急性破裂出血动脉瘤弹簧圈栓塞治疗与脑血管痉挛

目的分析电解可脱卸弹簧圈(GDC)栓塞治疗急性破裂出血动脉瘤脑血管痉挛的发生及治疗。方法Hunt-HessⅠ～Ⅲ级并在发病后72h内进行GDC栓塞治疗的动脉瘤病人86例,症状性血管痉挛的诊断根据迟发性神经功能损害,并有TCD和/或脑血管造影的证据。结果共发生症状性血管痉挛17例(19.8%),血管痉挛的发生率和Hunt-Hess分级及Fisher分级有显著的相关关系,平均随访13个月,17例发生症状性脑血管痉挛病人中恢复良好12例,中度致残4例,重度致残1例。结论GDC栓塞治疗动脉瘤后症状性血管痉挛的发生率并不高于常规手术治疗;放置腰椎蛛网膜下腔持续引流可能对降低症状性脑血管痉挛的发生有积极意义。     

The use of the “cross over technique” in the management of a traumatic vertebro-vertebral fistula

Summary A case of dissecting stab wound injury to the right vertebral artery with a vertebro-vertebral fistula is reported. Since a complete occlusion of a VV-fistular was not possible from a proximal approach with detachable balloons only retrograde catheterisation of the right vertebral artery via the left vertebral artery was undertaken (cross over technique). The introduction of thrombogenic platinumcoils led to a successful and complete occlusion of the fistula.     

可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘

目的总结外伤性颈内动脉海绵窦瘘(TCCF)血管内神经介入治疗的经验。方法应用BOSTON公司及BALT公司球囊导管及球囊，在X线电视监视下经右股动脉插管。在球囊内注入适量等渗非离子造影剂(优维显)闭塞瘘口。结果13例病人全部治愈，11例一次栓塞成功，2例两次栓塞成功，颈内动脉通畅率为100％，无并发症发生。结论可脱性球囊经血管内神经介入栓塞治疗TCCF，其损伤小、安全可靠，可作为TCCF的首选治疗方法。     

外伤性颈内动脉海绵窦瘘球囊封堵术140例

目的观察球囊栓塞治疗外伤性颈内动脉海绵窦瘘的临床效果。方法经股动脉穿刺入路,将造影导管送入颈动脉进行血管造影明确诊断后,再将同轴微导管超选入瘘口内,将可脱球囊充盈脱下栓塞瘘口,达到治愈目的。结果本组140例病人中有126例治疗后痊愈,14例临床症状体征明显改善,未出现永久性严重并发症,随访3个月～3年,15例病人复发。结论经导管介入栓塞瘘口是治疗外伤性颈内动脉海绵窦瘘的一种行之有效方法,其具有创伤小、疗效好、并发症少等优点,为治疗该病首选方法。     

可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘

目的：探讨可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘的临床意义。方法：应用可脱性球囊经动脉途径栓塞治疗21例颈内动脉海绵窦瘘。结果：21例患者中,瘘口栓塞17例,闭塞颈内动脉4例,均治愈。其中瘘口栓塞后1例并发球囊早泄瘘口复发,经再次球囊栓塞成功。颈内动脉通畅率为80.9%。随访3-6个月未见复发。结论：可脱性球囊栓塞术是治疗外伤性颈内动脉海绵窦瘘的首选术式。     

Exposure of workers to pulsed gradients in MRI

PURPOSE: To numerically evaluate the electric field/current density magnitudes and spatial distributions in healthcare workers when they are standing close to the gradient coil windings near the magnetic resonance imaging (MRI) scanner ends. MATERIALS AND METHODS: Anatomically realistic, whole-body male and female voxel phantoms are engaged to model the workers at various positions near the ends of three cylindrical gradient coils (x-, y-, and z-axis gradients). The numerical calculations of induced fields are based on an efficient, quasistatic finite-difference method. RESULTS: The simulations show that it is possible to induce electric fields/current densities above levels recommended by the International Commission for Non-ionizing Radiation Protection (ICNIRP) and the Institute of Electrical and Electronics Engineers (IEEE) standards when the workers are standing close to the gradient coils and when two or three gradients are switched simultaneously, as is often the case. CONCLUSION: The longitudinal gradient tends to induce more fields in workers than the transverse coils. The strongest levels of field exposure are observed when all three gradients are operated simultaneously and can be above regulations when the healthcare worker is close to the gradient coils. Other postures such as bending into the magnet shall be investigated in further studies.     

Successful embolization using interlocking detachable coils for a congenital extrahepatic portosystemic venous shunt in a child

The authors report the case of a 6-year-old boy with a congenital extrahepatic portosystemic venous shunt. He had hyperammonemia. The shunt was 18 mm in diameter and located between the inferior mesenteric vein and the left internal iliac vein. The flow in the shunt was very rapid. After decreasing blood flow by inflating a balloon catheter inserted into the left internal iliac vein from the femoral vein, a microcatheter was coaxially advanced to the shunt to embolize the shunt. Embolization was successfully performed with interlocking detachable coils and microcoils without any complication. This patient's hyperammonemia resolved soon after the procedure.     

Radiographic characteristics of Cook detachable and Gianturco coils as well as clinical results of transcatheter closure of the patent ductus arteriosus

Summary Purpose: To describe the radiographic appearance of the Gianturco and the Cook detachable coils and present the clinical results in patients who underwent transcatheter closure of patent ductus arteriosus. Materials and methods: Between January 1994 and June 1997, eighty-two patients underwent closure of patent ductus arteriosus (PDA) using either Gianturco or Cook detachable coils. The chest x-ray and echocardiography of all patients were reviewed and the following parameters were evaluated: 1) the size of the heart (cardiothoracic ratio), 2) the position and the type of the coils in the postero-anterior and the lateral projection, 3) the number of coils used, 4) the existence of residual ductal flow, 5) Doppler velocity in the left pulmonary artery. Results: Complete occlusion was achieved in 94%, and cardio-thoracic ratio regressed from 0.57 to 0.53 (p < 0.01), after a mean follow-up of 1.2 years. The identification of the different coils on the chest radiograph was successful in only 47% of cases, difficulties arising especially, when multiple coils were used. In 55 patients (67%) the coil position was judged to be optimal, in 27 patients (33%) suboptimal. The latter correlates with the presence of residual shunt. Multiple coils correlated more with a left pulmonary artery flow velocity exceeding 1.5 m/s. Conclusion: Coil-occlusion of patent ductus arteriosus is effective and leads to reduced cardio-thoracic ratio. Radiographic coil identification is possible but may be difficult if multiple coils are deployed. Suboptimal coil position led more often to residual PDA shunt. Multiple coils are more commonly associated with increased LPA velocities, but hemodynamic significant obstruction to flow is rare. Eingegangen: 23. April 1999, Akzeptiert: 9. Juni 1999     

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。