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Objective To observe the effect of dexmedetomidine in cerebral aneurysm embolization in pa-tients with hypertension. Methods Sixty patients with hypertension undergoing emergency cerebral aneurysm em-bolization were randomly divided into two groups:research group(dexmedetomidine given group) and control group. SBP,DBP,HR,plasma norepinephrine(NE):baseline value(T0),before intubation(T1),after intubation (T2),after extubation(T3). Extubation time and anesthetic-related complications were also recorded. Results The hemodynamic parameters and plasma norepinephrine concentration in the research group were more stable than those in the control group at different time point during perioperative period. There was no difference between two groups about extubation time. The incidence of anesthetic-related complications in research group was lower than control group(P < 0.05). Conclusions Dexmedetomidine can reduce the stress response of intubation ,extuba-tion and perioperative hemodynamic fluctuations in cerebral aneurysm embolization in patients with hypertension. It can also reduce the consumption of prorofol and the incidences of adverse effects.
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Objective To explore the effect of Ulinastatin on proinflammatory cytokines of patients undergoing operation of intracranial aneurysm embolization. Methods 40 patients undergoing operation of intracranial aneurysm embolization were randomly divided into 2 groups (n = 20): ulinastatin group (Group U), normal saline group (Group C). In group U, 6 000 IU/kg Ulinastatin was infused via vein before anesthesia induction, the group C received the injection of isovolume normal saline. Exsanguinated arterial blood at T1, T2, T3, T4 and T5 five time points were taken to measure TNF-α and IL-6 in serum. Results The contents of TNF-α and IL-6 in serum both increased at T3, T4 and T5 compared to that at T1 in both groups; both TNF-α and IL-6 significantly decreased in Group U compared to that in Group C at the same time point. Conclusion Ulinastatin may inhibit the release of inflammatory mediators and lighten cerebral ischemia-reperfusion injury in patients undergoing operation of intracranial aneurysm embolization.
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Objective To explore clinical effects of transcatheter aneurysm embolization and cerebrospinal fluid replacement therapy for the treatment of subarachnoid hemorrhage .Methods Clinical path data of 85 cases of subarachnoid hemorrhage patients from January 2010 to August 2012 were analyzed ,and all were used transcatheter aneurysm embolization and cerebrospinal fluid re-placement therapy to observe the clinical effects .Results A total of 85 patients with 84 cases were cured or improved(98 .82% ) , died in 1 case(1 .18% ) and occur complications in 10 cases(11 .76% ) .68 cases of those were followed up for 0 .5-2 .0 years and no case occurred rebleeding .85 patients were hospitalized for 10 to 40 days ,and the average hospital stay was(17 .5 ± 13 .0)d .Conclu-sion Transcatheter aneurysm embolization is a safe ,effective method treating subarachnoid hemorrhage ,combined with cerebrospi-nal fluid replacement therapy to shorten the course ,reduce complications and improve the cure rate .
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PURPOSE: To compare the time-of-flight and contrast-enhanced- magnetic resonance angiography techniques in a 3 Tesla magnetic resonance unit with digital subtraction angiography with the latest flat-panel technology and 3D reconstruction in the evaluation of embolized cerebral aneurysms. INTRODUCTION: Many embolized aneurysms are subject to a recurrence of intra-aneurismal filling. Traditionally, imaging surveillance of coiled aneurysms has consisted of repeated digital subtraction angiography. However, this method has a small but significant risk of neurological complications, and many authors have advocated the use of noninvasive imaging methods for the surveillance of embolized aneurysms. METHODS: Forty-three aneurysms in 30 patients were studied consecutively between November 2009 and May 2010. Two interventional neuroradiologists rated the time-of-flight-magnetic resonance angiography, the contrast-enhanced-magnetic resonance angiography, and finally the digital subtraction angiography, first independently and then in consensus. The status of aneurysm occlusion was assessed according to the Raymond scale, which indicates the level of recanalization according to degrees: Class 1: excluded aneurysm; Class 2: persistence of a residual neck; Class 3: persistence of a residual aneurysm. The agreement among the analyses was assessed by applying the Kappa statistic. RESULTS: Inter-observer agreement was excellent for both methods (K = 0.93; 95 percent CI: 0.84-1). Inter-technical agreement was almost perfect between time-of-flight-magnetic resonance angiography and digital subtraction angiography (K = 0.98; 95 percent CI: 0.93-1) and between time-of-flight-magnetic resonance angiography and contrast-enhanced-magnetic resonance angiography (K = 0.98; 95 percent CI: 0.93-1). Disagreement occurred in only one case (2.3 percent), which was classified as Class I by time-of-flight-magnetic resonance angiography and Class II by digital subtraction angiography. The agreement between contrast-enhanced-magnetic resonance angiography and digital subtraction angiography was perfect (K = 1; 95 percent CI: 1-1). In three patients, in-stent stenosis was identified by magnetic resonance angiography but not confirmed by digital subtraction angiography. CONCLUSION: Digital subtraction angiography and both 3T magnetic resonance angiography techniques have excellent reproducibility for the assessment of aneurysms embolized exclusively with coils. In those cases also treated with stent remodeling, digital subtraction angiography may still be necessary to confirm eventual parent artery stenosis, as identified by magnetic resonance angiography.
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Adult , Aged , Female , Humans , Male , Middle Aged , Angiography, Digital Subtraction/methods , Contrast Media , Embolization, Therapeutic , Imaging, Three-Dimensional/methods , Intracranial Aneurysm/diagnosis , Magnetic Resonance Angiography/methods , Epidemiologic Methods , Embolization, Therapeutic/instrumentation , Intracranial Aneurysm/therapy , Observer Variation , RecurrenceABSTRACT
@#Objective To summarize the technique of stent combined with coils to treat middle cerebral artery bifurcation wide-necked aneurysms. Methods 15 patients were reported. Results 11 of 15 aneurysms were completely occluded and 4 were incompletely (>95%) occluded. Transient ischemia of cerebral occurred in a case. 8 aneurysms were followed up for 6～12 months, 1 presented neck remnant growth. Conclusion It is satisfied to use the stent combined with coils to treat middle cerebral artery bifurcation wide-necked aneurysm, which may protect the parent artery.
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Objective To evaluate double microcatheter technique for detachable coil treatment of wide-necked intracranial aneurysms. Methods Routine endovascular coil occlusion was not achieved in 6 cases of wide-necked intracranial aneurysms. A second femoral arterial sheath was inserted on the opposite side . A second microcatheter was positioned within the aneurysm. The detachable coils were introduced via double microcatheter simultaneously or successively till the aneurysm were compactly embolized. The coils were detached after satisfactorily positioned. Results Total 6 cases of wide-necked aneurysms were successfully embolized with detachable coil. Aneurysmal sacs were 100% embolized in 2 cases, over 90% in 4 cases. 1 case suffered moderate disablement as a result of complication of. Angiographic follow-up in 5 cases revealed no recurrent or rerupture.Conclusions The double microcathter technique may be an optional method during embolization of some complicated wide-necked aneurysms.
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Objective To assess hemodynamics and histology of the aneurysms by treating experimental wide necked aneurysms endovascularly with a combination of stents and electrolytic detachable coils.Methods An experimental model was surgically constructed in the necks of six canines for simulating intracranial wide necked aneurysms. Balloon expandable metal stents were positioned across the aneurysms in bilateral carotid arteries of six canines with additional intraaneurysmal placement of detachable microcoils in only unilateral carotid artery of each canine. Sonography and angiography were performed in different stages and histologic examinations were achieved finally. Results Stent placement was successful in all six canines. Aneurysms treated with only stents placement showed no significant thrombus formation with slow growing of neointima over the neck of the aneurysm. Thrombosis occurred in the aneurysms treated with stents and coils in a short time and neointima covered the neck of the aneurysms completely.Conclusions Endovascular treatment of wide necked aneurysms using stents combined with electrolytic detachable coils may prevent re rupture of the aneurysms and promote neointima formation over the neck of the aneurysms.