt.The collateral,which had a large diameter and high flow,and therefore a high risk of coil migration,was successfully embolized with 8 GDC.There were no complications such as coil migration or cerebral infarction.Transcatheter embolization increased her systemic oxygen saturation from 81%-84% to 94%-95%,and increased her ability to exercise.The embolization procedure using flexible GDC was low risk compared with other rigid coil embolization techniques when performing embolization of tortuous and dilated collateral veins.     

MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis

Introduction The aim of this study was to systematically review published data on the diagnostic performance of magnetic resonance angiography (MRA) compared with digital subtraction angiography as reference standard in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils. Methods A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Two reviewers independently assessed the methodological quality of each study. A meta-analysis of the reported sensitivity and specificity of each study was performed. Results The inclusion criteria were met by 16 studies. The studies had moderate methodological quality. Pooled sensitivity and specificity of nonenhanced time-of-flight MRA (TOF-MRA) for the detection of residual flow (within the aneurysmal neck and/or coil mesh) were 83.3% (95% CI 70.3–91.3%) and 90.6% (95% CI 80.4–95.8%), respectively. Pooled sensitivity and specificity of contrast-enhanced MRA (CE-MRA) for the detection of residual flow were 86.8% (95% CI 71.4–94.5%) and 91.9% (95% CI 79.8–97.0%), respectively. All pooled estimates were subject to heterogeneity. There were no statistically significant differences in pooled sensitivity and specificity between TOF-MRA and CE-MRA. Conclusion The results of this study suggest that both TOF-MRA and CE-MRA achieve a moderate to high diagnostic performance. However, the findings should be interpreted with caution because the included studies were of moderate methodological quality and all pooled estimates were subject to heterogeneity. More well-designed studies are required to confirm the current results and MRA at higher field strength (>1.5 T) needs to be further explored.     

Stent-assisted coil embolization of intracranial wide-necked aneurysms

The endovascular treatment of cerebral aneurysms with coils poses significant technical challenges, particularly with respect to wide-necked aneurysms. We present the results of our initial experiences in using a stent for endovascular treatment of aneurysms, with an emphasis on potential applications, technical aspects, and associated complications. Twenty-three wide-necked aneurysms from 22 patients were treated during the 13-month study period. Seven patients presented with subarachnoid hemorrhage. Aneurysms were located at the internal carotid artery (n=14), the vertebral artery (n=3), the basilar artery (n=5), and the middle cerebral artery (n=1). A Neuroform stent² was used for stent-assisted procedures. Premedication with antithrombotic agents was available for unruptured cases. Postprocedural antithrombotic medication was prescribed for all patients. Nineteen aneurysms were primarily stented, followed by coil placement. For five of these aneurysms, stenting was performed subsequent to failure of an attempt to frame with an initial coil. Stenting for the remaining four aneurysms was performed as a rescue procedure to prevent the migration of previously placed coils. Complete occlusion was obtained in ten aneurysms, nearly complete occlusion (95% or more occluded) in 11 aneurysms, and partial occlusion (less than 95% occluded) in one aneurysm. In one aneurysm, we failed to navigate the microcatheter into the aneurysmal sac through the interstices of the stent. Stent thrombosis was noted during the procedure in one patient. Hemorrhagic complication on the 25th day after the procedure was noted in one patient. No procedure-related complications were observed during the procedure or during follow-up in the remaining 20 patients, including seven patients who did not receive antithrombotic agents prior to endovascular treatment owing to recent subarachnoid hemorrhage. To overcome the technical limitation in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, even though longer periods of follow-up are required.     

Three-dimensional time-of-flight MR angiography for evaluation of intracranial aneurysms after endosaccular packing with Guglielmi detachable coils: comparison with 3D digital subtraction angiography

The sensitivities and specificities of three-dimensional time-of-flight MR angiography (3D-TOF MRA) and 3D digital subtraction angiography (3D-DSA) were compared for evaluation of cerebral aneurysms after endosaccular packing with Guglielmi detachable coils (GDCs). Thirty-three patients with 33 aneurysms were included in this prospective study. 3D-TOF MRA and 3D-DSA were performed in the same week on all patients. Maximal intensity projection (MIP) and 3D reconstructed MRA images were compared with 3D-DSA images. The diameters of residual/recurrent aneurysms detected on 3D-DSA were calculated on a workstation. In 3 (9%) of 33 aneurysms, 3D-TOF MRA did not provide reliable information due to significant susceptibility artifacts on MRA. The sensitivity and specificity rates of MRA were 72.7 and 90.9%, respectively, for the diagnosis of residual/recurrent aneurysm. The diameters of residual/recurrent aneurysms that could not be detected by MRA were significantly smaller than those of detected aneurysms (mean 1.1 vs mean 2.3 mm). In one aneurysm of the anterior communicating artery (ACoA), the relationship between the residual aneurysm and the ACoA was more evident on MRA than DSA images. MRA can detect the recurrent/residual lumen of aneurysms treated with GDCs of up to at least 1.8 mm in diameter. 3D-TOF MRA is useful for follow-up of intracranial aneurysms treated with GDCs, and could partly replace DSA.