未破裂脑动脉瘤血管内治疗的安全性及影像学结果

目的　观察未破裂脑动脉瘤血管内治疗后的安全性及影像学结果。方法　将可解脱弹簧圈栓塞未破裂脑动脉瘤 (必要时支架或球囊辅助 ) ,去除可能的出血因素。结果　 5 7例共 6 5个未破裂动脉瘤 ,5 2个致密栓塞 ,12个栓塞程度大于 90 % ,1个栓塞程度少于 90 %。血管造影随访 (6～ 36个月 ) ,30个致密栓塞 2 9个仍稳定 ,1个动脉瘤再生长 ;11个栓塞程度大于 90 %中 1个完全消失 ,7个稳定 ,3个再生长 ;1个栓塞程度少于 90 %的再生长。结论　未破裂脑动脉瘤血管内治疗是必要的也是安全的方法 ,致密栓塞的影像学结果更好 ,长期疗效需进一步的随访观察。     

A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms

Introduction We report the results of a prospective clinical study using a new self-expanding nitinol stent (Enterprise) designed for the treatment of wide-necked intracranial aneurysms. Methods We treated 31 saccular, wide-necked intracranial aneurysms in 30 patients. Ten aneurysms had recanalized after prior endovascular treatment without a stent, and 21 aneurysms had not been treated before. Results Stent deployment was successful in all procedures. Additional coil embolization was performed in all aneurysms. Initial complete angiographic occlusion was achieved in 6 aneurysms, a neck remnant was left in 18 aneurysms and there were 7 residual aneurysms. Angiographic follow-up examinations of 30 lesions after 6 months demonstrated 15 complete occlusions, 8 neck remnants and 7 residual aneurysms. One patient refused the 6-month angiographic follow-up. Spontaneous occlusion of the aneurysm had occurred in 14 patients, and 6 aneurysms showed recanalization. Four of these residual aneurysms were retreated. At the 6-month follow-up, 29 parent arteries were unaffected, whereas two parent vessels demonstrated minor asymptomatic narrowing at the stent site. Two patients experienced one or more possible or probable device-related serious adverse events during the 6-month follow-up period. There was no procedural morbidity or mortality at 6 months after the procedure. Conclusion The reported results demonstrated the safety and feasibility of the Cordis Neurovascular Enterprise stent in the treatment of wide-necked intracranial aneurysms. Initial clinical and angiographic results are favorable. Werner Weber and Martin Bendszus contributed equally to this work.     

Wingspan stent-assisted coiling of intracranial aneurysms with symptomatic parent artery stenosis: experience in 35 patients with mid-term follow-up results

Background

There is a potential risk of aneurysm rupture after parent artery revascularization because of increased blood flow. The purpose of this study is to assess the efficacy and safety of Wingspan stent-assisted coil embolization in the treatment of intracranial aneurysms with symptomatic parent artery stenosis.

Methods

Thirty-five consecutive patients (19 men, 16 women; age range, 48–79 years; mean age, 60.4 years) harboring 35 unruptured wide-necked or fusiform intracranial aneurysms (mean size 6.8 mm; range 2.5–18 mm.) with symptomatic parent artery stenosis (mean degree 71.1%; range 50–92%) were treated with the Wingspan stent-assisted coiling. Twenty-four lesions were located in the anterior circulation and eleven in the posterior circulation. Patients were premedicated with antiplatelet therapy consisting of aspirin 300 mg and clopidogrel 75 mg for at least 3 days before the procedure. Following pre-dilatation and stent placement, a coiling microcatheter entered the aneurysm through the interstices of the stent, and then coiling was performed. After the procedure, clopidogrel 75 mg daily was recommended for an additional 30 days, and aspirin 100 mg was recommended throughout follow-up. For all patients, clinical follow-up was conducted by clinic visitation, or telephone interview. Angiographic follow-up with DSA was recommended at 6 months and 1 year after the procedure. Angiography follow-up (mean time 10.6 months) was obtained in 31 cases (88.6%). The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome and follow-up angiography were evaluated.

Results

In every case, technical success was achieved. The degree of stenosis was reduced from 71.1% to 17.4% after balloon angioplasty and stenting. Immediate angiography demonstrated complete occlusion in 25 cases (71.4%), neck remnant in 7 cases (20.0%), and incomplete occlusion in 3 cases (8.6%). Procedure-related morbidity occurred in two patients (5.7%), including thromboembolism (n = 1) and occlusion of small penetrating arteries (n = 1). At follow-up (mean time 18.3 months), two additional cases of ischemic stroke occurred. The overall frequency of any stroke, intracranial hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 11.4%. No rehemorrhage of treated aneurysm occurred. At angiographic follow-up, four cases demonstrated ≥50% in-stent restenosis (12.9%), one of which was symptomatic, and two aneurysms (6.4% of the follow-up angiograms) demonstrated recanalization.

Conclusion

We found that the Wingspan stent-assisted coil embolization was helpful in the treatment of intracranial aneurysms with parent artery stenosis.     

Solitaire AB支架辅助栓塞颅内动脉瘤临床随访研究

目的观察Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤初中期效果。方法回顾性分析2009年至2012年期间采用Solitaire AB支架辅助弹簧圈栓塞治疗的49例颅内宽颈动脉瘤患者49个动脉瘤,其中41例患者41个动脉瘤（26个破裂出血,15个未破裂）术后随访12～48个月,根据改良Rankin评分、DSA、CTA或MRA检查评价颅内动脉瘤影像学及临床结果。结果栓塞术后有2例动脉瘤再次破裂出血,3例脑梗死,1例载瘤动脉闭塞,死亡1例,并发症发生率为14.2%。栓塞术后12个月DSA、MRA或CTA检查显示,32个动脉瘤（32/41,78.0%）完全栓塞,明显高于术后即刻（21个,42.9%）（P＝0.02）;瘤颈残留7个（17.1%）,部分栓塞2个（4.9%）,均较术后即刻有改善。24个动脉瘤（58.5%）稳定而无变化,复发4个（9.7%）。末次随访时改良Rankin评分显示0分18例（43.9%）,1分10例（24.4%）,2分5例（12.2%）,3分4例（9.8%）,4分2例（4.85%）,5分2例（4.85%）。患者日常活动能力自理率为80.5%,预后良好。结论 Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤安全有效,有助于提高完全栓塞率,降低操作相关并发症。     

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.     

ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results

Multiple techniques for anterior cruciate ligament (ACL) reconstruction are currently available, most of which use hardware or resorbable material for fixation of the graft inside or outside the bony tunnels. In this study, the long-term results of 95 patients at a mean follow-up of 10.7 years were assessed. The ACL was reconstructed using a patellar tendon autograft with a press-fit fixation. Between 1987 and 1991, 159 patients were operated by the senior author (PH), 95 could be seen for follow-up. Evaluation included detailed history, physical examination, functional knee ligament testing, KT-1000 arthrometer testing, the IKDC standard evaluation form, Lysholm, Flandry, and Tegner scoring systems. Radiographs were obtained preoperatively and at follow-up to assess the grade of osteoarthritis. Subjectively, none of the patients that were seen for follow-up complained of instability. Numbness of the skin was reported by 54% of the patients and pain during knee walking was described as mild in 25% and severe in 2%. The mean Flandry score was 243 (max: 280). The mean Lysholm score was 93.2 at follow-up and the Tegner activity level was 6.8 preinjury and 6.0 postoperatively. The average KT-1000 side-to-side difference was 1.8 mm on a manual maximum pull. The IKDC knee scoring revealed 84% of the patients with normal (A) or nearly normal (B) knee joints, 15% were (C), 1% was (D). Radiographically, joint space narrowing was found in 19%, 15%, and 25% for the patello-femoral, medial, and lateral compartments, respectively. Meniscus surgery was a determining factor. This study presents long-term clinical data on a press-fit fixation for ACL reconstruction. Results were excellent and good in more then 80% of the followed patients. The advantages of the press-fit fixation are direct bone-to-bone healing of the graft, decreased donor site morbidity, cost-effectiveness and ease for revision surgery.     

Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?

Introduction  Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation. The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography (DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up. Materials and methods  From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers 1 and 2) and two other reviewed DSA images. Results  Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity of CE-MRA to detect aneurysm recanalisation was 95.5%. Conclusion  CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up.     

Internal carotid bifurcation aneurysms: frequency, angiographic anatomy and results of coiling in 50 aneurysms

INTRODUCTION: Internal carotid artery (ICA) bifurcation aneurysms are uncommon. Little is known about incidence, anatomical characteristics and results of endovascular treatment. We report our experience with endovascular treatment of 50 ICA bifurcation aneurysms in 46 patients. METHODS: There were 13 men (28%) and 33 women (72%) with a mean age of 49.3 years (range 23-76 years). Of 50 aneurysms, 26 (52%) were ruptured and 24 (48%) were unruptured. Of the 46 patients, 23 (50%) had one to five additional aneurysms. RESULTS: The frequency of ICA bifurcation aneurysms was 2.4% (53 of 2,249, 95% CI 1.8-3.1%). Their mean size was 9.6 mm (median 6 mm, range 2-55 mm). Aneurysm neck was symmetrically on A1 and M1 in 30 aneurysms (60%), dominant on A1 in 14 (28%), on M1 in 2 (4%) and on the ICA in 4 (8%). Aneurysm fundus projection was superior in 28 aneurysms (56%), posterior in 9 (18%), anterior in 10 (20%) and lateral in 3 (6%). Four aneurysms were coiled with balloon assistance. Procedural morbidity and mortality of coiling was 2% each. During follow-up, 7 of 50 aneurysms (all 10 mm or larger) were additionally treated (retreatment rate 14%). CONCLUSION: ICA bifurcation aneurysms are rare with a frequency of 2.4% of treated aneurysms in our institution. They are often associated with additional aneurysms. Most aneurysm necks are located symmetrically on A1 and M1 and fundus projection is mostly superior. Coiling is safe and effective for the management of these aneurysms. The aneurysms that needed retreatment were >/=10 mm.     

Follow-up of intracranial aneurysms treated with matrix detachable coils: a single-center experience

BACKGROUND AND PURPOSE: Matrix coils are polymer-coated bioactive coils used in treatment of intracranial aneurysms. The current study is aimed at evaluating the efficacy and safety of these coils in treatment of ruptured and unruptured aneurysms. METHODS: Seventy-seven consecutive patients with 84 aneurysms were included in the study. Forty-six aneurysms were treated with Matrix coils alone, and 38 were treated with Matrix coils in combination with other coils/devices. Angiographic follow-up was available in 64 patients with 70 aneurysms. Length of follow-up ranged from 6 to 28 months with mean of 10 months. Both postembolization and follow-up angiograms were graded on a 3-point Raymond scale. Aneurysms were classified as stable, improved, or recanalized based on the follow-up angiograms. Recanalization was considered major if it was saccular and its size would theoretically permit retreatment with coils. RESULTS: At the end of the initial procedure, 47 (56.0%) aneurysms showed complete occlusion (Raymond 1), 20 (23.8%) showed contrast filling the neck of the aneurysm (Raymond 2), and 16 (19.0%) showed contrast filling the sac of the aneurysm (Raymond 3). Of the 70 aneurysms in which follow-up angiograms were available, 55.7% remained stable in appearance, 20.0% showed improved occlusion, and 24.3% demonstrated recanalization; 8.6% demonstrated major recanalization. There were 2 aneurysm rebleeds (both incompletely packed); one resulted in death. CONCLUSION: Matrix coils are safe to use and the recanalization rate of aneurysms treated with these coils appears to be at least comparable with historical studies with Guglielmi detachable coils.     

Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume

Our purpose was to evaluate the postoperative aneurysm occlusion volume and clinical results of treating unruptured intracranial aneurysm using three-dimensional (3D) coils. Over a 2-year period 62 aneurysms (39 with a neck 4 mm, 23 with a neck >4 mm) in 62 patients in five participating centres were treated. The procedure consisted, firstly, of framing the aneurysm with one or more spherical 3D coils, and secondly, of filling it with two-dimensional (2D) helical coils. Anatomical and clinical results were evaluated by univariate analysis. Multivariate analysis was used to identify independent predictors of these results. For neck sizes 4 and >4 mm, angiographic occlusion was complete in 31 (79%) and 16 (70%) aneurysms, respectively; the mean percentage of occlusion volume was 31.4% and 29.5%, respectively, and postoperative morbidity was 3% and 4%, respectively, with no significant differences between the two groups. There were no deaths. However, occlusion volume correlated with sac size (P=0.037) and sac-to-neck ratio <1.5 (P=0.073), except when three or more 3D coils per aneurysm were used (P=0.516 and P=0.308, respectively). Occlusion volume correlated with the number of 3D coils per aneurysm (P<0.001) and was an independent predictor of angiographic complete occlusion (P=0.002). The use of the largest number of 3D coils per aneurysm was safe and may improve the postoperative volume and angiographic occlusion of aneurysms with a neck >4 mm, provided the sac-to-neck ratio is 1.5.     

Initial clinical experience with spiral CT and 3D arterial reconstruction in intracranial aneurysms and arteriovenous malformations

We studied 32 consecutive patients with known or suspected cerebrovascular abnormalities studied with spiral CT following a intravenous bolus injection of iodinated contrast medium with a power injector. Flow was 3 or 4 ml/s. In an attempt to define the appropriate delay time and scan duration a cranial angio-CT without table increment was performed on 10 patients. Enhancement was measured by manually placed regions of interest within the left middle cerebral artery and the inferior sagittal sinus. All patients except one had intraarterial angiography (DSA) for comparison. In 6 patients with an arteriovenous malformation (AVM) follow-up was possible after one and/or two embolisation procedures. These patients had plain and contrast-enhanced spiral CT. The diagnosis was aneurysm in 9 (8 berry aneurysms, one giant fusiform aneurysm), AVM in 13 (all supratentorial) and traumatic arteriovenous fistula in one. In 9 patients there were no detectable pathological vascular findings. After 3D reconstruction the size (between 5 and 28 mm), location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs and the distribution of the embolisation material could be demonstrated clearly. The main feeding vessel(s), nidus and draining veins were reliably shown. The decreased extent of the AVMs after embolisation was clearly demonstrated. There was no difference in diagnosis when DSA and 3D-CT were compared by two independent radiologists. We consider arterial spiral CT with 3D reconstruction to have the potential of offering important diagnostic information for the treatment of intracranial AVMs and aneurysms.The authors would like to dedicate this paper to Prof. Dr. sc. med. R. Lehmann     

单个弹簧圈栓塞颅内微小动脉瘤的单中心经验

目的探讨单个弹簧圈栓塞颅内微小动脉瘤(最大径<3 mm)的可行性和疗效。方法 2001年1月至2011年1月对72例颅内微小动脉瘤患者的77个动脉瘤进行单个弹簧圈栓塞,其中动脉瘤破裂出血52例,多发性动脉瘤13例。用3D-DSA选择工作角度测量动脉瘤大小(前后径、上下径、宽颈、最大径和瘤颈)。随访脑血管造影3～88个月(平均24.8个月)。结果对所有77个微小动脉瘤成功实施了单个弹簧圈栓塞,其中10个采用球囊辅助弹簧圈栓塞,19个联合支架辅助弹簧圈栓塞。术中破裂出血7例,发生脑栓塞事件2例,术中弹簧圈移位2例。术后即刻造影示完全栓塞42个,次全栓塞30个,部分栓塞5个。除2例死亡外,所有病例进行了至少2次复查(术后3和12个月),其中再通5个,对3个进行了再次栓塞,延迟性弹簧圈移位2例。12个月后复查造影示完全栓塞61个,次全栓塞14个。结论单个弹簧圈栓塞颅内微小动脉瘤可行、安全并有效,联合支架辅助治疗可以降低其再通率。     

Time-of-flight MR angiography at 3T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils

Objective

To compare 3D time-of-flight MR angiography (TOF-MRA) at 3 Tesla (3 T) with digital subtraction angiography (DSA) for the evaluation of intracranial aneurysm occlusion after endovascular coiling.

Methods

In a prospective study, 51 consecutive patients (25 females, 26 males; median age, 51 years) with 51 saccular aneurysms treated with endovascular coiling underwent simultaneous DSA and 3 T TOF-MRA at follow-up. DSA and TOF-MRA images were analyzed independently by two senior neuroradiologists. Findings were assigned to 1 of 3 categories in the Raymond classification: complete obliteration, residual neck or residual aneurysm. Agreement between observers and techniques was evaluated using κ statistics.

Results

DSA images were not interpretable for one patient. Interobserver agreement was determined as excellent for DSA (κ = 0.86) and TOF-MRA (κ = 0.80). After reaching a consensus, DSA follow-up showed 26 (51%) complete obliterations, 20 (39%) residual necks and 4 (8%) residual aneurysms. TOF-MRA showed 23 (45%) complete obliterations, 22 (43%) residual necks and 6 (12%) residual aneurysms. Comparison between TOF-MRA and DSA showed excellent agreement between the techniques (κ = 0.86). In the four cases that were misclassified, TOF-MRA findings were assigned to a higher class than for DSA.

Conclusion

TOF-MRA at 3 T is at least as efficient as DSA for the evaluation of intracranial aneurysm occlusion after endovascular treatment with detachable coils. We suggest that TOF-MRA at 3 T might be used as the primary method for imaging follow-up of coiled intracranial aneurysms.     

Modern cross-sectional imaging in the diagnosis and follow-up of intracranial aneurysms

Digital subtraction angiography (DSA) is still considered the gold standard for most applications in neurovascular imaging. However, with the ongoing development of cross-sectional imaging modalities DSA is increasingly being replaced by less invasive methods. This contribution describes the diagnostic value and the increasing potential of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the diagnosis and follow-up of intracranial aneurysms. The main role of CTA is in the diagnosis and therapy planning of ruptured aneurysms; in contrast, MRA plays an increasingly important role in the screening for asymptomatic aneurysms (especially in cases of familial subarachnoid hemorrhage) and in the follow-up after endovascular therapy with coils and/or intracranial stents. Technical issues concerning examination technique are covered here as well as an approach to advanced postprocessing of the image data. Furthermore, a brief outlook on the impact of new developments (MRA with parallel imaging and at 3.0 T) is given.     

TRUFILL DCS Orbit 水解脱弹簧圈栓塞治疗颅内小动脉瘤及宽颈动脉瘤

TRUFILLDCSOrbit属第二代水解脱弹簧圈[1]。我院用于小动脉瘤及宽颈动脉瘤进行了栓塞治疗,效果良好,报道如下。临床资料一、一般资料15例患者,男7例,女8例;年龄34～77岁,平均56岁。共17枚动脉瘤。二、临床表现15例均以蛛网膜下腔出血(SAH)急性起病,并经CT检查证实。以突发剧烈头痛、后颈部不适为突出表现。7例伴不同程度的昏迷史,7例有高血压病史。动脉瘤按Hunt Hess分级:1级2例,2～3级9例,4～5级4例。三、影象学检查15例均经DSA脑血管造影检查确诊。动脉瘤位于前交通动脉7例;后交通动脉4例;颈内动脉分叉部1例;大脑中动脉分叉部1例…     

Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results

Introduction  Coiling associated with placement of self-expandable intracranial stents has amplified the treatment of intracranial wide-necked aneurysms, but the durability of this treatment and the existence of delayed recurrence are not yet well known. The purpose of this report is to present our experience with the Neuroform Stent associated with coiling and to evaluate complications, effectiveness, and long-term results of this technique. Methods  A retrospective study of 42 patients with wide-necked cerebral aneurysms treated with the Neuroform Stent was performed. Mean aneurysm size was 11.3 mm. Mean neck size was 5.33 mm. All patients were treated with coiling and stenting. Clinical and angiographic follow-up was available in 38 patients (90.5%). The overall follow-up time ranged from 6 months to 5 years (mean, 42 months), but most of the patients (92%) had a follow-up period superior to 1 year. Results  Successful deployment of 41 stents (97%) was obtained. Permanent procedural morbidity was observed in only one patient (2.4%). Long-term complete aneurysmal occlusion was obtained in 27 patients (71%). Aneurysmal regrowth was observed in four patients (9.5%) on the first control angiogram. After the first control angiogram, no delayed recanalization or regrowth was observed. During the follow-up period, there were no hemorrhagic events, no delayed thrombosis, and no stent displacement. Conclusion  Our results demonstrate the effectiveness of the technique, a small rate of procedural complications, and long-term tolerance of the Neuroform Stent. Despite some evidence of early aneurysmal recurrence, long-term durability of stent-assisted aneurysm occlusion is stable after the first year.     

Infrarenal aortic stents: Initial clinical experience and angiographic follow-up

From March 1990 to May 1991, arterial stents were placed in seven patients because of a tight stenosis (five patients) or a total chronic occlusion (two patients) located in the infrarenal aorta. In one case, the aortic occlusion extended to both common iliac arteries. After balloon dilatation, aortic stents were successfully positioned in all cases. Bilateral common iliac recanalization and stent placement were performed in one case. No complications occurred in any of the patients. Follow-up data were derived from clinical assessments and angiographic results. After a 15.1-month mean follow-up period (range 12–24 months), the seven aortic stents remained patent. Three iliac artery procedures were performed in two of the patients as well. Claudication recurred in three of the seven patients which was related to a common iliac occlusion (one case) or distal progression of atherosclerosis (two cases). Aortic stents seem to be suitable for treating failed angioplasty of aortic lesions but the procedure remains technically difficult when there is associated severe atherosclerosis of the proximal common iliac arteries. Nevertheless, considering the morbidity rate (0%) and the patency rate in this series, this technique could become an alternative to surgical treatment for infrarenal aortic occlusive lesions.     

Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: a single center experience

Objective

The aim of the present retrospective study is to compare outcome of the endovascular treatment using the Enterprise stent in intracranial wide-necked saccular and dissecting aneurysms.

Methods

Forty-six patients with 50 complex intracranial aneurysms admitted between June 2009 and November 2010 were treated using Enterprise stents. Thirty-one aneurysms were wide-necked saccular, 19 aneurysms dissecting. In 48 cases, aneurysms were occluded by stent-assisted coiling; in 2 cases, by stent alone.

Results

Among the aneurysms treated with the Enterprise stent, patient sex, aneurysm location, hypertension history and the immediate angiographic results differed significantly between the saccular and dissecting aneurysm groups. However, recurrence rate, clinical follow-up outcomes did not differ significantly between the saccular and dissecting groups. There was 1 (2%) procedure-related complication, which caused death in the saccular group. At mean 9.1-month follow-up, the result was good in all dissecting cases and good in 30 saccular cases. There was 1 recurrence in each group.

Conclusions

Enterprise stent is very useful for endovascular embolization of intracranial wide-necked saccular and dissecting aneurysms because it is easy to navigate and place precisely. The overall morbidity and mortality rates were low.     

再次椎体成形术的应用

目的探讨再次经皮椎体成形术(PVP)处理首次PVP术后疼痛不缓解的可行性、方法及疗效。方法骨质疏松症并椎体压缩骨折9例共9节行PVP治疗后疼痛不缓解,其中轻度压缩3例、中度以上压缩6例,包括合并囊性积液4例4节和粉碎性压缩2例2节;椎体转移性肿瘤4例共5节行经皮椎体成形术治疗后2～4个月疼痛复发。均采用再次PVP治疗,术后CT观察PMMA分布状况和有无渗漏,并进行临床疗效评价和观察有无并发症。结果再次PVP技术均成功,再注入PMMA量平均为4．8ml,随访1～18个月,CR10例、PR3例。CT证实椎体周围PMMA渗漏2例,但无一例出现临床症状。2例椎体转移肿瘤分别于再次PVP后4、5个月死亡,但无明显相应病变椎体平面疼痛。结论对骨质疏松性椎体压缩骨折PVP后疼痛不缓解及椎体内转移性肿瘤疼痛复发者,再次PVP的疗效显著。关键技术是经椎弓根穿刺至椎体内致痛区并充分充填PMMA。