颈动脉海绵窦瘘的诊断与球囊栓塞治疗(附96例报告)

目的 探讨颈动脉海绵窦瘘(CCF)的血管造影特点及用可脱球囊栓塞的效果。方法 96例均行数字减影血管造影(DSA)，显示瘘口部位及大小后行可脱球囊栓塞治疗。结果 96例中，89例1次栓塞成功；7例术后复发，瘘口再通，第2次栓塞成功。13例闭塞颈内动脉。结论 CCF球囊栓塞为首选治疗方法。术中应尽量保留颈内动脉通畅。     

可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞大型颅内动脉瘤

目的 探讨可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞颅内大型动脉瘤的安全性和有效性。方法 可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞颅内大型动脉瘤4例，动脉瘤直径14～21mm，首先用可解脱弹簧圈在动脉瘤内成篮，然后用游离纤毛铂金弹簧圈进行篮内填塞，最后再用可解脱弹簧圈进行瘤体及瘤颈的致密栓塞。结果 3个动脉瘤获得完全致密栓塞，1个动脉瘤有瘤颈残留。临床随访3～12个月，无出血及脑缺血性事件发生。结论 可解脱弹簧圈结合游离纤毛铂金弹簧圈是一种可选的栓塞颅内大型动脉瘤安全、有效的方法。     

难治性颅内动脉瘤血管内支架治疗的初步结果

目的　总结血管内支架结合电解可脱卸弹簧圈 (GDC)治疗分叉部宽颈动脉瘤及复发动脉瘤的技术及疗效。方法　采用血管内支架结合GDC治疗 5例颅内动脉瘤 ,其中颈内动脉分叉部动脉瘤2例 ,基底动脉宽颈瘤 1例和后交通宽颈动脉瘤复发 2例。 3例支架跨重要侧支血管及穿动脉放置。通过支架上的网孔将微导管送入动脉瘤腔 ,继续GDC填塞。结果　 4例动脉瘤达到致密填塞 ,1例大部填塞 ,载瘤动脉及侧支血管通畅 ,1例术后出现动眼神经麻痹 ,3个月后恢复。影像学随访 3～ 6个月 ,无支架内狭窄。结论　联合使用支架及GDC是治疗分叉部宽颈动脉瘤及复发动脉瘤的有效方法 ,临床应用前景广阔。支架覆盖重要动脉开口并不影响血流。     

Interventional magnetic resonance angiography with no strings attached: wireless active catheter visualization.

Active instrument visualization strategies for interventional MR angiography (MRA) require vascular instruments to be equipped with some type of radiofrequency (RF) coil or dipole RF antenna for MR signal detection. Such visualization strategies traditionally necessitate a connection to the scanner with either coaxial cable or laser fibers. In order to eliminate any wire connection, RF resonators that inductively couple their signal to MR surface coils were implemented into catheters to enable wireless active instrument visualization. Instrument background to contrast-to-noise ratio was systematically investigated as a function of the excitation flip angle. Signal coupling between the catheter RF coil and surface RF coils was evaluated qualitatively and quantitatively as a function of the catheter position and orientation with regard to the static magnetic field B0 and to the surface coils. In vivo evaluation of the instruments was performed in interventional MRA procedures on five pigs under MR guidance. Cartesian and projection reconstruction TrueFISP imaging enabled simultaneous visualization of the instruments and vascular morphology in real time. The implementation of RF resonators enabled robust visualization of the catheter curvature to the very tip. Additionally, the active visualization strategy does not require any wire connection to the scanner and thus does not hamper the interventionalist during the course of an intervention.     

Bioptome-assisted coil occlusion of moderate-large patent ductus arteriosus in infants and small children.

Coil occlusion of patent ductus arteriosus (PDA), although inexpensive, is technically challenging for the moderate-large ducts in small children. Bioptome assistance allows better control and precision. We describe case selection strategies, technique, immediate and short-term results of bioptome-assisted closure of moderate-large (>/= 3 mm) PDA in 86 infants and children 6 mm (> 4 mm for children under 5 kg) and/or shallow ampullae (by echocardiography) underwent operation (n = 41). Specific technical modifications included use of long sheaths (5.5-8 Fr) for duct delineation and coil delivery, cutting of coils turns (51 patients) to accommodate the coils in the ampulla, and simultaneous delivery of multiple coils (n = 43). As far as possible, coils were deployed entirely in the ampulla. Median fluoroscopy time was 7.3 min (1.2-42 min). Successful deployment was feasible in all (final pulmonary artery mean pressures, 20 +/- 4.6 mm Hg). Coils embolized in 14 (16%) patients (all retrieved). Complete occlusion occurred immediately in 63 patients (73%) and in 77 patients (89%) at 24 hr. Three patients had new gradients in the left pulmonary artery. Follow-up (62 patients; median duration, 13 months) revealed small residual Doppler flows in 11 patients (18%) at the most recent visit. Bioptome-assisted coil occlusion of moderate-large PDA in selected infants and small children is feasible with encouraging results.     

支架辅助GDC治疗颅内动脉瘤术中并发症的防治

目的 回顾总结血管内支架治疗颅内动脉瘤术中并发症，以提高使用血管内支架结合电解可脱卸弹簧圈(GDC)治疗颅内夹层及宽颈动脉瘤的安全性。方法 105例难治性动脉瘤，首先将冠脉支架跨动脉瘤颈放置，通过支架的网孔将微导管送入动脉瘤腔，填入GDC。结果 6例患者术中出现支架移位，1例发生动脉瘤破裂出血，1例发生大脑中动脉穿支出血，1例发生支架塌陷，1例发生颈内动脉夹层动脉瘤，1例弹簧圈突入小脑后下动脉(PICA)起始部，10例发生血管痉挛，经对症处理，预后良好。结论 在支架植入过程中，联合采用多种措施可减少并发症的发生；支架和GDC联合应用治疗颅内夹层及宽颈动脉瘤安全、有效。     

Electromagnetic perspective on the operation of RF coils at 1.5-11.7 Tesla.

In this work experimental and numerical studies of the MR signal were performed at frequencies ranging from 64 MHz to 485 MHz, utilizing three different MRI coils: a single-strut transverse electromagnetic (TEM)-based coil, a TEM resonator, and a high-pass birdcage coil. The experimental analyses were conducted using 1.5 and 8 Tesla whole-body systems and volume RF head coils. The simulation data were obtained utilizing an in-house-developed finite difference time domain (FDTD) model. Pertinent data from the numerical and experimental setups were compared, and a remarkable agreement between the two methods was found that clearly demonstrates the effectiveness of the FDTD method when it is applied rigorously. The numerical and experimental studies demonstrate the complexity of the electromagnetic (EM) fields and their role in the MR signal. These studies also reveal unique similarities and differences between the transmit and receive field distributions at various field strengths. Finally, for ultra high-field operations, it was demonstrated mathematically, numerically, and experimentally that highly asymmetric inhomogeneous images can be acquired even for linear excitation, symmetrical load geometries, and symmetrical load positioning within the coil.     

电解可脱弹簧圈栓塞治疗颅内动脉瘤

目的:分析应用电解可脱卸弹簧圈(GDC)栓塞治疗颅内动脉瘤的临床效果。方法:6例因蛛网膜下腔出血或其他神经系统症状的病人。经CT或(和)MR以及DSA检查证实为颅内动脉瘤。其中左侧后交通动脉3例,右侧后交通动脉1例,前交通动脉1例,C2段1例。瘤体直径在5～20mm之间。在神经安定+局麻下行动脉瘤栓塞术。先作载瘤动脉造影,明确动脉瘤的大小、形状、体/颈比以及与载瘤动脉的关系。再将微导管和微导丝塑形为相应的形状后经指引导管送至动脉瘤腔中部,选择合适的GDC进行填塞,直至致密填塞。结果:全部病人均一次性栓塞治疗成功,技术成功率为100%。栓塞后即刻行脑血管造影显示动脉瘤腔填塞满意,填充程度均在95%以上。全部病人均无再次出血和并发症产生。结论:经皮穿刺GDC栓塞术是颅内动脉瘤安全、有效和微创的治疗手段。     

颈内动脉海绵窦瘘的栓塞治疗

目的　进一步探讨颈内动脉海绵窦瘘 (CCF)血管内栓塞治疗的方法及临床价值。方法　在DSA监视下 ,采用法国Balt公司的同轴可脱性球囊技术 ,对 12例CCF患者进行了可脱性球囊栓塞治疗。结果　一次完全性地栓塞了颈内动脉瘘口 ,又保持了颈内动脉通畅 ,大脑前、中动脉显示清晰者 11例 ,占 92 % ;术后临床症状和体征完全消失。结论　采用可脱性球囊血管内栓塞是治疗CCF的最好方法 ,其操作简单 ,安全可靠 ,疗效好 ,值得进一步推广。     

Varicocele embolization: Anatomical variations of the left internal spermatic vein and endovascular treatment with different types of coils

Purpose

To present anatomical variations of left internal spermatic vein and a comparison between treatments with hydrogel-coated and non-coated platinum coils in patients with varicocele.