血管内支架结合电解可脱卸弹簧圈治疗宽颈后交通动脉瘤

目的：总结血管内支架结合电解可脱卸弹簧圈（Guglielmi detachable coil,GDC)治疗宽颈后交通动脉瘤的临床体会，对其指征、操作要点及主要并发症进行初步探讨。方法：24例宽颈后交通动脉瘤，植入球囊膨胀型网孔冠脉支架覆盖动脉瘤颈，再将微导通过支架网孔超选进入动脉瘤腔内行GDC填塞。结果：完全填塞19例，90％以上填塞3例，60％－70％填塞2例，载瘤动脉通畅，平均随访6．8个月，所有患未出现神经功能障碍。结论：血管内支架结合GDC是治疗宽颈后交通动脉瘤的有效方法，长期疗效有待进一步随访。     

球囊辅助瘤颈成形术治疗颅内宽颈动脉瘤

目的　总结球囊辅助瘤颈成形术在颅内宽颈动脉瘤治疗中应用的临床体会。方法　采用球囊辅助瘤颈成形术对 18例患者 2 0个颅内宽颈动脉瘤进行栓塞治疗 ,先将微导管超选入动脉瘤内 ,再将不可脱卸球囊于动脉瘤颈处充盈覆盖瘤颈 ,电解可脱卸弹簧圈 (GDC)填塞动脉瘤。结果　 17个动脉瘤治疗成功 ,完全填塞的动脉瘤 12个 ,次全填塞 (>90 % ) 4个 ,不完全填塞 (<90 % ) 1个 ,载瘤动脉均保持通畅 ,平均随访 9.4个月 ,临床效果优良。结论　采用球囊辅助瘤颈成形术治疗颅内宽颈动脉瘤是安全、有效的方法     

Comparison of Long-Term Angiographic Results of Wide-Necked Intracranial Aneurysms : Endovascular Treatment with Single-Microcatheter Coiling,Double-Microcatheter Coiling,and Stent-Assisted Coiling

ObjectiveEndovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups. MethodsBetween January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with single-microcatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively. ResultsClinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01). ConclusionLong-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.     

夹闭术与血管内治疗破裂性宽颈动脉瘤的比较

Objective To analyze the clinical efficacy of clipping and endovascular treatment for ruptured wide-necked aneurysm Methods 143 patients with ruptured wide- necked aneurysm were treated by clipping ( n =83) or endovascular treatment ( n =60). Their complication rates、recurrence rates and modified Rankin scale scores at six months after leaving hospital were evaluated. Results The complication rate in endovasular treatment group was less than that in clipping group( P ＜ 0.05) significantly. The recurrence rate in clipping group was less than that in endovasular treatment group( P ＜ 0. 05) significantly. The modified Rankin scale in endovasular embolization group was less than that in clipping group( P ＜ 0. 05) significantly. Higher recurrence rate and lower complication rate were observed in endovasular treatment group. Patients with endovascular treatment had better prognosis. Conclusion Endovascular treatment for ruptured wide - necked aneurysm is efficient and safe. Better quality of life could be achieved.     

支架辅助栓塞大脑前动脉A1段微小动脉瘤

目的探讨支架辅助大脑前动脉A1段微小宽颈动脉瘤(动脉瘤最长径≤3mm,且动脉瘤颈/瘤体宽径比≥3/4)血管内治疗的可行性及效果。方法回顾分析Neuroform支架辅助栓塞10例12个大脑前动脉A1段微小宽颈动脉瘤的临床影像、血管内治疗和随访资料。结果 10例病人均在成功植入Neuroform支架后行动脉瘤栓塞,其中致密栓塞7例,3例90%栓塞,所有患者均随访6～24月无再出血,4例术后3～6月行CTA复查,6例于术后6～12月复查血管造影,未见再生长。结论大脑前动脉A1段宽颈微小动脉瘤的血管内治疗,技术上可行,操作相对安全,有效。     

夹闭术与血管内治疗破裂性宽颈动脉瘤的比较

Objective To analyze the clinical efficacy of clipping and endovascular treatment for ruptured wide-necked aneurysm Methods 143 patients with ruptured wide- necked aneurysm were treated by clipping ( n =83) or endovascular treatment ( n =60). Their complication rates、recurrence rates and modified Rankin scale scores at six months after leaving hospital were evaluated. Results The complication rate in endovasular treatment group was less than that in clipping group( P ＜ 0.05) significantly. The recurrence rate in clipping group was less than that in endovasular treatment group( P ＜ 0. 05) significantly. The modified Rankin scale in endovasular embolization group was less than that in clipping group( P ＜ 0. 05) significantly. Higher recurrence rate and lower complication rate were observed in endovasular treatment group. Patients with endovascular treatment had better prognosis. Conclusion Endovascular treatment for ruptured wide - necked aneurysm is efficient and safe. Better quality of life could be achieved.     

颅内宽颈动脉瘤介入治疗技术探讨（附27例报告）

目的探讨颅内宽颈动脉瘤介入治疗的有效方法。方法回顾分析近4年来,应用三维弹簧圈、球囊及支架辅助等介入治疗颅内宽颈动脉瘤27例的临床资料。结果1例球囊辅助弹簧圈栓塞的患者死亡,其余患者栓塞效果满意,康复良好,随访未见动脉瘤复发。结论先前难以治疗的颅内宽颈动脉瘤,经综合应用介入治疗方法均能得到较好的救治,介入治疗方法临床应用前景良好。     

血管内支架结合微弹簧圈栓塞颅内宽颈动脉瘤

目的　探讨和总结应用血管内支架结合弹簧圈技术治疗颅内宽颈动脉瘤的技术。方法　回顾性分析 16例颅内宽颈动脉瘤 ,瘤颈 /瘤体比为 0 5～ 1∶1,均采用血管内支架结合弹簧圈技术治疗。结果　 16例血管内支架结合弹簧圈技术治疗的动脉瘤 ,12例完全栓塞 ,4例大部 (>95 % )栓塞。有 7例随访 6个月～ 1年 ,有 1例出现动脉瘤复发。 1例术后出现一过性脑缺血的表现。结论　在栓塞宽颈颅内动脉瘤时应用血管内支架结合弹簧圈技术 ,可避免弹簧圈突入载瘤动脉 ,提高了宽颈颅内动脉瘤的疗效     

CT angiography for assessment of intracranial basilar apex aneurysm neck diameter reduction poststenting for treatment planning

Background and Purpose : Once a contraindication for a neuro‐interventional therapeutic approach, some wide‐necked aneurysms can now be treated with stent assistance. Radiologically assessing the impact of a stent on the neck of a wide‐neck bifurcation, aneurysm remains a challenge however. Methods : A 76‐year‐old female with a large irregular basilar apex aneurysm was referred for endovascular treatment. Angiographic imaging revealed a basilar apex aneurysm with a 6‐mm neck and a 14‐mm dome. The decision was made to perform staged stent‐assisted coiling of the aneurysm. In the interim time, although the stent was allowed to heal in place, a CTA was done to assess the positioning of the stent and the degree of neck narrowing. Results : The CTA showed that the neck had been narrowed from 6 to 2 mm hence making endovascular coiling feasible. Conclusion : Our case illustrates the use of CTA poststent deployment to visualize the change in aneurysm neck caliber precoil embolization. © 2009 Wiley‐Liss, Inc.