应用新型球囊Hyperglide或Hyperform辅助弹簧圈技术栓塞治疗颅内宽颈动脉瘤(附22例分析)

New type of MTI balloon (Hyperglide or Hyperform) assisted coiling for intracranial wide-necked aneurysms:report of 22 cases

目的探讨采用新型MTI球囊重塑技术栓塞治疗颅内宽颈动脉瘤的可行性及有效性。方法总结22例26个宽颈动脉瘤的栓塞治疗经验。均采用新型球囊Hyperglide或Hyperform置于载瘤动脉处,同时将微导管置于动脉瘤内,充盈球囊以封闭瘤颈口后将合适的弹簧圈推送进入动脉瘤内,重复进行充盈球囊和填塞过程,直至动脉瘤致密填塞。结果19例23个动脉瘤成功填塞;1例前交通动脉瘤因血管迂曲致球囊不能到位而改用其他技术栓塞;另1例前交通动脉瘤因球囊选择不当,瘤颈封堵不完全,导致部分弹簧圈移位进入载瘤动脉;1例动脉瘤术中破裂出血,病人死亡。结论新型球囊重塑技术有助于达到宽颈动脉瘤致密、有效的栓塞。

Objective To evaluate the feasibility and efficacy of a newly MTI-balloon remodeling technique for treating intracranial wide-necked aneurysms. Methods The experience with embolization of 26 intracranial wide-necked aneurysms in 22 patients was retrospectively analyzed. In the procedure, a new compliant balloon （Hyperglide or Hyperform） was placed into the parent artery and inflated to occlude the neck of the aneurysm, while the tip of the microcatheter was introduced into the aneurysm, and then a proper coil was deposited. The balloon was then deflated to verify appropriate coil placement and stability, and finally the coils were detached. This process was repeated until the aneurysm was completely embolized. Results Twenty-three aneurysms in the 19 cases were embolized successfully. Of the 2 cases of anterior communicating artery wide-necked aneurysm in which the remodeling technique failed, 1 received 3D coil basket technique for the balloon cannot reach the target artery due to vessel tortuosity, in another one, the Hyperglide balloon inflation cannot completely occlude the neck of the aneurysm, resulting in the coil dislodging into the patent artery. One patient died from aneurysm rupture caused by over-rigid Hydrocoil during the procedure. Conclusion This newly balloon remodeling technique is effective for complete embolization of wide-necked aneurysms.