Endovascular treatment of wide-necked aneurysms by using two microcatheters: techniques and outcomes in 25 patients.
Endovascular treatment of wide-necked aneurysms by using two microcatheters: techniques and outcomes in 25 patients.
复制标题
使用两根微导管对宽颈动脉瘤进行血管内治疗：25 名患者的技术和结果。
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
M. Han
中科院分区：
文献类型：
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作者：
O. Kwon;Seong Hyun Kim;B. Kwon;Hyun;J. H. Kim;C. Oh;M. Han
背景和目的
血管内闭塞具有不利构型的动脉瘤（例如宽颈和来自基底的重要分支）仍然是一项技术挑战。本研究的目的是评价使用两种微导管治疗复杂动脉瘤的影像学和临床结果。
方法
从2001年8月至2004年2月，使用两种微导管治疗了25例患者的25个动脉瘤。14名患者出现蛛网膜下腔出血（SAH），11名患者有未破裂的动脉瘤。动脉瘤位于基底动脉顶部（7个）、大脑中动脉分叉（4个）、后交通动脉（4个）、前交通动脉（3个）、小脑上级动脉（2个）、眼动脉（2个），海绵窦颈内动脉（伊卡）、颈内动脉背侧和基底中动脉各1个动脉瘤。16个动脉瘤（64%）的宽度等于或大于高度。在19例（76%）中，重要分支起源于动脉瘤基底，有些甚至与动脉瘤基底合并。平均瘤顶（高度）-瘤颈比为1.23 +/- 0.37（范围：0.65-2.33），19个动脉瘤（76%）大于或等于1.0。
结果
所有动脉瘤均成功栓塞。栓塞后即刻血管造影显示8个动脉瘤（32%）无残留造影剂填充，16个动脉瘤有一定程度的残留造影剂填充。然而，在16个不完全闭塞的动脉瘤中，有12个动脉瘤残留物被故意留下以保留重要分支。发生了2例并发症，包括1例血栓栓塞和1例弹簧圈突出，但均成功解决，未产生临床症状。除1例患者外，所有患者均表现出良好的临床结局。1例患者显示中度认知功能障碍。随访期间，未发生新的出血。
结论
我们对25例脑动脉瘤患者的经验表明，使用两种微导管的技术对于具有不利构型的动脉瘤的弹簧圈栓塞是可行和安全的。尽管缺乏血管造影随访使我们无法得出与其他技术（如支架置入和球囊颈保护）相比其有效性的结论，但我们认为该技术为复杂动脉瘤的血管内治疗提供了可靠的替代方案。
BACKGROUND AND PURPOSE
The endovascular occlusion of aneurysms with unfavorable configurations such as a broad neck and an important branch from the fundus remains a technical challenge. The purpose of this study was to evaluate the radiologic and clinical results of complicated aneurysm treatment by using two microcatheters.
METHODS
Twenty-five aneurysms in 25 patients were treated by using two microcatheters, from August 2001 to February 2004. Fourteen patients presented with a subarachnoid hemorrhage (SAH) and 11 had unruptured aneurysms. The aneurysms were of the basilar top (7), middle cerebral artery bifurcation (4), posterior communicating artery (4), anterior communicating artery (3), superior cerebellar artery (2), ophthalmic artery (2), and one aneurysm of each of cavernous internal carotid artery (ICA), dorsal ICA, and midbasilar artery. In 16 aneurysms (64%), the width of the aneurysm was the same or longer than the height. In 19 (76%), important branches arose from the aneurysm base, and some were even incorporated with the aneurysm fundus. The mean dome (height)-to-neck ratio was 1.23 +/- 0.37 (range, 0.65-2.33), and this was greater than or equal to 1.0 in 19 aneurysms (76%).
RESULTS
All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in eight aneurysms (32%), and some residual contrast filling in 16. The aneurysm remnants, however, were intentionally left to preserve important branches in 12 of the 16 aneurysms with incomplete occlusion. Two complications occurred, including one thromboembolic and one coil protrusion, but they were successfully resolved and produced no clinical symptoms. All patients except one showed excellent clinical outcomes. One patient revealed moderate cognitive dysfunction. During the follow-up period, no new bleeding occurred.
CONCLUSION
Our experience with 25 cerebral aneurysm patients shows that the technique of using two microcatheters is feasible and safe for coil embolization of aneurysms with unfavorable configurations. Although the lack of angiographic follow-up prevents us from drawing conclusions about its effectiveness as compared with other techniques such as stent placement and balloon-neck protection, we believe that this technique offers a reliable alternative for endovascular therapy of complicated aneurysms.
电可脱线圈颅内动脉瘤的血管内闭塞：动脉瘤颈大小与治疗结果的相关性。
DOI：
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发表时间：
1994
期刊：
AJNR. American journal of neuroradiology
影响因子：
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作者：
FernandezZubillaga,A;Guglielmi,G;Viñuela,F;Duckwiler,GR
通讯作者：
Duckwiler,GR