Safety and Effectiveness of Stent-Assisted Coil Embolization for Ruptured Intracranial Aneurysm

Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.

An unusual etiology of subarachnoid hemorrhage,basilar artery perforator aneurysms,in Macao:Three case reports and review of literature

BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.

Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management

BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms(RIAs)to determine the appropriate surgical treatment.AIM To assess the reliability of computed tomography angiography(CTA)in assessing different features of ruptured intracranial aneurysm and its impact on patient management.METHODS The final cohort of this study consisted of 146 patients with RIAs(75 male and 71 female)who underwent cerebral CTA.Their age ranged from 25 to 80,and the mean age±SD was 57±8.95 years.Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment.Inter-observer agreement was measured using kappa statistics.Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms(K=0.95,P=0.001),aneurysm location(K=0.98,P=0.001),and(K=0.98,P=0.001),morphology(K=0.92,P=0.001)and margins(K=0.95,P=0.001).There was an excellent interobserver agreement for the measurement of aneurysm size(K=0.89,P=0.001),neck(K=0.85,P=0.001),and dome-to-neck ratio(K=0.98,P=0.001).There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis(K=0.82,P=0.001),calcification(K=1.0,P=0.001),bony landmark(K=0.89,P=0.001)and branch incorporation(K=0.91,P=0.001)as well as perianeurysmal findings including vasospasm(K=0.91,P=0.001),perianeurysmal cyst(K=1.0,P=0.001)and associated vascular lesions(K=0.83,P=0.001).Based on imaging features,87 patients were recommended to have endovascular treatment,while surgery was recommended in 59 patients.71.2%of the study population underwent the recommended therapy.CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.

Ruptured venous aneurysm associated with a dural arteriovenous fistula:Two case reports

BACKGROUND In general,venous aneurysm associated with dural arteriovenous fistula(dAVF)is considered to be developed under long standing venous hypertension and manifested as venous ectasia of draining vein itself.However,discrete saccular shaped venous aneurysm without angiographic evidence of venous hypertension arising from the draining vein,like cerebral arterial aneurysm,is quite rare and its pathomechanism remains unclear in patients with dAVF.CASE SUMMARY In this report,we present two cases of ruptured saccular venous aneurysms associated with dAVF without venous hypertension or venous ectasia.In both cases,significant curve or stenosis is observed in draining vein,which is located in just distal portion of the venous aneurysms.These aneurysms were successfully treated with a transarterial embolization.Underlying mechanism of venous aneurysms in these cases is discussed.CONCLUSION Although there is little doubt that hemodynamic stress has a critical role in the development of venous aneurysms in patients with dAVF,preceding venous hypertension or venous ectasia is not necessary for development and enlargement of venous aneurysms.Considering the significant risk of rupture,a careful review of draining vein features including tortuosity or stenosis is needed,especially in venous aneurysms without evidence of venous hypertension.

The “Brain Stress Timing” phenomenon and other misinterpretations of randomized clinical trial on aneurysmal subarachnoid hemorrhage

Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.

Morphological characteristics associated with rupture risk of multiple intracranial aneurysms

Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study.Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter(PVD), aspect ratio(AR) and size ratio(SR) were evaluated using CT angiography.Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture.Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.Results: IAs located in the internal carotid artery(ICA) was associated with a negative risk of rupture, whereas AR, SR1(height/PVD) and SR2(depth/PVD) were associated with increased risk of rupture.When SR was calculated differently, the odds ratio values of these factors were also different.The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively.SR3(maximum size/PVD) was not associated with IAs rupture.Conclusions: IAs located in the ICA are associated with a negative risk of rupture, while high AR(>1.01), SR1(>1.48) or SR2(>1.40) are risk factors for multiple IAs rupture.

Spontaneous Disappearance of a Ruptured Intracranial Aneurysm

The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.

Statins as a Candidate of Drugs for Intracranial Aneurysm Treatment

The treatment for intracranial aneurysm (IA) is socially important because of poor outcome posed by subarachnoid hemorrhage after rupture. Further, the incidence of IAs in general public is high and, indeed, in developed countries many IAs are incidentally found through brain check. However, to date, options for treatment of IAs to prevent rupture are quite limited only to surgical procedures such as microsurgical clipping and endovascular coiling. Taking into account unavoidable risks of complication from surgical interventions and numerous aneurysm careers without treatment, less invasive medical therapies should be established. In human IA lesions, the presence of inflammatory responses, such as expressions of pro-inflammatory mediators and infiltration of inflammatory cells, have been reported, which suggests the involvement of inflammatory responses in the pathogenesis of IA. Recent experimental studies using rodent models have revealed the crucial role of inflammatory responses mediated by NF-κB activation in IA formation and progression and supported the notion that IA is an inflammatory disease affected intracranial arteries. To find out a candidate drug for IA treatments, the effect of several drugs with anti-inflammatory and anti-NF-κB actions on IA progression has been examined using rodent models and revealed the excellent inhibitory effect of statins (HMG-CoA reductase inhibitors) on IA progression. Based on these findings, the case-control study was recently carried out enrolling patients with unruptured or ruptured IAs to examine the effect of statin usage on rupture. This study revealed the significant differences in the ratio of statin usage between two groups and notably the remarkable reduction of risk of rupture of pre-existing IAs under statin usage at the adjusted odds ratio of 0.30. Recent laboratory and clinical studies make considerable achievement toward the future development of drugs for IA treatment and especially suggest the potential of statins as a candidate.

Clinical Efficacy of Shenmai Injection in the Treatment of Cerebral Vasospasm after Ruptured Aneurysm Surgery

Objective: To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. Methods: Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups. Results: There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (P > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. Conclusion: Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.

Simulation Analysis on the Rupture Trend of Intracranial Hemangioma

The rupture of intracranial aneurysm would lead to serious consequences, and different shapes of aneurysm have different effects on the rupture. In this paper, a mechanical analysis method is proposed for calculating the rupture trend of intracranial aneurysm based on three-dimensional image reconstruction and hemodynamic numerical calculation and evaluation. Firstly, the modeling of actual intracranial aneurysms was conducted based on CT intracranial aneurysm angiography plane images. Secondly, the model was simplified from the perspective of fluid mechanics analysis to establish the mechanical model of different forms of intracranial aneurysms. Then the flow mechanics characteristics of each model in rigid boundary and fluid-structure coupling boundary were analyzed. The simulation research was conducted on the condition of normal pressure difference and pressure pulsation, and the most dangerous position of intracranial aneurysms rupture was analyzed. The results validate the correctness of theoretical analysis.

Research progress in the causes of intracranial aneurysms

Subaracoid hemorrhage caused by intracranial aneurysms is characterized by high morbidity and mortality.There is no definite conclusion regarding the mechanism of formation,development,and rupture of intracranial aneurysms.It is generally believed to be related to congenital hereditary connective tissue diseases and acquired hemodynamic factors,vascular inflammation,and oral pathogens.In addition,gender,age,hypertension,and psychological status are also important factors.Relevant studies show a significantly lower quality of life in patients with intracranial aneurysms,and psychological factors should be studied in more depth.Neurological complications are considered an important factor in the decrease in quality of life.In conclusion,the formation,development,and rupture of intracranial aneurysms should result from a combination of congenital and acquired factors.

基于计算机辅助半自动测量的颅内动脉瘤形态学参数与动脉瘤破裂相关性分析

目的评估计算机辅助半自动测量的动脉瘤三维形态学参数与动脉瘤破裂风险的相关性。方法回顾性连续纳入2019年10月至2022年10月于首都医科大学宣武医院神经外科收治的破裂多发动脉瘤患者。采用计算机辅助半自动测量方法测量入组患者动脉瘤形态学参数(包括动脉瘤直径、最大径、宽度、瘤颈宽度、体积、入射角、载瘤动脉直径、表面积、波动指数、非球形指数),计算动脉瘤长宽比、宽颈比、纵横比和尺寸比,并记录动脉瘤位置信息。将多发动脉瘤中破裂责任动脉瘤纳入破裂组,其余动脉瘤纳入未破裂组。采用单因素分析及多因素二元Logistic分析评价破裂组和未破裂组形态学参数及动脉瘤位置信息的差异。结果56例破裂多发动脉瘤患者共126个动脉瘤纳入分析。在形态学方面,直径>5 mm[51.8%(29/56)比15.7%(11/70),P<0.01]、最大径>6 mm[57.1%(32/56)比25.7%(18/70),P<0.01]、入射角>107°[57.1%(32/56)比35.7%(25/70),P=0.016]、宽颈比>1.1[50.0%(28/56)比30.0%(21/70),P=0.022]、纵横比>1.1[46.4%(26/56)比25.7%(18/70),P=0.015]和尺寸比>1.9[57.1%(32/56)比10.0%(7/70),P<0.01]在破裂组与未破裂组之间差异均有统计学意义;在动脉瘤位置方面,破裂组动脉瘤主要位于颈内动脉后交通段[39.3%(22/56)]和大脑中动脉[23.2%(13/56)],而非破裂组动脉瘤主要位于大脑中动脉[28.6%(20/70)]和颈内动脉非后交通段[27.1%(19/70)],两组动脉瘤位置分布差异有统计学意义(P=0.003)。多因素Logistic回归分析结果表明,尺寸比>1.9为动脉瘤破裂的独立危险因素(OR=11.62,95%CI:2.40~56.15;P=0.002)。在动脉瘤位置方面,颈内动脉后交通段动脉瘤的破裂风险高于颈内动脉非后交通段动脉瘤(OR=19.25,95%CI:2.19~169.51;P=0.008)。结论对于多发性颅内动脉瘤,动脉瘤的三维形态学参数中尺寸比>1.9是动脉瘤破裂的独立危险因素,颈内动脉后交通段动脉瘤的破裂风险明显高于颈内动脉非后交通段动脉瘤。

烟雾病合并颅内动脉瘤破裂及治疗后卒中的临床分析

目的探讨烟雾病(Moyamoya disease,MMD)合并颅内动脉瘤(intracranial aneurysm,IA)破裂及治疗后卒中的影响因素。方法回顾性分析245例MMD合并IA病例资料,根据是否发生IA破裂分为破裂组(n=71)和未破组(n=174)。采用单因素分析和Logistic回归分析,归纳IA破裂的危险因素。记录病人随访资料,采用COX回归分析,归纳治疗后卒中的危险因素。结果MMD合并IA破裂发生率为28.98%;年龄>52.5岁(OR=1.997)、收缩压(SBP)>160mmHg(OR=2.042)是MMD合并IA破裂的独立危险因素,而颈内动脉IA不易破裂(OR=0.353)。随访期卒中发生率为6.53%;中大型IA(HR=3.940)、IA破裂史(HR=3.900)是MMD合并IA随访卒中的独立危险因素。结论高龄、高SBP的MMD合并IA破裂风险高;合并有中大型IA及既往IA破裂史的病人,发生卒中风险高。

血清缺氧诱导因子-1α、内皮素-1及基质金属蛋白酶-9联合检测对颅内动脉瘤破裂出血142例手术预后的价值

目的探讨血清缺氧诱导因子-1α(HIF-1α)、内皮素-1(ET-1)、基质金属蛋白酶-9(MMP-9)联合预测颅内动脉瘤破裂出血术后预后不良的价值。方法选取2020年1月至2022年1月东台市人民医院收治的颅内动脉瘤破裂出血病人142例作为研究组,另选取同期健康体检者140例作为对照组,检测病人术前、入院1周(均为术后)、术后6个月血清HIF-1α、ET-1、MMP-9水平并进行比较。另依据病人出院6个月后预后情况,将其分为预后良好组(101例)和预后不良组(41例),对比预后良好组和预后不良组术前、入院1周、术后6个月血清HIF-1α、ET-1、MMP-9水平,分析颅内动脉瘤破裂出血病人预后不良的影响因素及血清HIF-1α、ET-1、MMP-9单项及联合检测对颅内动脉瘤破裂出血病人预后不良的预测价值。结果研究组术前血清HIF-1α、ET-1、MMP-9水平均高于对照组(P<0.05);研究组随访6个月预后不良发生率为28.87%(41/142),血清HIF-1α、ET-1、MMP-9水平经重复测量方差分析差异有统计学意义(P<0.05),预后不良组入院1周、术后6个月血清HIF-1α(42.43±3.05)μg/L和(41.53±4.52)μg/L、ET-1(14.27±1.24)ng/L和(13.96±2.04)ng/L、MMP-9(15.57±1.81)μg/L和(14.68±2.65)μg/L均低于术前(51.19±4.38)μg/L、(16.50±1.45)ng/L、(18.26±2.29)μg/L;预后良好组入院1周、术后6个月血清HIF-1α(40.78±1.53)μg/L和(34.87±4.68)μg/L、ET-1(13.12±2.16)ng/L和(10.05±1.96)ng/L、MMP-9(14.87±1.20)μg/L和(12.21±2.87)μg/L均低于术前(47.82±4.13)μg/L、(14.89±2.75)ng/L、(17.41±1.21)μg/L;预后良好组术后6个月血清HIF-1α、ET-1、MMP-9水平均低于入院1周(P<0.05)。预后不良组术前、入院1周、术后6个月血清HIF-1α、ET-1、MMP-9水平均高于预后良好组(P<0.05)。预后不良组多发动脉瘤、脑积水、Hunt-Hess分级Ⅳ~Ⅴ级、CT Fisher分级3~4级、手术时机为≥72 h、并发脑血管痉挛、并发脑梗死病人占比均高于预后良好组(P<0.05);Hunt-Hess分级Ⅳ~Ⅴ级、手术时机为≥72 h、术前及入院1周血清HIF-1α、ET-1、MMP-9高水平均是颅内动脉瘤破裂出血预后不良的危险因素(P<0.05);受试者操作特征曲线显示,术前及入院1周血清HIF-1α、ET-1、MMP-9三者联合预测颅内动脉瘤破裂出血病人预后不良的灵敏度(97.56%、95.12%)和曲线下面积(0.93、0.91)高于单独预测(P<0.05),特异度与单独评估比较差异无统计学意义(P>0.05)。结论颅内动脉瘤破裂出血病人术前血清HIF-1α、ET-1、MMP-9水平均高于健康人群,术前和入院1周血清HIF-1α、ET-1、MMP-9高水平均是术后预后不良的独立危险因素,且对颅内动脉瘤破裂出血术后预后不良具有一定预测价值,但三者联合预测价值更高。

机器学习方法构建基于CT血管成像预测颅内动脉瘤破裂模型的研究

目的 探讨机器学习方法(LASSO回归)构建基于CT血管成像(CTA)预测颅内动脉瘤破裂模型的价值研究。方法收集133例颅内动脉瘤患者的临床资料和CTA检查结果,根据是否破裂分为破裂组(103例)和未破裂组(30例)。对比两组患者临床资料和CTA检查参数差异;分别使用Logistic回归和LASSO回归筛选与动脉瘤破裂相关的危险因素,再构建预测模型。结果与未破裂组患者相比,破裂组患者糖尿病史例数、不规则瘤体形态例数以及合并子囊例数较多、入射角度较高。单因素Logistic回归显示糖尿病史、瘤体形态合并子囊数、入射角度与动脉瘤破裂相关,使用这4个指标构建的模型其对动脉瘤破裂的预测效能中等,AUC值为0.766。LASSO回归筛选出糖尿病史、瘤形态、数量、宽度、入射夹角和子囊数均与颅内动脉瘤破裂显著相关,构建的模型其预测效能较高,AUC值为0.902。结论糖尿病史、瘤体形态,合并子囊、入射角度与动脉瘤破裂相关,LASSO回归构建的预测模型能较好地预测颅内动脉瘤破裂的风险。

Fisher Ⅲ-Ⅳ级颅内动脉瘤并发脑积水的影响因素分析

目的 探讨FisherⅢ-Ⅳ级颅内动脉瘤性蛛网膜下腔出血患者并脑积水的相关危险因素。方法 纳入宁夏医科大学总医院神经外科2015年5月—2022年1月收治的313例破裂颅内动脉瘤性蛛网膜下腔出血FisherⅢ-Ⅳ患者,根据不同治疗方式,分别比较并发脑积水和非脑积水2组患者的临床数据资料,经多因素Logistic回归分析患者发生脑积水的独立危险因素。通过独立危险因素构建预测模型,结合受试者工作特征(ROC)曲线,分析模型对患者并发脑积水的预测价值。结果 经单因素分析出开颅夹闭和血管内患者术后合并脑积水分别与FisherⅣ级(P=0.004)、持续腰大池引流(LD)(P=0.017)和Hunt-HessⅢ-V级(P=0.003)、FisherⅣ级(P=0.005)、去骨瓣减压术(P=0.042)、肺炎(P=0.016)相关。经多因素分析得出,开颅夹闭后并脑积水发生的独立危险因素为FisherⅣ级[P=0.007,优势比(OR)=17.949,OR 95%置信区间(CI):2.181~147.682],LD(P=0.003,OR=4.717,OR 95%CI:1.486~89.027)。ROC曲线分析显示,FisherⅣ级+LD[曲线下面积(AUC)=0.747 8,95%CI:0.644 3~0.851 4,P=0.000 2,P_(H-L)=0.851]。血管内栓塞后并脑积水发生的独立危险因素为FisherⅣ级(P=0.048,OR=3.598,OR 95%CI:1.014~12.768),Hunt-HessⅢ-V级(P=0.039,OR=8.610,OR 95%CI:1.113~66.583)。ROC曲线分析显示,FisherⅣ级+Hunt-HessⅢ-V级(AUC=0.705 1,95%CI:0.617 5~0.792 6,P=0.000 8,P_(H-L)=0.789)。结论 颅内破裂动脉瘤Fisher分级Ⅲ-Ⅳ级患者发生脑积水独立危险因素因不同治疗方式而不同。开颅夹闭和血管内栓塞后并发脑积水的独立危险因素分别为FisherⅣ级、持续LD和FisherⅣ级、Hunt-HessⅢ-Ⅳ级。

颅内破裂微小动脉瘤超早期血管内治疗的疗效分析

目的 探讨颅内破裂微小动脉瘤超早期血管内治疗的临床疗效。方法 2017年5月~2022年11月收治的35例颅内破裂微小动脉瘤采用超早期(发病24小时内)血管内治疗,分析临床基本信息、血管内治疗结果、临床及影像随访结果等资料。结果 动脉瘤最大径平均为(2.5±0.4)mm,血管内治疗35例责任动脉瘤,其中单纯弹簧圈栓塞23例(65.7%),支架结合弹簧圈栓塞12例(34.3%)。术后即刻栓塞RaymondⅠ级20例(57.1%),Ⅱ级13例(37.2%),Ⅲ级2例(5.7%)。围手术期并发症4例(11.4%),包括术中破裂2例(5.7%),术中支架内血栓形成2例(5.7%),术后大面积脑梗死开颅去骨瓣减压1例,术后死亡1例。影像随访24例(68.6%),复发1例予以再治疗。临床随访33例,mRS 0~2级31例(93.9%)。结论 颅内破裂微小动脉瘤超早期血管内治疗临床疗效满意,术中破裂、血栓形成为围手术期主要并发症。

微导丝结合微导管辅助技术在瘤颈发出重要分支血管的颅内破裂动脉瘤栓塞中的应用

目的探讨微导丝结合微导管辅助分支血管保护技术在瘤颈发出重要分支血管的颅内破裂动脉瘤血管内治疗中的应用价值。方法回顾性分析2021年6月至2022年6月血管内栓塞治疗的8例瘤颈发出重要分支血管的颅内破裂动脉瘤的临床资料。术中使用微导丝携微导管放置于动脉瘤瘤颈处分支血管内,利用张力对分支血管予以保护,辅助行弹簧圈栓塞治疗。结果所有病例均顺利完成手术,术中未发生动脉瘤破裂或血管栓塞并发症。术后即刻造影显示,Raymond分级1级6例,2级2例;所有分支血管术后血流通畅。术后3~6个月随访,DSA显示动脉瘤均闭塞,无复发,分支血管通畅;GOS评分4~5分7例,3分1例。结论对于瘤颈发出重要分支血管的颅内破裂动脉瘤,术中利用微导丝结合微导管辅助分支血管保护技术行弹簧圈栓塞可行性好、安全性高、效果良好。

颅内动脉瘤破裂患者显微动脉瘤夹闭手术时机对疗效及预后的影响

目的探究显微动脉瘤夹闭手术时机对颅内动脉瘤(IA)破裂患者临床疗效和预后的影响。方法搜集2020-05—2023-05内江市第一人民医院治疗的96例颅内动脉瘤破裂患者的临床资料,根据患者发病至手术时间分为超早期组(24 h内)49例和早期组(24~72 h)47例,比较2组患者临床疗效、并发症和预后情况。结果2组患者手术完全夹闭率和术中IA再破裂率比较差异无统计学意义(91.84%比85.11%,6.12%比4.26%,P>0.05)。超早期组术前IA再破裂发生率低于早期组(0比12.77%,P<0.05),并发症发生率低于早期组(16.33%比34.04%,P<0.05),预后良好率高于早期组(85.71%比68.09%,P<0.05)。结论在IA破裂24 h内的超早期进行显微动脉瘤夹闭手术疗效优于发病后24~72 h,超早期手术能够降低术前IA再破裂风险,减少并发症,改善患者预后。

两种抗血栓方案在颅内破裂动脉瘤支架辅助栓塞术后的疗效对比

目的对比颅内破裂动脉瘤支架辅助介入栓塞手术后采用直接抗血小板治疗与先抗凝治疗再抗血小板治疗的疗效差异。方法通过回顾性队列研究,分析2019年1月至2021年12月在重庆医科大学附属第一医院接受支架辅助介入栓塞手术的142例颅内破裂动脉瘤患者。根据术后抗血栓方案,抗血小板组37例(26.1%),先抗凝治疗再抗血小板治疗组105例(73.9%)。比较两组患者的年龄、性别、糖尿病、高血压、术后出血及缺血并发症、动脉瘤尺寸、动脉瘤数量、动脉瘤位置等差异;所有患者进行临床随访,通过分析术后出血事件、缺血事件的发生例数和评估出院后2-5个月(平均3个月)mRS评分比较两组患者的短期预后来评价不同治疗方案的疗效。结果抗血小板组患者和先抗凝治疗再抗血小板治疗组的年龄、性别、高血压、糖尿病、动脉瘤数量、动脉瘤尺寸和动脉瘤位置无显著差异(P>0.05)。共有29例患者介入术后出现出血并发症,其中全程抗血小板组12例,先抗凝治疗后再改用抗血小板组17例,与抗血小板治疗组的患者相比,先抗凝治疗再抗血小板治疗组的患者出血并发症发生率更低(16.2%vs 32.4%;P<0.05)。两组患者的临床预后良好率(81.1%vs 81.0%)、临床预后不良率(18.9%vs 19.0%)、死亡率(5.4%vs 2.9%)差异无统计学意义。结论与全程抗血小板治疗相比,先抗凝再改用抗血小板治疗可降低颅内破裂动脉瘤患者支架辅助介入栓塞术后出血并发症的发生率。