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.

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.

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.

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.

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 aneurysms in 64 cases were embolized with MDS, 51 in 48 with GDC, and 8 in 8 with both MDS and GDC. Clinical data including sex, age, subarachnoid hemorrhage (SAH), Hunt & Hess grading, diameter and neck width of aneurysms, number and length of coils used per aneurysm, occlusive ratio, and complications were compared between MDS and GDC groups.Results. MDS and GDC groups were comparable (t-test or x2 -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. 2% ).Conclusions. 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.

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

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.

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.

Safety and efficacy of complete versus near-complete coiling in treatment of intracranial aneurysms

Objective:This study aimed to evaluate the clinical and angiographic outcomes of aneurysms that were completely or near-completely embolized and ascertain whether complete embolization is important in the stent-assisted coiling(SAC)of intracranial aneurysms.Methods:This retrospective study enrolled 390 patients(417 aneurysms).Among them,complete(100%)or nearcomplete(>90%)angiographic obliteration of the aneurysms on immediate angiography was accomplished.Baseline characteristics,complications,angiography follow-up results,and clinical outcomes were analyzed.Results:Cumulative adverse events occurred in 30 patients(7.7%),including thromboembolic complications in 17(4.4%),intraoperative rupture in 10(2.6%),and others in 3(0.8%).Statistical analyses revealed an increased intraprocedural rupture rate in the initial completely occluded aneurysms(5.6%compared with 1.0%).The incidence of cumulative adverse events was higher in patients with completely occluded aneurysms(11.1%)than in those with near-completely occluded aneurysms(5.5%).Angiography follow-up was available for 173 aneurysms.Aneurysm occlusion status at follow-up was correlated with stent placement(p?0.000,odds ratio?5.847),size(p?0.000,odds ratio?6.446 for tiny aneurysms;and p?0.001,odds ratio?5.616 for small aneurysms),and initial aneurysm occlusion status(p?0.001,odds ratio?3.436).Complete occlusion at followup was seen in 82.6%of the initial complete occlusion group versus 63.0%of the initial near-complete occlusion group.The incidence of complete occlusion at follow-up was higher in the initial completely occluded aneurysms with SAC(100%)than in the initial completely occluded aneurysms with non-SAC(65.2%).Conclusions:Initial complete treatment may lead to higher complication rates and good clinical outcomes at follow-up.Stent placement may enhance progressive aneurysm occlusion.Initial complete occlusion with SAC can provide durable closure at follow-up.

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.

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。

NBCA医用胶联合弹簧圈三明治法栓塞脾动脉瘤17例疗效分析

目的:探讨氰基丙烯酸异丁酯(NBCA)医用胶联合弹簧圈三明治法栓塞脾动脉瘤的疗效及安全性。方法:选择2018年3月至2023年7月采用经导管注入NBCA医用胶和弹簧圈三明治法栓塞脾动脉瘤的患者17例,回顾性分析临床资料和影像资料,评价栓塞成功率、临床疗效及手术相关并发症。结果:17例患者中男9例,女8例,年龄33~77岁;真性动脉瘤20例,假性动脉瘤2例;多发3例,单发14例;瘤体位于脾动脉近段3例,中段10例,远段9例。所有患者均成功栓塞,未发生严重手术并发症;术后随访3~36个月,腹部增强CT示脾动脉瘤铸型良好,未见复发、增大或破裂出血。结论:经导管NBCA医用胶联合弹簧圈三明治法栓塞脾动脉瘤成功率高,安全有效。

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。

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。

三种不同支架置入辅助弹簧圈栓塞治疗颅内动脉瘤的疗效及安全性比较

目的:比较Solitaire AB、Neuroform、Lvis/Lvis jr支架分别置入辅助弹簧圈栓塞治疗颅内动脉瘤的疗效及安全性。方法:回顾性分析接受弹簧圈栓塞治疗的103例颅内动脉瘤患者的临床资料,根据治疗方案将其分为Solitaire AB组(n=37),Neuroform组(n=34)及Lvis/Lvis jr组(n=32),比较各组患者的治疗效果及安全性。结果:各组患者支架均定位满意,且成功释放,技术成功率均为100%。术后即刻、术后6个月,Lvis/Lvis jr组Raymond分级优于Solitaire AB组和Neuroform组(P<0.05)。治疗后,各组患者血清神经生长因子(NGF)、S-100B蛋白表达水平均降低(P<0.05),且Lvis/Lvis jr组低于Solitaire AB组和Neurofor组(P<0.05)。术后6个月,各组患者屏气前动脉平均血流流速(Vm)、屏气后Vm、屏气指数(BHI)及改良Rankin量表(mRs)评分比较,差异均无统计学意义(P>0.05)。各组患者并发症总发生率比较:Lvis/Lvis jr组低于Solitaire AB组和Neuroform组(P<0.05)。结论:Lvis/Lvis jr支架置入辅助弹簧圈栓塞治疗颅内动脉瘤的短期疗效及安全性优于Solitaire AB、Neuroform支架。

低剂量替罗非班用于急性颅内破裂动脉瘤支架置入结合弹簧圈栓塞治疗的有效性和安全性分析

目的探讨低剂量替罗非班用于支架置入结合弹簧圈栓塞治疗急性颅内破裂动脉瘤的有效性和安全性。方法回顾性连续纳入2011年4月至2020年9月常州市第一人民医院神经外科收治的颅内动脉瘤破裂伴蛛网膜下腔出血并于入院24~48 h内行支架置入结合弹簧圈栓塞且使用抗血小板聚集药物治疗患者335例,根据抗血小板聚集药物治疗方案的不同,将患者分为双抗组(89例)和替罗非班组(246例)。收集所有患者的基线及临床资料并进行组间比较,包括年龄、性别、高血压病、糖尿病、入院Hunt-Hess分级、入院改良Fisher量表评分、动脉瘤直径(>5 mm、≤5 mm)、动脉瘤位置(前循环、后循环)及术后急性脑积水或脑室积血、术后即刻动脉瘤栓塞情况。所有患者颅内动脉瘤破裂伴蛛网膜下腔出血均为入院后急诊头部CT平扫确认。术后即刻采用Raymond分级标准评估栓塞效果:Ⅰ级指完全不显影(完全栓塞),Ⅱ级指仅瘤颈显影(不完全栓塞),Ⅲ级指瘤体显影,其中Raymond分级Ⅰ~Ⅱ级为有效栓塞。替罗非班组:在动脉瘤瘤腔内填入弹簧圈后、支架释放时,给予4.2μg/kg替罗非班静脉注射后以0.07μg/(kg·min)静脉滴注维持6~8 h,并在停止静脉滴注2 h前予序贯阿司匹林100 mg与氯吡格雷75 mg双联抗血小板聚集药物治疗。双抗组:至少于支架置入前2 h给予顿服负荷剂量阿司匹林300 mg+氯吡格雷300 mg,术后第2天给予阿司匹林100 mg+氯吡格雷75 mg。所有患者均接受术后持续口服6个月阿司匹林(100 mg/d)和术后持续口服3个月氯吡格雷(75 mg/d)治疗。观察并比较两组有效性指标、安全性指标、不良事件及其他并发症发生情况,其中有效性指标为术中及术后72 h内血栓事件发生率,安全性指标为术中及术后早期(术后48 h以内)颅内出血事件发生率、术后晚期(术后48 h及以后)颅内出血事件发生率和脑室外引流相关颅内出血事件(症状性、无症状性)发生率,不良事件为药物相关血小板减少症发生情况,其他并发症指延迟性脑缺血事件发生情况。采用改良Rankin量表(mRS)评分评估患者术后180 d临床预后,将mRS评分≤2分定义为预后良好,mRS评分>2分为预后不良,其中6分为死亡。结果(1)替罗非班组与双抗组的基线及临床资料的组间差异均无统计学意义(均P>0.05)。(2)替罗非班组与双抗组术后180 d良好预后[75.2%(185/246)比74.2%(66/89),P=0.845]及死亡[10.2%(25/246)比12.4%(11/89),P=0.566]患者比例差异均无统计学意义。(3)抗血小板聚集方案有效性比较结果显示,替罗非班组与双抗组术中[0.8%(2/246)比4.5%(4/89),P=0.075]、术后72 h血栓事件[11.0%(27/246)比13.5%(12/89),P=0.527]发生比例差异均无统计学意义。(4)抗血小板聚集方案安全性比较结果显示,替罗非班组术后早期颅内出血事件发生率低于双抗组[2.8%(7/246)比10.1%(9/89),P=0.014],接受脑室外引流术发生症状性脑室外引流相关颅内出血事件患者比例组间差异无统计学意义(0比2/15,P=0.050)。两组术中颅内出血事件(1.6%比3.4%,P=0.580)、术后晚期颅内出血事件(3.3%比4.5%,P=0.836)、药物相关血小板减少症(0.4%比1.1%,P=0.461)发生比例差异均无统计学意义。结论低剂量替罗非班方案用于支架置入结合弹簧圈栓塞治疗颅内急性破裂动脉瘤在预防血栓事件方面与双抗效果类似,且不增加早期出血事件发生率。