Modified technique to create morphologically reproducible elastase-induced aneurysms in rabbits

INTRODUCTION: The purpose of this study was to create morphologically reproducible elastase-induced model aneurysms in rabbits. METHODS: We created 120 elastase-induced aneurysms in rabbits using two different methods: the standard technique (group 1, n=62) and a modified technique (group 2, n=58). In the standard technique a small cutdown with a focal area of exposure of the mid-right common carotid artery (RCCA) was employed, while in the modified technique the RCCA was completely exposed to its origin. We measured aneurysm sizes (neck diameter, width and height) in the two groups. The aneurysm sizes were compared between the two groups using Student's t test, and the standard deviations of the aneurysm sizes were compared between the groups using the F test. RESULTS: The mean aneurysm neck size, width and height in group 1 were 3.4+/-1.2 mm, 3.8+/-1.0 mm and 8.0+/-1.7 mm, respectively, and in group 2, were 3.2+/-0.9 mm, 3.7+/-0.6 mm and 9.1+/-1.8 mm, respectively. The differences in mean aneurysm neck and width between the two groups were not significant (P>0.05). However, there were significant differences in the standard deviation of these two parameters between the two groups (P<0.05 and P<0.01, respectively). The mean aneurysm height in group 2 was larger than in group 1 (P<0.001), but no significant difference in the standard deviation of this parameter between the two groups was found (P>0.05). CONCLUSION: The results indicate that more consistent aneurysm diameters can be created using the modified technique.     

大脑前动脉水平段优势血流与前交通动脉瘤的关系

目的：提出一个脑血管造影征象，即“大脑前动脉水平段优势血流征”（简称Ａ１优势）。并探讨了该征象的形成，及与前交通动脉瘤的关系。材料与方法： 统计分析了８７例颅内动脉瘤的ＤＳＡ资料。结果：在２７例前交通动脉瘤患者中，１８例有Ａ１优势。其中１７例前交通动脉瘤发生在Ａ１优势侧，仅１例发生在对侧。结论：本组资料表明前交通动脉瘤多发生在同侧Ａ１优势血流者，因此，这一征象对诊断前交通动脉瘤具有重要意义。     

侵袭性垂体腺瘤的MRI表现与MMP-9表达的相关性

目的研究侵袭性垂体腺瘤侵袭鞍底、鞍旁的不同MRI表现与MMP-9表达水平的相关性。资料与方法经手术、病理证实的垂体腺瘤90例,免疫组织化学染色,评价MMP-9的表达水平与肿瘤对鞍底及鞍旁的不同侵犯程度的MRI表现之间的关系。结果手术证实侵袭性垂体腺瘤59例。蝶窦腔内见肿瘤者30例（58.8%）,对诊断肿瘤侵袭性的敏感性为59%,特异性为100%,阳性预测值为100%,阴性预测值为65%。受侵犯的海绵窦中有95%（57/60）超过该侧颈内动脉外侧壁连线,对诊断肿瘤侵袭性的敏感性为95%,特异性为100%,阳性预测值为100%,阴性预测值为98%。垂体腺瘤包绕范围〉2/3者37侧,对诊断相应侧别海绵窦受侵袭的敏感性为62%,特异性为100%,阳性预测值100%,阴性预测值84%。侵犯海绵窦或鞍底的垂体腺瘤的MMP-9表达水平均高于未侵犯海绵窦或鞍底的垂体腺瘤。结论将鞍底破坏,窦腔内直接可见肿瘤组织作为鞍底受侵袭的MRI标准,将肿瘤向两侧超过颈内动脉海绵窦段和床突段外侧壁连线,或肿瘤包绕颈内动脉范围〉2/3至完全包绕作为海绵窦受侵袭的MRI标准。     

The Amplatzer vascular plug for large vessel occlusion in the endovascular management of aneurysms

The Amplatzer vascular plug (AVP) is derived from the Amplatzer device used in correction of cardiac septal defects. We present a large series of the use of the AVP in the endovascular management of aneurysms. Three patients with a combination of aortic and peripheral aneurysms underwent embolisation with the AVP. Plugs with 10–16 mm diameter were used and delivered using introducer/guiding sheaths. A total of 16 internal iliac arteries, 2 common iliac arteries (CIA), 4 subclavian (SCA) arteries, 1 superior mesenteric (SMA) and 1 popliteal artery were embolised. Successful occlusion with the AVP was achieved in 21 out of 24 vessels (87.5%), of which 18 (75%) occluded immediately and 3 (12.5%) were delayed occlusions. The three patients who are considered to have failed to occlude with the AVP required the use of additional embolic agents. At the end of the 17-month follow-up all 24 target vessels had occluded. Two patients developed persistent buttock claudication, and one had a left hemiparesis. The AVP is useful as an adjunctive device in the management of aneurysms. It has a particular role in embolisation of large-diameter vessels with a short implantation zone. The device is safe and easy to use.     

The value of MDCT in diagnosis of splenic artery aneurysms

OBJECTIVE: To evaluate the clinical value of multiple detector computed tomography (MDCT) in the diagnosis and planning the treatment of splenic aneurysms. METHODS: Eight cases with splenic artery aneurysms (SAA) were retrospectively reviewed. Sixty four-slice spiral CT scans were performed. Intravenous contrast material was injected at 4ml/s, and arterial and venous phase images were obtained. Subsequently, arterial phase images were analyzed and made for CT angiography. The diagnosis was made by using axial and reconstructive images. All of the patients were also performed Doppler color echocardiography. RESULTS: All patients showed splenic artery and splenic artery aneurysms clearly with CT arterial phase images. Among them, six patients had splenic artery aneurysms, one had giant splenic artery aneurysms (GSAA) and one had splenic artery pseudoaneurysms. Ultrasound examination only diagnosed six of them. CONCLUSION: MDCT is a noninvasive and valuable method in diagnosis of splenic artery aneurysms and has high value in determination of treatment plan.     

超声心动图监测房间隔缺损封堵术后血流动力学改变的研究

目的:应用超声心动图观察房间隔缺损(ASD)封堵术后血流动力学变化。方法:对成功实施ASD封堵术的30例患者行超声心动图检查,分别于术前24h、术后48h及术后3个月记录三尖瓣口及肺动脉瓣口多普勒血流频谱,测量三尖瓣口舒张早期及舒张晚期血流速度(E峰、A峰),及肺动脉瓣口血流峰值、平均流速和速度时间积分。结果:ASD封堵治疗术后三尖瓣口E峰、A峰峰值速度及肺动脉瓣口血流速度、积分和压力阶差显著降低。结论:超声心动图能够方便检测ASD封堵治疗术前后右心血流动力学改变,反映右心功能改变,为临床评价掌握ASD术后的恢复情况提供有用信息。     

血管腔内弹性蛋白酶诱导兔动脉瘤模型制作进展

血管腔内弹性蛋白酶诱导兔动脉瘤模型因其形态学、组织学、血流动力学与人类颅内动脉瘤相似,广泛应用于颅内动脉瘤病因、栓塞材料等方面研究。现总结国内外血管内弹性蛋白酶诱导兔动脉瘤模型相关文献,阐述动物模型制作方法及特点     

MRA在诊断颅内动脉瘤中的应用

目的：研究MRA诊断颅内动脉瘤的原理与方法，优势与不足以及临床价值。方法：选择经DSA证实为颅内动脉瘤的息者30例，行三维MRA及MRI检查，全部病例均经手术证实。结果：MRA对颅内动脉瘤的敏感性为90％，结合原始断层图像和MRI，敏感性则高达97％，较准确显示了3mm以上动脉瘤的形态、大小及与载瘤动脉的关系。对于检测血栓性动脉瘤MRA优于DSA影像。结论：MRA是一种无创伤的血管检查技术．可准确显示动脉瘤。对于Willis环区动脉瘤，MRA可取代常规血管造影。     

Evaluation of a newly designed flow diverter for the treatment of intracranial aneurysms in an elastase-induced aneurysm model,in New Zealand white rabbits

Introduction

In this study, we analyzed angiographic and histologic aneurysm occlusion of a newly designed flow-diverting device. Visibility and flexibility, as well as occlusions of side branches and neointimal proliferation were also evaluated.

Methods

Aneurysms were induced in 18 New Zealand white rabbits and treated with a braided, “closed-loop-designed” device of nitinol. Additional devices were implanted in the abdominal aorta to cover the origin of branch arteries. Angiographic follow-ups were performed immediately after placement of the device, after 3 months (n?=?9) and 6 months (n?=?9). The status of aneurysm occlusion (using a five-point scale) and the patency of branch arteries were assessed.

Results

Aneurysm occlusion rates were noted as grade 0 in 2 (11 %), grade I in 1 (6 %), grade II in 1 (6 %), grade III in 9 (50 %), and grade IV in 5 (28 %) of 18 aneurysms, respectively, indicating a complete or near-complete occlusion of 78 % under double antiplatelet therapy. Aneurysm occlusion was significantly higher at 6 months follow-up (P?=?0.025). Radiopaque markers provided excellent visibility. Limited device flexibility led to incomplete aneurysm neck coverage and grade 0 occlusion rates in two cases. Distal device occlusions were found in three cases, most likely due to an extremely undersized vessel diameter in the subclavian artery. No case of branch artery occlusion was seen. Intimal proliferation and diameter stenosis were moderate.

Conclusion

The tested flow diverter achieved near-complete and complete aneurysm occlusion under double antiplatelet therapy of elastase-induced aneurysms in 78 %, while preserving branch arteries.     

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     

三维旋转血管造影技术在颅内动脉瘤诊疗中的应用

目的：探讨平板DSA三维旋转血管造影（3D-RA）在颅内动脉瘤的诊断和介入治疗中的应用技术。方法：72例患者利用平板DSA行常规全脑血管造影,再行3D-RA,并利用其Integris 3D-RA工作站行三维重组,分析其2D与3DRA对颅内动脉瘤显示的差异。结果：平板DSA常规全脑血管造影检出颅内动脉瘤56个,利用其3D-RA检出动脉瘤76个。结论：3D-RA可显著提高颅内动脉瘤的检出率,应用好3D-RA技术是指导临床诊断和治疗颅内动脉瘤的重要手段。     

The endovascular approach in the management of patients with multiple intracranial aneurysms

To investigate the role of endovascular treatment we performed a retrospective study of our patients with multiple intracranial aneurysms seen in our institution between October 1992 and March 1995. This period was chosen to study a homogeneous group of patients since the appearance of controlled detachable coils, and to obtain the largest number of patients with angiographic follow-up of the aneurysms treated. We studied 53 patients with a total of 128 aneurysms, in 46 of whom we treated 67 aneurysms by the endovascular approach. Of these, 5 aneurysms in 3 patients were treated by occlusion of the parent vessel and 62 aneurysms in 43 patients with coils, 52 with Guglielmi detachable coils and 10 with mechanically detachable spirals. Complete occlusion was obtained in 58 aneurysms, and partial occlusion in 9. The therapy caused permanent neurological deficit in 3 cases (6.5 %), and there was 1 case of rebleeding (incomplete occlusion of the aneurysm). No deaths occurred. All aneurysms were treated in 29 of the 53 patients. Endovascular procedures were used for 16 patients (30 %), surgery was performed in 1 patient (2 %) and the two were combined in 12 (23 %). In 23 of 53 cases (43 %), unruptured aneurysms were left untreated, usually because of their small size. In 1 patient with unruptured aneurysms, the endovascular approach failed and the patient refused surgery. Received: 1 September 1995 Accepted: 12 August 1996     

球囊辅助瘤颈成形术治疗颅内宽颈动脉瘤

目的　总结球囊辅助瘤颈成形术在颅内宽颈动脉瘤治疗中应用的临床体会。方法　采用球囊辅助瘤颈成形术对 18例患者 2 0个颅内宽颈动脉瘤进行栓塞治疗 ,先将微导管超选入动脉瘤内 ,再将不可脱卸球囊于动脉瘤颈处充盈覆盖瘤颈 ,电解可脱卸弹簧圈 (GDC)填塞动脉瘤。结果　 17个动脉瘤治疗成功 ,完全填塞的动脉瘤 12个 ,次全填塞 (>90 % ) 4个 ,不完全填塞 (<90 % ) 1个 ,载瘤动脉均保持通畅 ,平均随访 9.4个月 ,临床效果优良。结论　采用球囊辅助瘤颈成形术治疗颅内宽颈动脉瘤是安全、有效的方法     

颅内动脉瘤破裂的血流动力学和形态学因素

随着计算机断层摄影血管成像(CTA)、磁共振血管成像(MRA)等影像技术的广泛应用,越来越多的无症状性颅内动脉瘤被检测出来,如何从中鉴别出高破裂风险的动脉瘤成为治疗的关键,本文就近年来动脉瘤破裂的危险因素做一总结.     

Percutaneous coil embolization in the management of peripheral mycotic aneurysms

Traditional surgical treatment of a peripheral mycotic aneurysm has included emergency ligation and bypass. Occlusion of vessels just proximal and distal to a mycotic aneurysm can be safely accomplished via percutaneous embolization with coils. Surgery can be performed electively in a noninfected field. Coils can be placed near the site of vessel disruption minimizing loss of collateral flow.     

MSCTA在后循环脑动脉瘤诊断和治疗中的价值

目的：评价多层螺旋CT血管成像（MSCTA）在后循环脑动脉瘤的诊断和治疗中的价值。方法：临床怀疑脑动脉瘤的患者行多层螺旋CTA检查。所有后循环动脉瘤患者纳入本研究,运用最大密度投影和容积再现技术评价动脉瘤的形态、大小、位置和瘤颈形态及动脉瘤与颅骨和周围血管的关系,并根据多层螺旋CTA结果选择血管内治疗或外科治疗。结果：460例中的98例患者发现102个后循环动脉瘤。多层螺旋CTA诊断所有后循环动脉瘤的敏感性、特异性和准确性分别是96.1%,98.7%和97.9%。多层螺旋CTA对于后循环动脉瘤诊断的准确性与DSA的结果差别没有统计学意义。通过CTA评价认为65个后循环动脉瘤适合行血管内治疗,19个后循环动脉瘤适合外科夹闭治疗,另外18个后循环动脉瘤行随访。结论：多层螺旋CTA在后循环动脉瘤诊断方面有很高的准确性,可以作为后循环动脉瘤诊断的首选影像检查,并在指导其治疗方面具有较高的临床应用价值。     

Endovascular treatment of aneurysms on the feeding arteries of intracranial arteriovenous malformations

The association between intracranial aneurysms and arteriovenous malformations (AVMs) is well documented. Recent advances in the understanding of the haemodynamics of this association encourage an aggressive approach to these aneurysms. However, the pathophysiology of these aneurysms is not fully understood and a strategy for their management has not been established. We describe seven patients, with eight aneurysms, on the feeding arteries of AVMs. The aneurysms could be divided into those located 1. proximally on the superficial feeding artery (type I; 4 aneurysms); 2. distally on the superficial feeding artery (type II; 3 aneurysms); and 3. on the deep feeding artery (type III; 1 aneurysm). All aneurysms were treated by the endovascular procedure prior to, or simultaneously with, treatment of the AVM, using detachable coils or liquid embolic material. All aneurysms were obliterated successfully, with no adverse events. Each patient further received treatment of the AVM. None of the patients suffered intracranial haemorrhage after treatment for the aneurysms. Based on our experiences, we discuss the indications for this approach for each type of aneurysm. We believe endovascular treatment could be an important alternative for treatment of aneurysms associated with AVMs, thus reducing the risk of haemorrhage. Received: 6 October 1997 Accepted: 5 June 1998     

The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients

The value of intraoperative digital subtraction angiography in surgery for intracranial aneurysms, the benefits and cost-effectiveness are a matter of discussion. We prospectively studied 126 patients with 144 aneurysms, most on the anterior intracranial circulation, who underwent clipping and intraoperative angiography. Follow-up was 28.4 ± 13.1 months. We tried to work out the indications for intraoperative angiography of the anterior circulation and its cost-effectiveness. In 10.3 % of patients (9 % per aneurysm) unexpected findings were shown by intraoperative angiography: inadequately clipped aneurysms in 10 (7.9 %), a completely unclipped aneurysm in one (0.8 %) and occluded major arteries in two (1.6 %). A broad neck was a variable of statistical significance for inadequate clipping or stenosis or occlusion of an adjacent vessel. There was a strong trend for aneurysms more than 15 mm in diameter to be “risky”. Their site was not a predictive factor. We believe that intraoperative angiography is indicated in surgery not only on large and giant aneurysms, but also broad-based aneurysms of the anterior cerebral circulation regardless of their size. It is cost-effective compared to postoperative angiography. The rate of stroke in our hands was 0.8 %. Received: 19 January 2000 Accepted: 3 November 2000