微导管辅助三维弹簧圈技术栓塞宽颈基底动脉顶端动脉瘤

Microcatheter assistant three-dimensional Guglielmi detachable coil basket technique for embolizationof a wide-necked basilar tip aneurysm: technique note

目的探讨颅内宽颈动脉瘤血管内治疗的方法。方法采用微导管辅助三维弹簧圈技术对1例男性55岁脑动静脉畸形(AVM)伴发基底动脉顶端宽颈动脉瘤病人行双侧股动脉入路,先将1条Prowler14微导管置于右侧大脑后动脉内以挡住瘤颈,随后将另1条Prowler10微导管置于动脉瘤内。先置入1个三维GDC,使其良好成篮,随后送入4枚GDC,完全致密填塞动脉瘤,最后用NBCA闭塞了50%的AVM。结果造影显示载瘤动脉通畅,术后病人神经功能完好无损。结论微导管辅助三维弹簧圈技术栓塞对于治疗某些宽颈动脉瘤是可行的方法。

Objective To discuss a technique note of embolization of a wide-necked basilar tip aneurysm. Methods A 55-year-old male cerebral arteriovenous malformation patient associated with a wide-necked basilar tip aneurysm was treated by microcatheter assistant three-dimensional Guglielmi detachable coil (3D-GDC) basket technique. After bilateral femoral arteries approaches were achieved, a Prowler 14 microcatheter was catheterized into the right posterior cerebral artery to bridge the aneurysm neck. Another Prowler 10 microcatheter was inserted into the aneurysm dome for coil packing. The first 3D-GDC was inserted into the aneurysm dome and forming a stable coil basket structure, another 4 GDC coils were packed into the aneurysm. After successfully densely packing of the aneurysm, the AVM were embolized with NBCA glue by microcatheter wedging technique via three pedicles and achieved 50% obliteration of the nidus. Results The angiogram revealed the totally obliteration of the aneurysm and patency of the parent artery. The post-embolization course was uneventful. The patient was neurologic intact and was discharged 4 days after endovascular therapy. Conclusion Microcatheter assistant 3D-GDC basket technique is a feasible method for embolization of some selective patients with wide-necked intracranial aneurysm.