Stent-assisted coil embolization versus simple coil embolization for large and giant intracranial aneurysms: comparison of postoperative recurrence rate / 介入放射学杂志

Objective To compare the recurrence rate and long-term follow-up angiographic findings between stent-assisted coil embolization and simple coil embolization in treating large and giant intracranial aneurysms.Methods The clinical data and imaging materials of a total of 90 patients with large and giant intracranial aneurysms (＞10 mm,91 aneurysms in total),who were admitted to authors' hospital during the period from January 2004 to January 2016 to receive interventional embolization therapy,were retrospectively analyzed.Of the 90 patients,52 patients (52 lesions in total) received simple coil embolization (SCE group)and 38 patients (39 lesions in total) received stent-assisted coil embolization (SACE group).Postoperative recurrence rates of aneurysm were compared between the two groups,and recurrence risk factors were analyzed.Results The whole postoperative recurrence rate of aneurysm and re-treatment rate were 38.5％(35/91) and 20.9％(19/91) respectively;the recurrence rate and re-treatment rate of SACE group were 35.9％ (14/39) and 17.9％ (7/39) respectively,while those of SCE group were 40.4％ (21/52) and 23.1％ (12/52) respectively;the differences between the two groups were not statistically significant (P＞0.05).Multivariate logistic regression indicated that the recurrence risk factors of large or giant intracranial aneurysms included rupture of aneurysm (OR=0.284,95％CI=0.083-0.978,P=0.046),simple coil embolization (OR=5.03,95％ CI=1.04-24.44,P=0.045),concurrent hypertension (OR =0.13,95％ CI=0.036-0.51,P=0.003)and long time after operation (OR=1.002,95％CI=1.001-1.003,P=0.002).Conclusion Compared with simple coil embolization,stent-assisted coil embolization can reduce the recurrence rate of aneurysm.Rupture of aneurysm,simple coil embolization,long time after operation and concurrent hypertension are independent risk factors for recurrence of aneurysm after transcatheter arterial embolization.

Design and clinical application of balloon-type head fixation pillow for interventional neuroradiology operation / 医疗卫生装备

Objective To develop a balloon-type head fixation pillow for interventional neuroradiology operation.Methods Some radiotransparent sponge with high elasticity and strength and some nonopaque cloth with high skin compatibility were employed to make pillow base adaptable to the posterior fossa, neck and shoulder. A inflatable balloon made of anti-tensile airtight nylon was used to fix the underjaw.Results The fixation pillow gained advantages over the common one in imaging times, X-ray exposure dose and abnormal condition.Conclusion The head fixation pillow may decrease operating time, exposure dose and complications during interventional neuroradiology operation, and thus is worth popularizing clinically.

The vascular architecture characteristics of the complex direct cavernous sinus arteriovenous fistula and its interventional treatment / 介入放射学杂志

Objective To analyze the vascular architecture characteristics of the complex direct cavernous arteriovenous fistula (cd-CAVF) and to discuss its treatment and the curative effect of interventional embolization. Methods The hospitalization records, imaging features and operation records of 12 patients with cd-CAVF were retrospectively analyzed. Results In the 12 patients with cd-CAVF, the lesion’s blood supply arteries included internal carotid artery (ICA,n=8), primary trigeminal artery (PTA,n=1), middle cerebral artery (MMA,n=2) and basilar artery (BA,n=1). Different degrees of “arterial steal” phenomenon could be observed in all patients. The drainage routes included the superior ophthalmic vein and the inferior petrosal sinus (n=10), and cortical vein (n=2). Interventional embolization was carried out via ICA (n=4), through both ICA and BA (n=5), through MMA (n=2), or through BA (n=1). For the embolization of the lesion the balloons were used in 8 patients, steel coils were adopted in 2 patients, and balloons together with coils were employed in 2 patients. All the patients were followed up for 3-6 months. After the treatment the clinical symptoms and signs disappeared, and the lesions were completely cured in all patients with no complications. During the follow-up period of (60.2 ±26.8) months no recurrence of CAVF was observed. Conclusion The blood supply of cd-CAVF comes directly from the rupture of the blood vessels surrounding the cavernous sinus wall, the “arterial steal” phenomenon is prone to occur, and the drainage via the superior ophthalmic vein and the inferior petrosal sinus is more often seen. Transarterial balloon embolization is very effective for the treatment of cd-CAVF, and the use of coils together with multi-artery approaches is an effective supplementary method.

Interventional embolization therapy for cerebellar arteriovenous malformations associated with aneurysm / 介入放射学杂志

Objective To evaluate the clinical effect of endovascular embolization for the treatment of cerebellar arteriouvenous malformations (AVMs) associated with aneurysm, and to discuss its technical points. Methods The clinical data of 142 patients with cerebellar AVMs were retrospectively analyzed. Of the 142 patients, 42 had concomitant aneurysms. The patients were divided into concomitant aneurysm group and without aneurysm group. Using univariate and multivariate statistical models, the patient’s gender and age, the presence or absence of hemorrhage, the lesion’s location and size, and the presence or absence of deep venous drainage were analyzed. Results A total of 61 concomitant aneurysms were detected in the 42 patients, which were located within the malformation mass (n=14) or on the feeding artery (n=47). The concomitant aneurysms located in the malformation were closely related to AVM hemorrhage and the deep venous drainage. During the follow-up period after endovascular embolization, no recurrence of bleeding was observed in all the 42 patients. Conclusion In order to reduce the relapse rate of hemorrhage, the formulation of therapeutic measures should be based on the management of the concomitant aneurysm when endovascular embolization treatment is employed for AVM associated with aneurysm.

Stent-assisted coiling for unruptured vertebral dissecting aneurysm / 实用医学杂志

Objective To evaluate the efficacy of stent-assisted coiling in the treatment of unruptured vertebral dissecting aneurysm. Methods We retrospectively reviewed 59 consecutive patients with unruptured vertebral dissecting aneurysms that underwent endovascular treatment. 31 patients received single stent-assisted coiling, 28 patients received multiple stent-assisted coiling. Results Clinical outcome was favorable in 56 of the 59 patients, the modified Rankin Scale score had no difference in both groups (P = 0.24). The immediate obliteration grade in multiple-stent group was higher than that in single-stent group (75.0% vs. 41.9%, P=0.010). What′s more, the recurrence rate was lower in multiple-stent group (0% vs. 19.4%, P = 0.043). Conclusions Stent-assisted coiling in the treatment of unruptured vertebral dissecting aneurysm is safe and effective , multilayer disposition of stents with coils will decrease the complications and facilitate the aneurysmal occlusion. Larger , prospective studies are necessary to explore the long-term outcomes of reconstruction therapy.

Three-dimensional CT angiography with volume rendering for the dignosis of multiple intracranial aneurysms / 中国脑血管病杂志

Objective:To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with multiplanar reformation. Results: In the past one year,there were 10 patients diagnosed as having multiple intracranial aneurysms by 3D-CTA and altogether 24 aneurysms were visualized,including 10 small aneurysms(≤5mm.Three dimensional CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site,shape,size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick,reliable,and relatively noninvasive method for diagnosing multiple intracranial aneurysms.It delineates detailed aneurysmal morphology,and provides useful information for planning microsurgical approaches.

Primitive trigeminal artery-cavernous sinus fistula and ICA-primitive trigeminal artery aneurysm:report of two cases and review of literatures / 中国脑血管病杂志

The authors described two cases with primitive trigeminal artery. Case 1 was a 32-year-old woman who suffered dizziness and a serious pulsatile intracranial bruit on the left ear, and sometimes associated with pulsatile intracranial bearing-pain on the left temporal side six months before she was admitted to the hospital. She also suffered from obvious diplopia on left lateral gaze for the last 5 months. She had suffered no recent trauma. Magnetic resonance imaging(MRI) demonstrated a suspected intracranial aneurysm located in left cavernous sinus. Digital subtraction angiography (DSA) was performed and a primitive trigeminal artery-cavernous sinus fistula in left side was found. Intraluminal occlusion of the fistula was successfully performed immediately after angiography using 6 Guglielmi detachable coils (GDC), and the patient was cured finally. Case 2 was a 28-year-old woman who suffered a serious intermittent cephalodynia associated with soreness on the left body two years before she was admitted to the hospital. She had suffered no recent trauma. Magnetic resonance angiography(MRA) demonstrated a suspected intracavernous aneurysm of the right internal carotid artery, Digital subtraction angiography (DSA) was performed. Right internal carotid angiography showed a primitive trigeminal artery (PTA) run between the cavernous segment of the internal carotid artery and the distal portion of the basilar artery. On initiation of PTA of R-ICA a small wide-necked saccular aneurysm was incidentally visualized. The aneurysm was successfully embolized after angiography using 2 Stent (Neuroform, 4.5mmm × 20mmm)-assisted detachable coils (Matrix), the ICA and PTA were preserved, and the patient was cured finally.

Interventional treatment of dural arteriovenous fistula / 中华外科杂志

<p><b>OBJECTIVES</b>To summarize the characteristics of interventional treatment of dural arteriovenous fistulae (DAVFs) and improve clinical curative effects.</p><p><b>METHODS</b>The clinical data from 135 patients with DAVFs were analyzed retrospectively.</p><p><b>RESULTS</b>Seventy-four patients were cured, 53 were significantly improved, 8 unchange, and 1 died of intracranial haemorrhage.</p><p><b>CONCLUSIONS</b>Clinical presentations and prognosis of DAVF depend on the types of venous drainage. Compression of the affected carotid artery and endovascular embolization are safe and effective.</p>

Interventional treatment of 126 patients with anterior communicating artery aneurysm / 中华外科杂志

<p><b>OBJECTIVES</b>To analyse the characteristics of interventional treatment for anterior communicating artery aneurysm (AcoAA) and improve curative effects.</p><p><b>METHODS</b>In 126 patients, detachable microcoils were used to embolize the AcoAA via endovascular approach. Those patients failed to be embolized were treated by surgical clipping.</p><p><b>RESULTS</b>Of the 109 patients who were embolized successfully, 97 were achieved 100% occlusion, 12 95% - 98% occlusion. In the other 17 patients who failed to interventional treatment 15 were treated surgically and 2 no treatment because of cerebral vascular spasm. 123 patients were cured, one died, and 2 had aneurysms disappeared without any operations, as proved by follow-up for 5 months to 1 years. Of 32 patients checked by cerebral angiography 3 weeks to 30 months after operation, 30 showed disappeared of aneurysms and 2 had recurrence. The recurred aneurysms were successfully reembolized.</p><p><b>CONCLUSIONS</b>Most of AcoAAs can be cured by endovascular interventional treatment. Those who failed to be treated by embolization can be cured surgically. Few patients may be healed spontaneously. The long term effects of treatment should be followed-up for a long time.</p>

THE DIAGNOSIS AND ENDOVASCULAR TREATMENT FOR THE INTRACRANIAL DURAL AND CEREBRAL ARTERIOVENOUS MALFORMATIONS / 解放军医学杂志

Objective To study the angiographic characteristics of congenital intracranial dural and cerebral arteriovenous malformations, and their relationship to the structural characteristics and clinical feature. Methods The clinical histories, cerebral angiograms, and endovascular treatment of 52 cases of the dural and cerebral arteriovenous malformations were analyzed. Results All 52 patients were treated successfully with interventional therapy with introduction of intravascular emboli through microcatheters. In 2 patients, surgical excision was performed after embolism. In another 4 patients, X-ray knife treatment was carried out. Seventeen patients resumed their work, comprising 44.7% of all patients, and in 16 patients symptoms of epilepsy or head ache were markely improved, comprising 42.1% of the group. Conclusion It is important to study structural characteristics with angiograms for successful treatment of congenital artero-venous anomalies of the brain. [HS(1*2/3]

Traumatic basilar-cavernous fistula associated with aneurysm of basilar artery / 中华创伤杂志(英文版)

A 19-year-old boy's left temporal region was struck by a screwdriver, he immedietly lost consciousness for several minutes, when he came back he had a serious headache and obvious left ptosis. CT scanning showed an intracranial air accumulation and obvious traumatic subarachnoid hemorrhage (SAH), 2 weeks later magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed a traumatic aneurysm in basilar artery. Digital subtraction angiography (DSA) was performed 4 weeks later, revealing a basilar-cavernous fistula and a saccular aneurysm of the basilar artery in his head. After the patient was treated with endovascular embolization therapies twice and with mechanical detachable spiral (MDS) for 5 months the patient was cured finally.