支架辅助弹簧圈栓塞颅内前交通动脉瘤

目的 总结Solitaire AB支架辅助弹簧圈栓塞颅内前交通动脉瘤的有效性和安全性.方法 回顾分析2010年7月至2011年12月23例Solitaire AB支架辅助弹簧圈栓塞颅内前交通动脉瘤患者的病例资料,通过评估动脉瘤栓塞率、载瘤动脉保留、患者预后、并发症等,判断应用该支架的安全性和有效性.结果 手术成功率100％,动脉瘤完全栓塞17例(74％),近全栓塞4例(17％),不完全栓塞2例(9％).载瘤动脉完全保留.无死亡病例,随访见mRS评分0～1分22例,3分1例.支架引起脑血管痉挛并发症1例,无临床症状.结论 Solitaire AB支架用于辅助弹簧圈栓塞颅内前交通动脉瘤是有效和安全的.     

支架后释放技术在颅内宽颈动脉瘤栓塞治疗中的应用

目的探讨支架后释放技术在颅内宽颈动脉瘤栓塞治疗中的安全性、疗效及技术优势。方法回顾分析2007年1月至2009年5月间支架后释放技术（支架输送至载瘤动脉动脉瘤段,先填塞部分弹簧圈后再释放支架）治疗的153例178＂个动脉瘤患者的动脉瘤及载瘤动脉解剖形态,支架植入技术操作程序,临床和造影结果。结果所有动脉瘤均成功植入支架,其中Neuroform支架76枚、Enterprise支架72枚、LEO支架33枚。术后即刻完全栓塞136个动脉瘤（76．4％）,瘤颈残留29个（16．3％）,部分栓塞13个（7．3％）。术中弹簧圈拉丝1例,血栓栓塞并发症1例。平均术后9．3个月后DSA随访74例,MRA随访44例,显示3例动脉瘤再通。结论支架后释放技术是颅内动脉瘤栓塞治疗中的一种重要手段,能显著提高动脉瘤颈覆盖率而达到血管重建目的,使支架治疗技术成功率、安全性和疗效进一步提高。     

新型颅内Solitaire支架辅助弹簧圈栓塞颅内复杂动脉瘤

目的探讨新型自膨式闭环颅内Solitaire支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤的疗效及安全性。方法回顾性分析采用Solitaire支架辅助弹簧圈栓塞治疗的23例颅内复杂动脉瘤患者的临床资料。包括未破裂动脉瘤2例,破裂动脉瘤21例。行单纯支架治疗2例,支架辅助弹簧圈栓塞21例。结果 23例共使用24枚支架,23枚支架均成功定位、释放,1枚解脱后移位;栓塞后即刻造影示动脉瘤致密栓塞16例,瘤颈残留4例,瘤体显影3例。术后发生抗凝、抗血小板聚集相关并发症2例。出院时按改良Rankin评分0分19例,1分2例,2分1例。死亡1例。结论 Solitaire支架输送简单,顺应性好,定位准确,完全释放后仍可以完全回收,安全性高,即刻栓塞效果满意。     

支架辅助弹簧圈栓塞颅内宽颈动脉瘤的临床研究

目的分析支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤疗效及随访结果。方法回顾性分析44例(45个)颅内宽颈动脉瘤支架辅助弹簧圈栓塞的结果,所有患者进行随访,进行改良Rankin评分(mRS)。16例患者行动脉造影或MRA随访。结果术后即刻栓塞程度:0级栓塞12个,1级栓塞22个,2级栓塞9个,3级栓塞2个。手术相关并发症7例,其中4例为血栓栓塞并发症。平均随访7.8个月,mRS 0分31例,1分5例,2分3例,3分2例,4分2例,5分1例。2个动脉瘤再通,再次栓塞治疗。结论支架辅助弹簧圈栓塞颅内宽颈动脉瘤是比较安全有效的治疗方法,血栓栓塞事件是主要并发症,抗血小板凝集不充分可能是血栓栓塞事件的主要原因。平行式方法栓塞可以提供足够的支撑力,达到致密栓塞的结果。     

支架辅助栓塞在颅内动脉瘤治疗中的应用

蛛网膜下腔出血是仅次于脑梗死和高血压性脑出血的第三大脑血管疾病,目前人群的发病率在2％～7％[1],致死致残率高,颅内动脉瘤破裂是导致其发生的最主要的原因.2002年国际蛛网膜下腔动脉瘤试验(International Subarachnoid Aneurysm Trial,ISAT)[2]及颅内破裂动脉瘤治疗的临床和...     

Lvis支架在颅内宽颈动脉瘤栓塞中的应用

目的 探讨Lvis支架在颅内宽颈动脉瘤栓塞术中的应用效果。方法 对2014年7月至2015年12月应用Lvis支架辅助栓塞治疗的15例宽颈动脉瘤的临床资料进行回顾性分析,评估其疗效。结果 15例中,Raymond Ⅰ级栓塞11例,Ⅱ级3例,Ⅲ级1例;有效栓塞率93.3%。栓塞过程中未发生动脉瘤破裂。术中发生1例血栓事件,经立即溶栓等处理后闭塞动脉再通,但该病人术后1周死于心肌梗死。术后2例出现对侧肢体活动障碍并意识障碍,经肝素化及加大替罗非班用量后好转。所有存活病人术后随访3个月均恢复良好,复查DSA证实动脉瘤均无复发,载瘤动脉通畅。结论 Lvis支架操作简单,各种型号齐全,适合颅内大多数瘤动脉,各项性能均表现良好,适合颅内宽颈动脉瘤的栓塞治疗,但致栓性较强,需重视。     

44例支架辅助弹簧圈栓塞颅内动脉瘤临床分析

目的探讨支架辅助弹簧圈栓塞治疗颅内动脉瘤的安全性及有效性。方法收集我科支架辅助弹簧圈栓塞治疗颅内动脉瘤的患者44例,对其临床资料、手术方法、并发症及预后进行回顾性分析分析。Raymond分级评价动脉瘤即刻栓塞程度,术后6个月改良Rankin量表(modified Rankin scale,mRS)评估疗效。结果 44例患者共51个动脉瘤,破裂动脉瘤28个(54. 90%),未破裂动脉瘤23(45. 1%)个,均为宽颈动脉瘤。术中使用支架类型包括LVIS、LVIS JR.、Enterprise、LEO支架。所有患者支架完全释放。Ⅰ级栓塞率74. 5%。术中支架内血栓形成7例(15. 90%),发生出血性并发症4例(9. 09%)。死亡3例(6. 82%)。术后6月随访结局良好81. 81%(mRS评分0-2分)。结论支架辅助栓塞颅内动脉瘤技术对于治疗复杂动脉瘤相对安全、有效。改良术中操作、针对患者采取个体化抗凝治疗是避免并发症发生的主要措施。     

支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤

目的探讨支架辅助弹簧圈栓塞颅内复杂动脉瘤的效果。方法采用Solitaire AB支架辅助弹簧圈栓塞治疗颅内动脉瘤17例(共23个动脉瘤)。结果 15例宽颈动脉瘤术中达到致密栓塞;2例未破裂颈内动脉巨大宽颈动脉瘤予以较疏松填塞。1例双侧大脑中动脉宽颈动脉瘤患者因术前出血量大,栓塞治疗后行开颅清除血肿、去骨瓣减压术。全组无死亡病例。术后随访3~30个月,16例恢复工作,1例呈迁延性昏迷状态(治疗3个月)。复查CTA或DSA,16例动脉瘤消失,1例疏松填塞的巨大颈内动脉宽颈动脉瘤患者,瘤腔仍有血流灌注,但动脉瘤未增大。结论支架辅助弹簧圈栓塞技术能够有效提高颅内复杂宽颈动脉瘤栓塞治疗的成功率,可有效防止再出血,提高复杂动脉瘤的治愈率。     

LVIS支架在颅内动脉瘤血管内栓塞治疗中的应用

目的 探讨LVIS支架辅助弹簧圈栓塞治疗颅内动脉瘤的可行性、安全性及有效性。方法 回顾性分析宁夏医科大学总医院神经外科2014年5月至2017年9月应用LVIS支架辅助弹簧圈栓塞治疗的83例（89枚动脉瘤）颅内动脉瘤的临床资料。结果 共使用LIVS支架90个,双LVIS支架辅助栓塞动脉瘤1枚;支架全部与微导管平行释放,术中完全释放支架61枚,半释放支架28枚;栓塞后即刻DSA示,Raymond分级Ⅰ级64枚,Ⅱ级22枚,Ⅲ级3枚。术中发生血栓形成4例（3例为支架内血栓形成）、动脉瘤破裂1例。术后随访4~36个月;DSA复查52例,6例由即刻栓塞Raymond Ⅱ级转变为Ⅰ级,3例复发;改良Rankin量表评分0~1分 63例,2分 9例,3分及以上11例。结论 LVIS支架辅助弹簧圈栓塞治疗颅内动脉瘤可行、安全,疗效显著;但支架内血栓事件以及如何选择适当型号的支架,仍是值得探讨的问题     

Enterprise支架与Solitaire支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤疗效分析

目的比较Enterprise支架与Solitaire支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤的安全性和有效性。方法 128例共133枚复杂动脉瘤,Enterprise支架治疗67例（68枚）,Solitaire支架治疗61例（65枚）,比较两组术后支架相关并发症发生率和术后3~12个月血管造影随访结果。结果 Enterprise支架治疗组和Solitaire支架治疗组术后30 d内患者临床并发症有血栓形成、短暂性脑缺血发作、脑卒中和脑出血,但两组的并发症发生率差异无统计学意义（P〉0.05）;术后3~12月血管造影随访结果示两种支架栓塞率及再通率无统计学差异（P〉0.05）。结论 Enterprise支架和Solitaire支架治疗颅内复杂动脉瘤效果均良好。     

Solitaire ab型支架辅助栓塞颅内复杂动脉瘤的临床分析

目的 观察新型自膨式Solitaire ab型支架用于辅助栓塞颅内复杂动脉瘤的疗效和安全性.方法 广东省中医院脑血管病中心脑病三科自2009年10月至2010年11月采用Solitaire ab型血管内支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤12例(13个动脉瘤),其中支架辅助弹簧罔栓塞动脉瘤10例,单纯支架置入2例.分析患者的临床资料和疗效.结果 12例患者共置入支架14枚,所有支架均成功放置,无回收或重新定位,1例患者弹簧圈部分脱入载瘤动脉,其余患者均无手术相关并发症;完全填塞8例,近全填塞1例,部分填塞3例;痊愈9例,好转2例,死亡1例,死亡原因为恶性心律失常.结论 Solitaire ab 型支架用于辅助栓塞颅内复杂动脉瘤有较好的安全性和短期临床疗效.

Abstract：

Objective To observe the efficacy and safety of a novel self-expanding stent Solitaire ab in the treatment of complex intracranial aneurysms. Methods Twelve patients (13 aneurysms), admitted to our hospital from October 2009 to November 2010, were treated with Solitaire ab stents. Ten patients were treated with stent-assisted coiling, the other 2 with stent placement alone.The clinical data and the treatment efficacy of these patients were analyzed. Results Fourteen stents were successfully deployed in 12 patients (13 aneurysms) with no recycling or re-positioning with a success rate of stent placement of 100%. Coil partly prolapsed into parent artery in 1 patient, and the others had no operation-related complications. Eight patients enjoyed completely filling, 1 near total filling and 3 partly filling. Nine patients got complete recovery, 2 partial recovery; and 1 died of malignant arrhythmia.Conclusion The use of Solitaire ab for the treatment of complex ntracranial aneurysms enjoys a good safety and short-term clinical outcome.     

颅内动脉瘤栓塞治疗的并发症

目的研究颅内动脉瘤栓塞治疗的并发症,分析其发生原因、预防措施及处理方法。方法对84例颅内动脉瘤进行栓塞治疗,微导管选用Tracker、Excel或Prowler系列,栓塞剂选用GDC或EDC。结果术中发生血管痉挛、血栓形成8例,动脉瘤破裂2例,弹簧圈落入载瘤动脉4例。无死亡。结论娴熟的微导管技术和术前仔细研究动脉瘤结构是减少术中并发症的关键。     

颅骨数字减影在颅内动脉瘤血管内治疗术后随访中的应用

目的探讨颅骨数字减影在颅内动脉瘤血管内治疗术后随访中的应用。方法共43例颅内动脉瘤患者行血管内弹簧圈栓塞或弹簧圈栓塞辅助支架成形术,术后3个月行正侧位颅骨数字减影和全脑血管造影术,观察弹簧圈位置、形态及动脉瘤是否复发。结果 43例患者中前交通动脉动脉瘤14例、后交通动脉动脉瘤17例、大脑中动脉动脉瘤5例、基底动脉尖端动脉瘤5例和小脑后下动脉动脉瘤2例。术后3个月时,颅骨数字减影与全脑血管造影术检查一致性约为97.67%(42/43),所显示复发率分别为2.33%(1/43)和4.65%(2/43),两种检查方法术后随访准确度差异无统计学意义(χ2=0.345,P=0.955)。结论颅骨数字减影用于颅内动脉瘤血管内治疗术后随访的准确度较高且安全有效。     

Endovascular stenting for treatment of mycotic intracranial aneurysms

Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology for which obliteration must be undertaken when they present with rupture or fail to respond to antibiotic therapy. Intracranial stents provide the unique ability to simultaneously preserve parent vessel integrity while obliterating the aneurysmal sac, but their use for the treatment of MIA has only been reported in a few instances for proximally located lesions. We report a patient with a MIA treated with endovascular stenting and review the literature for similar cases. Three case reports of four MIA treated with either stent monotherapy or stent-assisted coil embolization were identified. The clinical and radiographic features of each case were detailed. A 35-year-old with bacterial endocarditis from Streptococcus mitis was diagnosed with a ruptured 3 mm MIA of the pericallosal anterior cerebral artery after episodic diplopia. The MIA was successfully treated with stent-assisted coil embolization utilizing a Neuroform EZ stent (Stryker Neuroendovascular, Kalamazoo, MI, USA). Follow-up magnetic resonance angiography at 3 months demonstrated complete aneurysm obliteration, and the patient was neurologically intact. In the literature, a M1 segment middle cerebral artery MIA, bilateral cavernous carotid MIA, and a unilateral cavernous carotid MIA were also successfully treated with Neuroform, Helistent (Hexacath, Rueil-Malmaison, France), and SILK (BALT Extrusion, Montmorency, France) stents, respectively. We present the first patient with a pericallosal MIA treated with stent-assisted coil embolization. Proper treatment of the causative organism with antibiotics minimizes the risk of infectious seeding of the stent. Intracranial stenting may be safely and effectively utilized to treat select cases of MIA.     

电解可脱性微弹簧圈栓塞治疗颅内动脉瘤

目的总结电解式可脱性微弹簧圈（ＧＤＣ）栓塞治疗颅内动脉瘤的经验。方法１９９８年２月至１９９８年８月用ＧＤＣ栓塞治疗颅内动脉瘤５６例,其中蛛网膜下腔出血（ＳＡＨ）急性期病例１３例。术前Ｈｕｎｔ氏分级;７例为Ⅳ级,１４例为Ⅲ级,３５例为Ⅰ－Ⅱ级。采用美国ＢｏｓｔｏｎＳｃｉｅｎｔｉｆｉｃＣｏ．的ＧＤＣ进行栓塞治疗。结果５６例栓塞后无死亡及永久并发症,有２例前交通动脉瘤栓塞后出现一过性偏瘫,经内科治疗１周,症状、体征消失。５６例中４４例造影证实为完全闭塞,有８例为大部分闭塞。本组由于治疗时间均在半年内,无随访资料。结论ＧＤＣ栓塞治疗动脉瘤,是目前比较理想的治疗方法,但其远期疗效有待随访观察。     

Endovascular treatment of ruptured intracranial aneurysms

The Guglielmi detachable coil (GDC) is an important tool for the treatment of ruptured intracranial aneuryms by an endovascular approach. This new device may be introduced under fluoroscopy into the aneurysmal sac through a microcatheter. When the coil is judged well positioned, it can be detached with accuracy by electrolytic breakdown. The procedure is completed when a dense coil packing is obtained. When vasospasm is present, papaverin infusion or angioplasty may be used by the endovascular approach as well. Best results are achieved in cases of small aneurysm with small neck. The morbidity and mortality rates in the first 200 patients treated by GDC for a ruptured intracranial aneurysm were 4% and 1.5%, respectively. Complications are generally related to rupture of the malformation by the endovascular device or to thromboembolic events. Despite these promising results, further studies using larger numbers of patients are required to determine the exact role of these procedures in patient care. Received: 22 July 1998 Accepted: 23 July 1998     

Safety and long-term efficacy of endovascular treatment of small posterior communicating artery aneurysms by coiling with or without stent: A single center retrospective study

Objectives

Endovascular stents have been widely used in intracranial aneurysm embolization. In this work, we compared the safety and long-term efficacy of stent-assisted coiling with those of conventional coiling for small posterior communicating artery aneurysms, aiming at a better understanding of the related safety and efficacy profiles.

Methods

Between January 2008 and December 2011, 114 small PcomA aneurysms (defined as 3 mm ≤ maximum diameter < 10 mm in this study) in 108 patients were treated by endovascular treatment in our department. Patient demographics, aneurysm characteristics, angiographic results (initial and follow-up), and procedural complications were assessed.

Results

Embolization was successfully performed in all the patients. Complications occurred in 7.4% of patients in both groups. There was no associated mortality. Based on initial post-procedural angiography, the rate of complete aneurysm occlusion, neck remnant and residual sac in the stented group were 37.9%, 24.1%, and 37.9%, while in the conventional group the figures were 42.9%, 48.2%, and 8.9%, respectively. The initial angiographic results were significantly better in the conventional group, compared with the stented group (P = 0.038). The follow-up results showed that the rate of improvement in the stented group was significantly higher (53.3% vs. 14.0%; P < 0.001) and the recurrence rate was significantly lower than that in the conventional group (4.4% vs. 3.02%; P = 0.001).

Conclusion

Compared with conventional coiling, stent-assisted coiling of the small posterior communicating artery aneurysms does not increase the risk. Stents bear an advantage in reducing the recurrence rate, increasing progressive occlusion rate, and improving long-term prognosis in endovascular treatment of intracranial aneurysms.     

颅内动脉瘤破裂的超早期血管内介入治疗分析

目的 探讨颅内动脉瘤破裂超早期血管内介入治疗的优势及可行性。方法 27例不同部位颅内动脉瘤(30个)患者，一经全脑数字减影动脉造影术(DSA)检查证实，即在48h内、气管内插管全麻下行血管内介入治疗。术前：Hunt—Hess分级：I级～Ⅱ级16例，Ⅲ级7例，Ⅳ级3例，V级1例；其中采用机械性可脱性微弹簧圈(MDS)栓塞治疗2例，电解式可脱性微弹簧圈(GDC)栓塞治疗25例。结果 术后恢复良好者24例；出现一过性偏瘫、失语1例，单纯运动性失语1例，均于1个月后逐渐恢复；死亡1例(Hunt-Hess V级)。结论对Hunt-Hess分级I～Ⅳ级的患者实施超早期介入手术治疗可避免动脉瘤再次破裂出血，减少脑血管痉挛，降低死亡率；并具有微创、恢复时间短、术后并发症少等优势。     

应用HydroCoil栓塞系统治疗颅内动脉瘤的初步体会

目的 总结应用HydroCoil栓塞系统（HES）治疗颅内动脉瘤的初步体会。方法 应用HydroCoil结合水解铂金微弹簧圈栓塞治疗颅内动脉瘤患背14例共15个动脉瘤，其中前交通动脉瘤5个，后交通动脉瘤3个，大脑中动脉瘤2个，大腑后动脉瘤1个，椎动脉火层动脉瘤1个，基底动脉顶端动脉瘤1个，颈内动脉C2段动脉瘤2个：结果 12例患者13个动脉瘤完全栓塞，2例患者2个动脉瘤大部分栓塞：8例患者随访3-5个月，均朱见复发。结论 HES能安全有效的栓寒颅内动脉瘤，明显的提高动脉瘤填塞的致密度。栓塞后动脉瘤短期小易复发。长期临床效果仍有侍于进一步研究。