Stent-assisted coiling of intracranial carotid ophthalmic segment aneurysm segment aneurysms:Long-term follow-up from a single center

Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up of a large patient cohort.Methods:We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 at our center.Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale.The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up.The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone.Results:We enrolled 88 patients with 99 OSAs treated with coiling,of whom 76 were treated with SAC.The coiling procedures were successful in all 88 patients.Overall,complications occurred in 8 patients(9.1%).No procedure-related mortality was observed.67(76.1%)experienced immediate aneurysm occlusion at the end of the procedure.Long-term angiographic follow-up(18 months)was available in 45/88 aneurysms(51%)(average 18.7±5.2 months).Four patients continued their follow-up for 5 years after initial aneurysm treatment.After a clinical follow-up time of 28.7 months(range,12-51 months),85 patients(95.5%)achieved favorable clinical outcomes(mRS scores of 0-2).Conclusions:This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs.The procedural risks are low with relatively long-term effectiveness.

Mechanical compression management of the right middle cerebral artery inferior trunk using a stent during coil embolization of middle cerebral artery aneurysms:A case report and literature review

Endovascular coil embolization is a minimally invasive,rapid,and effective method for the treatment of intracranial aneurysms.However,complications associated with coil embolization,such as intraoperative aneurysm rupture or arterial occlusion,should be promptly managed during the procedure to avoid catastrophic consequences.This study presents a case of mechanical compression management of the right middle cerebral artery(MCA)inferior trunk during coil embolization for bilateral MCA aneurysms.The inferior trunk of the right MCA was abruptly occluded due to mechanical compression during coil embolization of the right MCA bifurcation aneurysm.A Solitaire AB stent(4×20 mm,Covidien/Medtronic,Dublin,Ireland)was implanted in the inferior trunk of the right MCA after tirofiban was injected via a microcatheter,and the right inferior trunk was recanalized.The patient also underwent coil embolization of the left MCA bifurcation aneurysm,without any complications.It is crucial to recognize compressive occlusion of adjacent aneurysm branches to avoid severe complications during intracranial aneurysm embolization.Stent placement is a rescue treatment option for recanalization of an occluded artery.

INITIAL COMPARISON OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH MECHANICAL DETACHABLE SPIRALS AND WITH GUGLIELMI DETACHABLE COILS

Objective.To compare the embolization effects of intracranial aneurysms with mechanical detachable spirals(MDS) and with Guglielmi detachable coils(GDC).Methods.One hundred and twenty cases with 125 intracranial aneurysms were embolized in Beijing Hospital from March 1995 to July 1999.Sixty-six aneursms in 64 cases were embolized with MDS,51 in 48 with GDC, and 8 in 8 with both MDS and GDC.Clinical data includng sex,age,subarachnoid hemorrhage(SAH),Hunt & Hess grading,diameter and neck width of aneurysms,number and length of coils used per aneurysm,occlusive radio,and complications were compared between MDS and groups.Results.MDS and GDC groups were comparable(t-test or X^2 -test ,all P value>0.10） in terms of age,sex,diameter of aneurysms[(8.46±3.42)mm vs.(7.38±3.45)mm],neck width[(3.49±1.50)mm vs.（3.26±1.52)mm],coils number [(4.65±3.01)vs.(4.24±2.65)] and their length[(460.2±398.5)mm vs.(422.9±387.1)mm] used per aneurysm,occlusive ratio in aneurysms embolized≥80%[(95.00±6.32%)vs.(94.19%±7.63%)],mortality and permanent complications(7.8% vs.4.25）。Couclusions,MDS and GDC are all materials for embolization of intracranial aneurysms.MDS is less expensive,but more difficult to control and of propensity to complications while GDC is more compliant ,easier to be used,safer,and have many alternative types for use as well as more extensive indications.

Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation:A case report

Embolization of collateral veins is often treated with rigid coils(Gianturco and interlocking detachable coils type).However,when dealing with tortuous and dilated collateral veins,there is a high risk for technical failure and coil migration due to inflexibility of the coils.To safely and successfully solve this problem,Guglielmi detachable coils(GDC) can be used for embolization.Their flexibility allows for easy navigation in tortuous veins,low risk of unintended coil release or coil migration,and safe deployment.A 12-year-old girl with a single ventricle had severe cyanosis and a low exercise tolerance 5 years after Fontan procedure.The symp-toms were caused by a tortuous and dilated collateral from the left phrenic vein into the left pulmonary vein,forming a right-to-left shunt.The collateral,which had a large diameter and high flow,and therefore a high risk of coil migration,was successfully embolized with 8 GDC.There were no complications such as coil migration or cerebral infarction.Transcatheter embolization increased her systemic oxygen saturation from 81%-84% to 94%-95%,and increased her ability to exercise.The embolization procedure using flexible GDC was low risk compared with other rigid coil embolization techniques when performing embolization of tortuous and dilated collateral veins.

Central retinal artery occlusion after endovascular coil embolization for internal carotid artery aneurysm

Dear Editor,We are writing this letter to report an unexpected rare caseofcentralretinalarteryocclusion(CRAO)happened after stent-assisted coiling for internal carotid artery(ICA)aneurysm in a female patient.CRAO is a devastating ocular emergency with poor visual prognosis and no universal acceptedtreatmentatpresent.CRAOisusuallyassociated witharterialhypertension,diabetesmellitus,renaldisease.

Amplatzer Plugs versus Coil Embolization of the Hypogastric Artery Prior to Endovascular Aortic Aneurysm Repair: Differences in Quality of Life

Purpose: To determine if there were differences in quality of life (QOL) within the first year following EVAR for patients undergoing internal iliac embolization depending on the type of device used. Methods: Patients who underwent endovascular AAA repair were identified using a Vascular surgery database at a tertiary care center from 2002-2008. The Radiology Information System and Image Viewer were then used to identify patients who underwent preprocedural embolization prior to endovascular aneurysm repair. Nine patients had embolization with nester coils, 9 had embolization with the amplatzer vascular plug, a type of nitinol based self expanding device. Another group of 8 patients who did not undergo preprocedural embolization was used as a comparator group. These patients were contacted via telephone and answered questions regarding QOL post procedure. The Australian Vascular QOL was the tool used to measure QOL. Differences in QOL were tabulated between the groups of patients. Results: Of the 9 patients who underwent embolization with amplatzer plug, the median QOL score was 60 (p value 0.575), the median QOL for the nester coil group was 52.5 and the comparator group was 58. Separate analysis was done dividing patients into two groups, with and without comorbidities without statistical significance. Conclusion: Patients who underwent preprocedural embolization using amplatzer plugs compared to coils had higher overall QOL scores although the difference was not significant.

Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report

BACKGROUND Most intrahepatic arterioportal fistulae(IAPF)are acquired.The few cases of congenital fistulae are diagnosed in infants and children.CASE SUMMARY We report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child.The patient had a 20-year history of abdominal distention and nausea.IAPF,along with splenomegaly and ascites,was found by Doppler sonography and confirmed by computed tomography angiography.The patient was treated with endovascular coil embolization,resulting in occlusion of the fistula.CONCLUSION This was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.

Unruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery Treated by Coil Embolization: A Case Report

Aneurysm at the origin of a duplication of the middle cerebral artery (DMCA) is very rare, and only 29 treated cases have been reported. All of the cases were treated by direct surgery except a ruptured case treated by intentional partial coil embolization. We report the first unruptured case treated by coil embolization and review the previously published cases. Coil embolization can be alternative treatment for an unruptured aneurysm at the origin of the DMCA. Stable framing to spare the origin of it and prevention of thromboembolic complications are keys for safe treatment.

Successful coil embolization with a basic technique for ruptured posterior tibial artery in a patient with Ehlers-Danlos syndrome type IV: A case report

The surgical management of vascular complication with Ehlers-Danlos Syndrome type IV (EDS-IV) is extremely challenging because of its tissue or organ fragility including arteries. Less traumatic maneuvers and devices have been recommended to perform the endovascular treatment for the vascular lesion of EDS-IV, although the endovascular procedure is less invasive than surgical intervention. We report a 23-year-old man with EDS-IV suffered from left posterior tibial arterial rupture. We performed internal trapping of the ruptured segment using detachable coils with a standard technique via the contralateral femoral artery puncture. The patient was discharged without any complication associated with the endovascular procedure. Embolization by a basic technique, performed with greatest care, is a safe and useful treatment option which we radiologists should try for managing EDS-IV patients.

Endovascular coil embolization of parent artery for giant intracranial basilar dissection:a case report and literature review

Objective The purpose of the current study was to evaluate the method and result of endovascular treatment for a giant unruptured dissection of the basilar artery (BA) . Methods A 14-year-old boy underwent computed tomography (CT) scan following a minor head trauma was incidentally found a lesion located

PED+Coils与单纯PED治疗颅内复杂动脉瘤术后并发症的护理

目的探讨PED+Coils与单纯PED治疗颅内复杂动脉瘤并发症的护理。方法回顾性分析本中心连续使用PED治疗35例患者的临床资料,根据2组患者围术期并发症情况,有针对性地采取相应的护理方案,包括脑缺血的护理、脑出血的护理、神经功能障碍的护理、心理护理、专业的出院指导及延续性护理在随访中的应用等。结果 35例患者中,PED+Coils组15例,单纯PED组21例。手术成功率100%。共使用PED 40枚,支架开放不良5例,其中PED+Coils组4例,单纯PED组1例。缺血性并发症4例(11.4%),其中PED+Coils组1例(6.7%),单纯PED组3例(14.2%),均为轻微脑梗死。PED+Coils组出血性并发症1例,为导丝操作相关性,右侧肌力0级。经相关护理和康复指导,除1例永久致残性并发症患者外,其余患者无遗留神经功能缺失。1例永久致残性并发症患者给予专业的康复训练,出院时左侧上肢肌力3级,左下肢肌力4^-级。结论专业的护理是保证患者并发症预后的关键。

Total splenic artery embolization for splenic artery aneurysms in patients with normal spleen

AIM:To evaluate total embolization of the main splenic artery in patients with splenic artery aneurysms(SAAs)and normal spleen.METHODS:Thirty-five consecutive patients with SAAs were referred for treatment with coil embolization.Patients were classified into two groups:coil embolization of the main splenic artery with complete occlusion of the artery and aneurysms(group A,n=16),and coil embolization of the aneurysmal sac with patency of the splenic artery(group B,n=19).Data on white blood cell(WBC)and platelet counts,liver function,and complications were collected on days 7 and 30,and subsequently at a 6-mo interval postoperatively.Abdominal computed tomography was routinely performed to calculate the splenic volume before and 1 mo after the procedure,and subsequently every 6 mo during follow-up.RESULTS:Coil embolization of the SAAs was technically successful in all 35 patients,with no procedurerelated complications.The post-embolization syndrome,including abdominal pain,fever and vomiting,occurred in six patients(37.5%)in group A and three patients in group B(15.8%).There were no significant differences in WBC and platelet counts between preoperatively and at each follow-up point after the procedures.There were also no significant differences in average WBC and platelet counts between the two groups at each follow-up point.There were significant differences in splenic volume in group A between preoperatively and at each follow-up point,and there were also significant differences in splenic volume between the two groups at each follow-up point.CONCLUSION:Total embolization of the main splenic artery was a safe and feasible procedure for patients with SAAs and normal spleen.

Total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism

AIM:To study the safety and feasibility of total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.METHODS:Fifteen consecutive patients with hypersplenism due to cirrhosis were enrolled in this study from January 2006 to June 2010.All patients underwent total embolization of the main splenic artery.Clinical symptoms,white blood cell(WBC) and platelet(PLT) counts,splenic volume,and complications of the patients were recorded.The patients were followed up for 1 and 6 mo,and 1,2,3 years,respectively,after operation.RESULTS:Total embolization of the main splenic artery was technically successful in all patients.Minor complications occurred in 13 patients after the procedure,but no major complications were found.The WBC andPLT counts were significantly higher and the residual splenic volume was significantly lower 1 and 6 mo,and 1,2,3 years after the procedure than before the procedure(P < 0.01).Moreover,the residual splenic volume increased very slowly with the time after embolization.All patients were alive during the follow-up period.CONCLUSION:Total embolization of the main splenic artery is a safe and feasible procedure and may serve as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.

Regenerative material for aneurysm embolizationA 3-dimensional culture system of fibroblasts and calcium alginate gel

Calcium alginate gel（CAG） has been shown to successfully model aneurysm embolization within a short period of time.However,gradually degrading CAG potentially results in aneurysm recanaliza-tion.In the present study,a regenerative embolic material was designed by seeding rat fibroblasts in a CAG.The study investigated the feasibility of constructing a 3-dimensional culture system.The fibroblasts grew well and firmly attached to the CAG.CAG was conducive for fibroblast growth,and resulted in a 3-dimensional culture system.Results show that CAG can be used theoretically as a vascular,regenerative,embolic material.

COMPARISON OF CELLULOSE ACETATE POLYMER AND ELECTROLYTIC DETACHABLE COILS FOR TREATMENT OF CANINE ANEURYSMAL MODELS

Electrolytic detachable coils (EDC) have been the main embolic materi als for intracranial aneurysms. Liquid aneurysmal embolic materials represented by cellulose acetate polymer (CAP) are still in controversy. In this research, t he embolization results and pathological reactions after embolization of canine aneurysmal models with EDC or CAP were observed and compared. Methods. The canine aneurysmal models constructed by anastomosis of venous pouch es were randomly grouped. The aneurysms were respectively occluded with CAP and electrolytic detachable coils that was named by Wu electrolytic detachable coil (WEDC) and made by us. Angiogram follow ups were performed at 24 hour, 2 week , and 2 month after embolization. The occluded aneurysms were dissected in each stage for light microscopic, electron microscopic, and histochemical research. Results. The effect of embolization was significantly better with WEDC than that with CAP . Post embolized complications such as aneurysm rupture and stenosis of parent arteries could only be found in CAP group. Pathol ogical research showed that CAP mass could packed the aneurysms more densely tha n coils. Acute chemical damage of aneurysmal wall and inflammatory cell infiltra tion was prominently found in early stage after CAP embolization. Organization of thrombus inside aneurysms and formation of endothelial tissue over the orific es of aneurysmal necks could be found in both groups 2 months after embolization . But parts of coils might be exposed outside endothelial layer. Conclusions. EDC are still the most safe, efficient, and reliable instruments to embolize aneurysm. CAP should be improved further to solve the problem of stron g chemical corrosion and difficulty in control before it is widely used.

超早期介入栓塞破裂颅内动脉瘤治疗体会

目的 研究在破裂出血急性期的颅内动脉瘤患者中,超早期(24 h内)采取介入栓塞治疗的临床疗效。方法 回顾性分析安徽医科大学附属滁州医院(滁州市第一人民医院)神经外科2020年4月—2022年7月收治的51例急诊破裂颅内动脉瘤患者,所有患者均在24 h内采取介入栓塞治疗,对患者临床资料、治疗效果、术后并发症等情况进行总结。结合Raymond分级标准,对术中及术后栓塞情况进行分析,以格拉斯哥预后评分(GOS)为基础,对患者预后情况进行评估。结果 所有患者介入栓塞手术均成功完成,其中RaymondⅠ级栓塞35例,Ⅱ级及Ⅲ级栓塞分别有10例、6例,其中动脉瘤术中破裂3例,予以快速填塞弹簧圈等急救措施后完全栓塞;4例患者发生血栓事件,给予替罗非班溶栓等措施后血流恢复。患者预后情况用GOS评分进行评估,其中良好、轻度残疾、重度残疾、死亡患者数量分别为36例、8例、4例、3例,死亡率为5.88%,总体预后良好。结论 急诊超早期对破裂的颅内动脉瘤患者采取栓塞方法治疗,可以减少动脉瘤二次破裂出血的机会,提高患者生存率及生存质量。

颌骨骨内动静脉畸形介入栓塞治疗远期疗效分析

目的 :探讨通过介入栓塞方式治疗颌骨骨内动静脉畸形的有效性和安全性。方法 :回顾分析就诊于上海交通大学医学院附属第九人民医院的颌骨骨内动静脉畸形患者9例,在DSA引导下予以介入栓塞治疗,通过DSA观察病变范围、预测硬化剂注射剂量以使药物注射入病变腔内,并对患者疗效、不良反应和并发症进行长期随访观察。结果:9例患者中,男6例(66.7%),女3例(33.3%);年龄7~51岁,平均21.3岁。出血是患者最主要的报告症状(6例,66.7%);供血动脉包括下牙槽动脉、面动脉以及上颌动脉分支。9例患者均于全麻下接受介入栓塞治疗,共治疗20次(每例患者接受1~5次,平均2.2次/例)。无水乙醇单次平均用量为21.95 mL。20次介入栓塞治疗中,9次应用弹簧圈辅助无水乙醇栓塞治疗,共使用158枚弹簧圈,平均17.6枚/次(80枚/9次)。另有2次使用博来霉素,5次使用少量150μm PVA颗粒辅助栓塞治疗。9例患者随访时间5~11年,其中,4例治愈,3例基本治愈,2例好转,治疗有效率为100%。结论:在颌骨骨内动静脉畸形治疗中,根据临床及影像学表现正确诊断、根据DSA造影结果采用以无水乙醇为主介入栓塞方案,可减少创伤、改善症状、控制病灶,获得相对满意的治疗效果,该方案安全、有效。

血管内治疗小脑后下动脉瘤24例临床经验

目的 探讨血管内治疗小脑后下动脉(PICA)瘤的治疗策略、安全性及临床疗效。方法 回顾性分析安徽医科大学第一附属医院2017年7月至2022年1月行血管内治疗的24例PICA动脉瘤病人的临床资料(其中,PICA近端13例、过渡段1例、远端10例;以蛛网膜下腔出血首诊的21例、未破裂动脉瘤3例),单纯栓塞12例、动脉瘤及载瘤动脉闭塞7例(闭塞材料使用弹簧圈3例、Onyx胶4例)、支架辅助弹簧圈栓塞5例。术后随访3~24个月。结果 24例PICA动脉瘤病人术中动脉瘤均栓塞顺利。23例病人无近期并发症,1例出血病人合并严重脑血管痉挛自动出院(临床预估死亡)。随访结果:19病人远期随访无复发;4例复发,其中2例二期行支架辅助栓塞,后期随访良好、未再复发;1例首次支架辅助栓塞病人再次行穿支架网孔弹簧圈单纯栓塞,后期随访良好、未再复发;1例首次单纯栓塞病人再次行弹簧圈栓塞,后期随访良好、未再复发。结论 血管内治疗PICA动脉瘤安全、可行,疗效可靠。根据动脉瘤血管解剖位置,对于破裂出血的PICA动脉瘤首次治疗倾向单纯栓塞或载瘤动脉闭塞术。首次单栓病例术后复发,可二期行支架辅助栓塞能取得满意效果。对于复发动脉瘤经再次血管内治疗可获得满意效果。

Neuroform Atlas支架在宽颈颅内动脉瘤的应用价值

目的探讨颅内宽颈动脉瘤栓塞治疗中Neuroform Atlas支架的临床应用价值。方法回顾性分析52例宽颈动脉瘤患者的临床资料,均在Neuroform Atlas支架的辅助下成功完成介入栓塞手术治疗。采用Raymond Roy分级评估动脉瘤栓塞情况,改良Rankin量表(Modified Rankin Scale,mRS)评分评估患者预后,对术后并发症与动脉瘤复发进行总结结果在52例宽颈动脉瘤患者中,动脉瘤位于大脑中动脉6例,前交通动脉14例,后交通动脉22例,大脑前动脉2例,基底动脉尖2例,椎动脉V4段2例,眼动脉段4例。40例破裂动脉瘤,12例未破裂动脉瘤。术后脑梗死2例,脑梗死合并出血2例,围手术期未见其他明显的介入相关并发症。术后即刻造影显示动脉瘤完全闭塞40例、瘤颈残留6例、瘤体小部分残瘤6例;随访6~12个月,动脉瘤完全闭塞46例,瘤颈残留4例,瘤体小部分残留2例。mRS评分在出院时:0分38例,1分10例,2分2例,3分2例;随访6~12个月,mRS评分0分46例,1分4例,2分2例。结论宽颈动脉瘤患者使用Neuroform Atlas支架辅助弹簧圈栓塞,具有手术成功率高、并发症低等优点,但需进一步跟踪观察其远期效果。

血管内弹簧圈栓塞术后不同MRRC分级颅内动脉瘤患者近期及远期疗效的比较

目的比较血管内弹簧圈栓塞术后不同改良的Raymond-Roy分级(MRRC)颅内动脉瘤患者近期及远期疗效。方法纳入接受血管内弹簧圈栓塞术的颅内动脉瘤患者248例,按术后MRRC分级分为Ⅰ级、Ⅱ级、Ⅲa级和Ⅲb级,比较各组近期及远期疗效。结果各组瘤体直径、瘤颈长度、动脉瘤位置、术前Hunt-Hess分级、手术方法和手术时长比较,差异均无显著性(P>0.05)。随MRRC分级提高,各组患者近期疗效改善率逐渐提高,恶化率逐渐降低(P<0.05)。248例患者中有53例出现复发,复发率为21.37%,MRRC分级Ⅰ、Ⅱ级患者远期复发率明显低于Ⅲa级和Ⅲb级患者(P<0.05)。结论随MRRC分级提高,颅内动脉瘤患者近期疗效逐渐提高,远期复发率逐渐提高。