Enterprise支架辅助弹簧圈栓塞治疗颅内动脉瘤的护理

目的:总结分析颅内动脉瘤介入治疗的护理经验。方法:在DSA引导下,输送微导管至合适的部位置入支架,并行弹簧圈栓塞术,或行单纯支架置入术。结果:本组21例患者除1例驼背患者术后1周并发肺部感染死亡外,其余患者恢复良好,末出现脑再出血、新的梗死灶及其他并发症。6～12个月DSA随访未发现支架移位和支架内狭窄。结论:娴熟的护理技术和高度的责任心,对保证介入手术的成功和患者的顺利康复起着很大作用。     

支架辅助弹簧圈栓塞治疗颅内动脉瘤

目的 探讨支架辅助弹簧圈栓塞颅内动脉瘤的血管内治疗方法。方法 回顾性分析宣武医院神经外科2001年10月至2003年3月间16例应用支架辅助弹簧圈栓塞颅内动脉瘤的病例。结果 16例患者中15例(94％)动脉瘤应用该联合技术得以成功栓塞,1例(6％)左椎动脉夹层动脉瘤应用双支架置入得以治愈,术后抗凝抗血小板治疗,无血管内治疗相关严重并发症。结论 支架辅助弹簧圈血管内栓塞技术对一些特殊部位的某些类型的宽颈、梭形和夹层动脉瘤治疗具有重要的临床价值,但该技术仍需不断改善,其治疗效果也需长期随访和评价。     

支架辅助弹簧圈栓塞颅内破裂动脉瘤并发症

目的 回顾性分析支架辅助弹簧圈栓塞颅内复杂动脉瘤的并发症发生率, 探讨并发症发生的原因及治疗方法.方法 蛛网膜下腔出血患者行支架辅助弹簧圈栓塞动脉瘤62例, 单发动脉瘤53例, 多发动脉瘤9例 (2个动脉瘤8例, 3个动脉瘤1例) , 共计72个动脉瘤, 除1例外, 均行支架辅助动脉瘤栓塞治疗.结果 完全填塞53个 (74.64%) , 近全填塞17个 (23.94%) , 部分填塞1个 (1.42%) .根据GOS预后评分, GOS5分52例, GOS 4分6例, GOS 3分3例, GOS 2分1例.预后良好的患者 (GOS 45分) 58例 (93.5%) .并发症发生率为14.5%, 其中急性血栓形成3例;栓塞过程中动脉瘤破裂2例;术中脑血管痉挛3例;术中造影未见明显异常, 术后有局灶性缺血性改变并伴轻度神经功能缺失1例.结论 支架辅助弹簧圈栓塞治疗颅内破裂动脉瘤是安全有效、切实可行的, 但应当在临床操作中提高临床技能、总结分析临床处理经验来降低并发症的发生, 并发症发生后的及时、正确处理亦相当重要.     

颅内支架植入辅助动脉瘤栓塞术的护理

目的探讨颅内支架植入辅助动脉瘤栓塞术的护理经验。方法对12例行支架植入辅助动脉瘤栓塞的患者做好心理护理,严防动脉瘤破裂,加强病情观察,预防并发症发生。结果12例患者全部治愈出院,其中9例完全栓塞,2例次全栓塞,1例不全栓塞。临床随访10-12个月,未见动脉瘤复发及支架移位。结论支架植入辅助动脉瘤栓塞术是一种安全可行的新技术,近期疗效好,正确的护理,可提高治愈率,减少致残率。     

不同颅内支架辅助弹簧圈栓塞颅内动脉瘤的安全性和有效性

目的探讨不同颅内支架辅助弹簧圈栓塞颅内动脉瘤的有效性和安全性。方法选取来本院进行颅内支架辅助弹簧圈栓塞的130例颅内动脉瘤患者（动脉瘤共130个）,随机分为A组和B组,每组65例,A组患者应用Solitaire AB支架,B组应用enterprise支架。比较两组颅内动脉瘤栓塞效果和并发症发生情况。结果 A组致密栓塞比例为38.46%,与B组的40.00%无明显差异（P〉0.05）;A组患者并发症发生率为10.77%,与B组的12.31%无明显差异（P〉0.05）。结论 Solitaire AB支架和enterprise支架辅助弹簧圈栓塞动脉瘤均可取得显著效果,并发症少,有效性和安全性较好,值得推广。     

应用支架辅助弹簧圈栓塞颅内复杂动脉瘤18例

为了探讨复杂性颅内动脉瘤的介入治疗方法，探讨支架辅助弹簧圈栓塞动脉瘤的适应证，我们对不能施行常规单纯微弹簧圈栓塞治疗的颅内复杂动脉瘤病例，行血管内支架辅助弹簧圈栓塞治疗18例，均取得较好的效果，现就其相关问题进行如下分析探讨。     

Enterprise支架辅助栓塞治疗颈内动脉眼动脉段动脉瘤的疗效分析

目的探讨Enterprise支架辅助弹簧圈栓塞术治疗颈内动脉眼动脉段动脉瘤的方法、可行性及预后。方法共收集40例颈内动脉眼动脉段动脉瘤患者,其中男性16例,女性24例,年龄21～70岁,平均52岁。Hunt-Hess分级评估:Ⅰ级9例;Ⅱ级15例;Ⅲ级9例;Ⅳ级6例;Ⅴ级1例。36例患者使用Enterprise支架辅助弹簧圈栓塞术治疗,4例行单纯弹簧圈栓塞术治疗,术后行眼动脉段动脉瘤3D-DSA造影,观察动脉瘤闭塞效果。术后随访患者24个月左右,应用格拉斯哥预后评分(Glasgow Outcome Scale,GOS)进行疗效评价。结果 40例眼动脉段动脉瘤完全闭塞37例,大部分闭塞2例,小部分闭塞1例。36枚Enterprise支架均被成功释放,4枚支架释放过程中出现移位现象,辅助弹簧圈栓塞治疗术后35例无并发症;行单纯弹簧圈栓塞术治疗眼动脉段动脉瘤共4例,1例术后发生视力障碍,1例术后发生视野缺损、轻度残疾。统计分析显示:Enterprise支架辅助弹簧圈栓塞治疗眼动脉段动脉瘤比行单纯弹簧圈栓塞术治疗发生较少并发症(χ2=4.512,P=0.041),且患者预后恢复优、GOS评分高(χ2=3.971,P=0.043)。结论应用血管内Enterprise支架辅助微弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤,闭塞效果好,术后并发症较少,患者预后恢复良好。     

Solitaire AB支架辅助栓塞颅内宽颈动脉瘤临床体会

目的:探讨Solitaire AB支架辅助栓塞颅内宽颈动脉瘤的安全性和有效性.方法:回顾性分析12例15个颅内宽颈动脉瘤病人的临床资料.对Solitaire AB支架辅助弹簧圈栓塞颅内宽颈动脉瘤技术特点进行探讨,并对病人进行疗效随访观察,评价该技术的安全性和有效性.结果:12例宽颈动脉瘤病人Solitaire AB支架...     

Endovascular treatment of intracranial aneurysms using coil embolization plus an Enterprise stent

Background  Several difficulties can arise from wide-neck cerebral aneurysms when treated with endovascular embolization. We aimed to investigate the effect of endovascular treatment of intracranial aneurysms using coil embolization plus an Enterprise stent.

Methods  Forty patients were treated with coil embolization plus an Enterprise stent between December 2008 and June 2010.

Results  The mortality of patients was 0. All stents were successfully implanted without any surgery-related complication.

Conclusion  The Enterprise stent has some advantages to be selected.

     

血管内治疗颅内动脉瘤分析(附34例)

目的探讨血管内栓塞治疗颅内动脉瘤的操作要点及并发症的防治。方法回顾性分析血管内栓塞治疗34例患者的临床资料,弹簧圈栓塞过程,宽颈动脉瘤采用球囊Remolding技术。结果100%栓塞21例;95%栓塞9例;90%栓塞4例。1例死亡,8例遗留有单瘫或失语。结论血管内栓塞治疗颅内动脉瘤具有微创、有效的特点。     

电解可脱铂金弹簧圈栓塞治疗颅内动脉瘤

目的总结颅内动脉瘤血管内介入治疗的经验,探讨电解可脱铂金弹簧圈栓塞颅内动脉瘤的技巧、效果及相关并发症的防治。方法回顾性分析我科介入治疗颅内动脉瘤34例36个动脉瘤的临床资料,其中电解可脱铂金弹簧圈栓塞34例,宽颈动脉瘤支架辅助弹簧圈栓塞2例。结果 36个动脉瘤致密栓塞29个动脉瘤,近致密栓塞4个动脉瘤,不全栓塞1个动脉瘤。术中破裂1例。随访3-9个月,26例基本恢复正常生活和工作,2例达到日常生活部分自理。无死亡病例。结论电解可脱弹簧圈栓塞颅内动脉瘤,具有创伤小、安全、可靠等优点,选择合适的技术和方法,对提高栓塞率、减少并发症具有重要的意义。     

Combined stent and coil in endovascular treatment of intracranial wide-necked and fusiform aneurysms

Background Wide-necked and fusiform aneurysms are challenges for interventional neuroradiologists and neurosurgeons since they may involve entire vessels or be irregular in shape, making is possible for Guglielmi detachable coil to protrude into the parent arteries. This study was to evaluate the endovascular treatment of intracranial wide-necked and fusiform aneurysms by using a combination ofstents and coils.Methods From October 2000 to July 2001, eighteen patients with intracranial wide-necked or fusiform aneurysms were treated with intraluminal stenting in combination with endosaccular coiling.Results Stent placement and coil packing were technically successful in all patients. There were no complications related to the procedure except for the migration of the stent in four cases. The aneurysms were embolized with the coils after precise stenting, and total occlusion was obtained in 13 cases, neck remnants in 3, and loose occlusion in 2. All the patients recovered well. Short-term follow-up angiograms suggested patency of the parent arteries without recanalization.Conclusions A combination of endovascular stenting and coil packing may be a favorable alternative for the treatment of intracranial aneurysms that are unsuitable for surgical clipping or coil embolization. Further study is necessary to assess the lonq-term outcome.     

单纯弹簧圈栓塞与支架辅助弹簧圈栓塞介入治疗颅内动脉瘤的对比研究

目的：对比研究单纯弹簧圈栓塞与支架辅助弹簧圈栓塞介入治疗颅内动脉瘤的临床疗效。方法：选取我院2012年5月～2016年5月收治的70例颅内动脉瘤患者作为研究对象,采用随机数字表法将其分为对照组（单纯弹簧圈栓塞介入治疗）和观察组（支架辅助弹簧圈栓塞介入治疗）各35例,比较两组患者临床疗效。结果：观察组治疗总有效率91.43%、复发率0%,同期对照组治疗总有效率80%、复发率17.14%,组间差异有统计学意义;术前两组患者格拉斯哥昏迷评分（Glasgowcomascale,GCS）、改良的 Rankin 评分（ModifiedRankinScale,MRS）、巴塞尔指数（Barthelindex,BI）无明显差异,术后各指标相比较,观察组更为理想且差异有统计学意义;两组生活质量比较,差异有统计学意义。结论：相较于单纯弹簧圈栓塞介入治疗,支架辅助弹簧圈栓塞介入治疗颅内动脉瘤效果更佳,可作为临床治疗的优选方案加以推广使用。     

血管内栓塞治疗颅内宽颈动脉瘤

目的：总结血管内栓塞治疗55例62枚颅内宽颈动脉瘤的体会,探讨颅内宽颈动脉瘤介入治疗方法、技术操作要点及存在问题。方法：55例颅内动脉瘤患中49例为破裂动脉瘤,按Hunt-Hess分级;Ⅰ级9例,Ⅱ级15例,Ⅲ级18例,Ⅳ级7例。采用双弯塑形、横向成篮、分部填塞及篮外填塞等方法治疗51例,瘤颈重塑形技术2例,血管内支架结合电解可脱卸弹簧圈（GDC）栓塞治疗3例。结果：栓塞程度：致密栓塞50个（80．6％）,90％以上8枚（12．9％）,90％以下4枚（6．5％）。术中出血2例（3．6％）,死亡2例（3．6％）。结论：GDC栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。采用双弯塑形、横向成篮、分部填塞、篮外填塞及重塑形（remodelling)技术等方法,可以明显提高宽颈动脉瘤的致密栓塞率。血管内支架结合GDC可能成为治疗颅内梭形及宽颈动脉瘤的有效方法。     

血管内栓塞治疗颅内动脉瘤并发症的临床分析

目的 探讨血管内栓塞治疗颅内动脉瘤并发症的防治,以提高血管内栓塞治疗颅内动脉瘤的安全性.方法 回顾性分析微弹簧圈栓塞治疗颅内动脉瘤66例(70个),4例发生动脉瘤破裂出血,2例发生血栓,1例发生微弹簧圈误栓,5例发生血管痉挛,分别进行对症处理.结果 因并发症而死亡2例(3.03%),因脑血管痉挛而出现的一过性神经功能障碍2例(3.03%),经积极处理后,预后良好.结论 栓塞技术的提高,栓塞材料的改进,术中发生情况的正确处理,有助于降低并发症的发生率.     

应用Neuroform支架技术治疗颅内宽颈动脉瘤的疗效分析

目的 探讨和总结颅内宽颈动脉瘤应用Neuroform自膨式支架结合弹簧圈治疗的新技术，评价Neuroform自膨式支架的顺应性、结合弹簧圈治疗的有效性。方法 回顾性分析采用Neuroform自膨式支架结合弹簧圈新技术治疗的30例颅内宽颈动脉瘤患者的疗效，30例患者的平均动脉瘤大小为9．5mm。在微导丝导引下推送Neuroform支架组合体，跨骑动脉瘤颈释放支架，其中一期支架辅助弹簧圈治疗动脉瘤20例，二期支架结合弹簧圈栓塞动脉瘤10例。结果 30例患者中术中完全栓塞21例（70％），大部分栓塞9例（30％）。术后支架移位2例，血栓性栓塞1例。术后临床随访29例，仅1例遗留永久性轻偏瘫；21例术后6～12个月经数字减影血管造影显示，7例动脉瘤残留需行二次治疗，其中4例第2次达到了完全栓塞。结论 支架辅助弹簧圈栓塞新技术提高了颅内宽颈动脉瘤的近期疗效，但长期疗效尚有待临床及血管造影随访结果来证实。     

Endovascular treatment of wide-necked intracranial aneurysms using of ＂remodeling technique＂ with the HyperForm balloon

Background Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the ＂remodeling technique＂ with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result.
Methods From June 2004 to September 2006, forty-two patients （20 men, 22 women） with wide-necked or large neck/fundus ratio aneurysms were treated by using the ＂remodeling technique＂ with the HyperForm balloon.
Results Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases （80.9%）, subtotal in 4 （9.5%） and incomplete in 2 （4.8%）. One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months.
Conclusions The ＂remodeling technique＂ with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms - located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurvsms when the standard remodelina techniaue miaht have failed.