微弹簧圈介入栓塞治疗颅内破裂动脉瘤22例临床分析

[目的]观察电解可脱弹簧圈（GDC）治疗颅内破裂动脉瘤的疗效.[方法]对22例22个颅内破裂动脉瘤,均在蛛网膜下腔出血急性期进行栓塞.[结果]致密填塞13例,疏松填塞9例,均保持载瘤动脉通畅无狭窄,无死亡及永久并发症.[结论]GDC栓塞治疗颅内破裂动脉瘤是创伤小,疗效理想的方法,对于宽颈型动脉瘤予球囊辅助亦能取得较好的疗效.     

脑破裂动脉瘤早期电解可脱弹簧圈的栓塞治疗

目的　总结颅内动脉瘤破裂早期用电解可脱弹簧圈 (GDC)栓塞治疗经验。方法　 4 7例破裂早期的颅内动脉瘤采用经股或颈动脉Seldinger s技术 ,全部用GDCl0系统和弹簧圈进行动脉瘤囊内栓塞。动脉瘤位置 :前循环动脉瘤 4 5个、后循环动脉瘤 4个。其中 2例为多发动脉瘤。动脉瘤体积均属小型 (<10mm)。结果　动脉瘤腔闭塞 10 0 %的 18个、闭塞 95 %的 2 0个 ,90 % 11个。死亡 2例 ,占 4 3%。 1例栓塞术后 36h再出血 ,行再次开颅动脉瘤夹闭术。重残 1例、轻残 2例 ,其余均恢复正常。随访 0 5～ 2年无再出血。结论　GDC动脉瘤囊内栓塞是治疗颅内动脉瘤破裂早期较理想方法     

大型和巨大型颅内动脉瘤的血管内治疗

[目的]探讨大型和巨大型颅内动脉瘤血管内治疗方法的选择并对结果进行分析.[方法]对16例经DSA确诊为大型和巨大型颅内动脉瘤进行了经皮穿刺血管内治疗,其中椎动脉瘤2例,基底动脉瘤4例,后交通动脉瘤1例,眼动脉瘤2例,颈动脉海绵窦段动脉瘤7例,分别采用了球囊,游离弹簧圈,MDS-N(机械解脱弹簧圈),GDC水解弹簧圈,Neuroform支架辅助水解弹簧圈栓塞技术.[结果]游离弹簧圈致密填塞6例,6例95%以上填塞,2例获90%填塞.2例行球囊载瘤动脉栓塞术.支架结合GDC或水解弹簧圈致密填塞4例,另4例应用水解弹簧圈有2例获致密填塞,2例获95%栓塞.除1例因术中游离弹簧圈脱入大脑中动脉术后出现轻偏瘫,其余病例临床症状消失或好转,8例随访2个月至3年,无再出血或症状加重.[结论]大型和巨大型颅内动脉瘤血管内治疗能获得满意的临床结果.     

MicroPlex水解弹簧圈栓塞治疗颅内动脉瘤

弹簧圈填塞治疗颅内动脉瘤(intracranial aneurysm,AN)的临床疗效已得到肯定.近年来,颅内动脉瘤的血管内治疗有了很大的进展,特别是MicroPlex水解弹簧圈的运用,使介入治疗又前进了一步,水解弹簧圈的超柔软性及对瘤体壁的顺应性,提高了动脉瘤的高致密性栓塞的可能性,为目前颅内动脉瘤最好的栓塞方法.     

电解可脱性弹簧圈栓塞治疗颅内动脉瘤

目的：探讨电解可脱性弹簧圈栓塞治疗颅内动脉瘤的疗效、操作方法及技术要点。方法：回顾性分析了21例经电解可脱性弹簧圈栓塞治疗的颅内动脉瘤患者的临床资料。结果：23个动脉瘤100％栓塞17个，95％栓塞3个，90％栓塞2个，过度栓塞1个。术后随访3～14月，无再出血病饼发生，其中2例重残，3例轻残，15例恢复良好，1例死亡。结论：电解可脱性弹簧圈血管内栓塞治疗颅内动脉瘤具有安全、微创的优点，是颅内动脉瘤主要的治疗手段。     

电解可脱性铂弹簧圈栓塞治疗急性破裂性颅内动脉瘤

【目的】探讨电解可脱性铂弹簧圈(GDC)栓塞治疗急性破裂性颅内动脉瘤的治疗效果。[方法]3例患者经数字减影血管造影确诊动脉瘤后使用Seldinger’s技术,通过微导管放置GDC栓塞颅内动脉瘤。【结果】成功栓塞3例颅内动脉瘤,均为100％栓塞。[结论]GDC是栓塞急性破裂性颅内动脉瘤较理想的方法,其较为安全可靠．且疗效确切。     

颅内动脉瘤破裂出血早期栓塞治疗27例分析

目的：探讨颅内动脉瘤破裂出血早期栓塞治疗的临床疗效。方法：回顾性分析经电解可脱式弹簧圈（GDC）早期栓塞治疗的27例颅内动脉瘤破裂出血患者的术后效果。结果：栓塞治疗后即刻造影显示：瘤腔栓塞100％24例（88．9％）,栓塞≥90％3例（11.1％）;术后2周内发生2次出血2例（7．4％）,其中死亡1例（3．7％）;随访6个月,轻微意识障碍5例（18．5％）;随访12个月,恢复良好23例（85．2％）,不全偏瘫2例（7．4％）。结论：颅内动脉破裂出血早期栓塞治疗安全、可靠,可有效防止动脉瘤再破裂,降低致死率及致残率。     

弹簧圈栓塞与显微外科夹闭治疗颅内动脉瘤的临床疗效比较

[目的]探讨比较颅内动脉瘤弹簧圈栓塞与显微外科夹闭治疗的临床疗效.[方法]对经16层螺旋CTA（MSCTA）和数字减影血管造影（DSA）证实颅内动脉瘤患者89例,54例行DSA下弹簧圈栓塞治疗,35例行显微外科夹闭治疗,术后用日常生活活动量表（ADL）中Barthel指数（BI）来评价两者的疗效.[结果]89例中,弹簧圈栓塞54例,外科手术夹闭35例.前循环动脉瘤59例,弹簧圈栓塞35例,外科手术夹闭24例,两者疗效对比无显著差异（P＞0.05）;后循环动脉瘤30例,弹簧圈栓塞17例,外科手术夹闭11例,两者疗效对比有差异（P＜0.05）.53例动脉瘤直径＜10 mm,弹簧圈栓塞32例,外科手术夹闭21例,两者疗效对比无显著差异（P＞0.05）;36例直径≥10 mm,弹簧圈栓塞22例,外科手术14例,疗效比较有差异（P＜0.05）.两组疗效从动脉瘤生长的位置、大小及病人的临床状态对比来看,弹簧圈栓塞疗效优于显微外科治疗.[结论]弹簧圈栓塞和显微外科夹闭是治疗颅内动脉瘤的主要方法,从总体疗效对比分析结果来看,可优先选择血管内栓塞治疗,但临床仍应根据具体情况综合分析、权衡利弊、正确的选择治疗方法.     

破裂脑动脉瘤栓塞时机与术后蛛网膜下腔出血的治疗

目的 探讨破裂性颅内动脉瘤血管内栓塞的时间与术后蛛网膜下腔出血(subarachnoid hemorrhage,SAH)的治疗.方法 西安交通大学医学院第一附属医院神经外科对118例破裂性颅内动脉瘤患者在发病后7 d内用电解可脱性弹簧圈(guglielmi detachable coil,GDC)进行动脉瘤囊内栓塞.术后早期处理已经聚积在蛛网膜下腔的出血,以及由于SAH而导致的脑部及全身性并发症.治疗效果经χ2检验.结果 118个动脉瘤中101个瘤腔100%闭塞,12个95%闭塞,5个被90%闭塞.术后115例临床痊愈,其治疗结果根据Glasgow预后评分:Ⅰ级89例,Ⅱ级14例,Ⅲ级9例,Ⅳ级3例,Ⅴ级3例.全组死亡3例,死亡率2.5%.术中并发脑血管痉挛8例,动脉瘤破裂3例,GDC脱出2例,脑梗塞1例.术后74例随访6～72个月均无再出血,3例复发者经二次补充GDC栓塞治愈.结论 对破裂性动脉瘤应早期进行血管内栓塞.术后治疗的策略应着眼于早期处理SAH,防治脑血管痉挛及延迟性缺血性神经功能障碍,并妥善处理脑部与全身并发症.     

微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤

目的探讨微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤的安全性及有效性。方法回顾性分析30例颅内动脉瘤在破裂出血后72小时内行微弹簧圈血管内栓塞治疗的临床资料。30例患者发病后均行CT检查,诊断为蛛网膜下腔出血,并经全脑血管造影证实为颅内动脉瘤,共检出34枚动脉瘤,其中单发26例,2枚4例。结果 34枚动脉瘤中,100%栓塞24枚,95%栓塞6枚,90%栓塞2枚,80%栓塞2枚。术后发生手术相关并发症6例,包括微弹簧圈脱出至载瘤动脉1例,术中动脉瘤破裂1例,严重脑血管痉挛2例,术后脑梗死2例。患者术后恢复良好25例;出现偏瘫4例,后经综合治疗后逐渐恢复;死亡1例,死亡原因:因口服抗血小板药并发消化道出血。随访1~6个月,无再出血病例发生。结论微弹簧圈血管内栓塞治疗是急性期破裂颅内动脉瘤的安全且有效的治疗方法;选择早期手术和及时术后处理对降低致残率、致死率有重要意义。     

血管内治疗急性期破裂颅内动脉瘤的疗效观察

目的探讨血管内治疗急性期破裂颅内动脉瘤的安全性及有效性.方法回顾性分析74例颅内动脉瘤在破裂出血后72h内行血管内治疗临床资料.结果74例患者发病后均行CT检查,证实为蛛网膜下腔出血,并经全脑血管造影证实为颅内动脉瘤,共检出92枚动脉瘤,其中单发57例,2枚10例,3枚以上7例.72h内进行血管内栓塞治疗,术中根据动脉瘤的形状、大小选择合适的支架及微弹簧圈栓塞.92枚动脉瘤中,致密填塞81枚,瘤颈残余4枚,填塞不充分2例,未作栓塞处理（非重要动脉瘤）5枚.结论血管内治疗急性期破裂颅内动脉瘤安全有效,可作为其首选治疗方式.     

后循环动脉瘤破裂急性期介入治疗的应用

目的研究后循环动脉瘤破裂急性期微导管栓塞术的临床价值。方法对11例后循环动脉瘤破裂急性期(3天内)的患者采用微导管技术进行动脉瘤腔栓塞术,针对手术成功率,术后再出血发生率,患者恢复情况以及6个月随访情况进行研究。结果11例患者接受了急诊栓塞术,共栓塞动脉瘤12个。手术成功率100%,致密填塞率83.3%,死亡1例。结论后循环动脉瘤急性期微导管栓塞术可有效降低急性期动脉瘤二次出血发生率。     

Y-stent-assisted coil embolization of anterior circulation aneurysms using two Solitaire AB devices: a single center experience

Wide-neck intracranial aneurysms remain a challenge to endovascular treatment. We describe our experience in repairing wide-neck aneurysms of the anterior circulation located at arterial branch points using coil embolization assisted by Y-stenting using two Solitaire(?) stents.Six wide-neck intracranial aneurysms located on the middle cerebral artery bifurcation( 3), pericallosal artery( 1), and anterior communicating artery( 2) were repaired by Y-stent-assisted coil embolization using two Solitaire(?) stents. Four cases were incidental findings of aneurysm and two cases were previously treated ruptured aneurysms that had undergone recanalization. All the cases were successfully treated without complications. Follow-up by digital subtraction angiography and magnetic resonance angiography at six months showed the stents to be patent with no recanalization of the aneurysm sacs. Repairing wide-neck aneurysms of the anterior circulation by Y-stent-assisted coil embolization using two Solitaire(?) stents is a simple and safe method of treating complex aneurysms. While the results are promising, larger series with longer term follow-ups are needed to corroborate that this treatment method is superior to other techniques.     

颅内动脉瘤诊疗策略探讨

目的 探讨颅内动脉瘤诊断方法 的选择以及开颅直接手术或采取血管内介入手术的取向等问题.方法 190例颅内动脉瘤患者中术前均行颅脑CT检查,MRI检查37例、MRA31例,通过重建CT血管成像技术(CTA)及三维CTA(3D-CTA)确诊134例;数字减影血管造影(DSA)/3D-DSA确诊142例;直接手术96例,其中因血管内手术失败而开颅4例;采用血管内介入治疗92例,其中ONYX胶栓塞2例,其余均采用GDC栓塞手术.另6例因再次出血,病情恶化等原因家属放弃治疗.结果 死亡9例,死因:2例再出血、3例严重血管痉挛,肺炎等并发症死亡4例;其余均痊愈出院.结论 CT为蛛网膜下腔出血的首诊选择,MRA可作为无出血史患者的检查,但不宜以此直接手术;CTA/3D-CTA在相当患者中可以确定动脉瘤的大小、部位、供血动脉及破裂点,并依此直接手术;DSA尤其3D-DSA对复杂性的动脉瘤的血供情况可清晰提示并指导手术.血管内栓塞治疗和直接开颅夹闭手术各有优点,我们主张急性期脑肿胀患者应首先行急诊介入治疗,但血管痉挛明显的患者应果断早期手术,其中多发性动脉瘤的重点是判断责任动脉瘤.     

颅内宽颈动脉瘤应用血管内支架辅助介入治疗的临床效果观察

目的探究颅内宽颈动脉瘤应用血管内支架辅助介入治疗的效果观察。方法资料随机选自2012年1月-2014年1月在本院诊治的颅内宽颈动脉瘤患者72例,按随机数字表方法分成两组,每组36例,予微弹簧圈栓塞的作对照组,予微弹簧圈栓塞联合血管内支架辅助的作研究组,分析两组疗效、治疗相关指标、预后、并发症、复发等。结果研究组进行性头痛、嗜睡、动眼神经麻痹等8.33%、5.56%与2.78%,均比对照组27.78%、25.00%与19.44%少（P〈0.05）;研究组手术时间（50.36±4.73）min、住院时间（8.13±1.64）d均比对照组（66.24±5.36）min、（13.57±1.82）d少（P〈0.05）;同时随访1年研究组再出血5.56%、载瘤动脉狭窄2.78%等并发症比对照组25.00%、8.33%少（P〈0.05）;随访1年和2年研究组复发率11.11%、16.67%均比对照组30.56%、38.89%少（P〈0.05）;随访2年内研究组动脉瘤的完成闭塞率83.33%,比对照组63.89%高（P〈0.05）。结论对颅内宽颈动脉瘤予血管内支架辅助介入治疗效果显著,且预后生活质量良好,具有一定临床应用和研究价值。     

3D-DSA在颅内动脉瘤诊断与血管内栓塞治疗中的应用

目的探讨3D-DSA在颅内动脉瘤诊断和血管内栓塞治疗中的应用价值。方法采用DSA或3D-DSA脑血管造影检查疑似颅内动脉瘤患者32例,根据造影结果决定治疗方案。结果共发现28例33个颅内动脉瘤。其中20例颅内动脉瘤进行了血管内栓塞治疗。14例用可解脱铂金弹簧圈(GDC)行动脉瘤栓塞术,6例用可脱性球囊行颈内动脉闭塞术。结论3D-DSA极大提高了脑血管造影检查的准确性和可靠性,也为动脉瘤的栓塞治疗提供了可靠保障。具有准确、安全和操作方便的特点,有很高的临床实用价值。     

Effect of endovascular treatment on headaches in patients with unruptured intracranial aneurysms

BACKGROUND: Patients with unruptured intracranial aneurysms often present with headaches. OBJECTIVE: To determine the effect of endovascular treatment on the character and frequency of headaches in patients with unruptured intracranial aneurysms. METHODS: We reviewed the medical records of all patients who underwent endovascular treatment for unruptured intracranial aneurysms within a 9.5-year period. These patients were mailed a standard questionnaire in which they were asked about the frequency and character of any headache experienced before or after (or both) endovascular treatment. They were also asked to grade improvement or worsening of headaches after the procedure as mild (activities of daily living were not affected), moderate (activities of daily living were affected), or significant (the change resulted in an ability to perform new activities of daily living or an inability to perform previous activities of daily living). RESULTS: Forty-seven patients with unruptured aneurysms who underwent Guglielmi detachable coil embolization responded to the questionnaire. Of these, 32 patients (mean age, 52.7 years [SD, 13.4]; 22 were women) had experienced headaches before the procedure. Nineteen patients (59%) reported improvement in severity of headaches after embolization. Improvement was graded as significant by 7 patients, moderate by 8, and mild by 4. Two patients (6%) reported worsening severity of headaches graded as moderate. Five of 15 patients without headaches before embolization reported onset of mild (n = 4) or severe (n = 1) headaches after treatment. CONCLUSION: Guglielmi detachable coil embolization of unruptured intracranial aneurysms was associated with reduction in severity of headaches in the majority of patients who had experienced preprocedural headaches.     

Intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis: A case report

ObjectiveWe describe a case of intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis (RA).Case PresentationA 29-year-old man with a medical history of RA since 18 years of age was admitted to our hospital for vomiting, dysarthria, and conscious disturbance. At 23, he underwent ligation of the left internal carotid artery (ICA) with superficial temporal artery to middle cerebral artery anastomosis because of acute infarct of the left hemisphere caused by arterial dissection of the left ICA. During the current admission, computed tomography (CT) revealed subarachnoid hemorrhage, and digital subtraction angiography (DSA) demonstrated dissecting aneurysms of the left intracranial vertebral artery (VA) and right extracranial VA. We diagnosed him with a ruptured dissecting aneurysm of the left intracranial VA and performed endovascular parent artery occlusion on the left VA. For the right unruptured VA aneurysm, we performed coil embolization simultaneously. At 2 weeks after the endovascular treatment, follow-up DSA revealed that multiple de novo dissecting aneurysms developed on the origin of the left VA and left and right internal thoracic arteries. Those aneurysms were treated with coil embolization. Other remaining aneurysms on the left thyrocervical trunk, right transverse cervical artery, and both common iliac arteries were treated by conservative therapy. While continuing medical treatment for RA, the patient recovered and was discharged to a rehabilitation hospital.ConclusionConsidering that RA-induced vasculitis can be a potential risk of vascular complications including multiple arterial dissections, physicians should carefully perform endovascular interventional procedures for patients with long-term RA.     

单一支架置入技术治疗颈内动脉微小动脉瘤的初步探讨

目的探讨单一支架置入技术栓塞治疗微小颅内动脉颈内动脉段（ICA）动脉瘤的预后。方法收集2003年8月至2012年1月收治的微小ICA动脉瘤（直径小于3mm）患者14例的临床资料,其中男4例,女10例;年龄35-72岁。采用单一支架置入技术栓塞治疗5例,采用支架辅助弹簧圈栓塞技术治疗9例。结果 13例血管内栓塞治疗微小ICA动脉瘤手术完全成功,1例（7.1%）患者出现术中动脉瘤破裂出血。仅支架置入组9个月后动脉瘤完全闭塞率80.0%,完全无症状率60.0%;支架辅助弹簧圈组12个月后完全闭塞率88.9%,完全无症状率55.5%。统计结果显示,仅支架置入组患者的改良Rankin量表（mRS）评分较支架辅助弹簧圈组高（t=4.21,P=0.039）,但是其动脉瘤完全闭塞率较低（χ2=5.09,P=0.011）。结论采用单一支架置入栓塞微小动脉瘤的患者完全闭塞率较低,但是患者的并发症少、预后生存质量较高。     

水解脱弹簧圈填塞治疗急性期破裂颅内动脉瘤1例

背景：以往多采用电解脱弹簧圈填塞治疗颅内动脉瘤,但电解脱弹簧圈解脱时间较长,解脱区质地硬,并发症发生率较高,不利于微小动脉瘤的栓塞。目的：观察水解脱弹簧圈填塞治疗急性期破裂颅内动脉瘤的效果。方法：经头颅CT检查确认蛛网膜下腔出血并有脑叶出血1例,数字减影血管造影系统证实为颅内动脉瘤,采用水解脱弹簧圈栓塞动脉瘤。结果与结论：经过治疗,患者破裂动脉瘤致密栓塞,填塞达99%,出血得到控制。提示水解脱弹簧圈的超柔软性及对瘤体壁的顺应性,操作方便,提高了动脉瘤的致密性栓塞的可能性,减少并发症的可能,应该为目前急性期颅内动脉瘤破裂较好的栓塞方法。