中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2014年
2期
117-120
,共4页
汪阳%李佑祥%姜除寒%吴中学%杨新健
汪暘%李祐祥%薑除寒%吳中學%楊新健
왕양%리우상%강제한%오중학%양신건
床突旁动脉瘤%血管内治疗%分类%微导管
床突徬動脈瘤%血管內治療%分類%微導管
상돌방동맥류%혈관내치료%분류%미도관
Paraclinoid aneurysms%Endovascular treatment%Classification%Microcatheter
目的 采用床突旁动脉瘤的改良分类指导微导管塑形,根据介入治疗结果分析该方法的有效性.方法 北京天坛医院神经介入科2009年1月至2011年12月连续介入治疗126例142个囊性床突旁动脉瘤.术前将动脉瘤分为Ⅰ型(眼动脉动脉瘤)和Ⅱ型(垂体上动脉动脉瘤).每一类动脉瘤被眼动脉和后交通动脉间的假想等分线分为两类,Ⅰ a和Ⅱa是位于等分线的近心端,Ⅰb和Ⅱb是位于等分线的远心端.每一种动脉瘤的分型都有相应的微导管塑形形态,Ⅰ a使用直管,Ⅰb使用“S”型导管,Ⅱa使用“C”型(＜90°)导管,Ⅱb使用大弯型(≥90°)导管.塑形后导管的可操作性使用1～5分评级.分析微导管的可操作性与介入治疗效果的关系.结果 142个动脉瘤中,有56个(39.4％)动脉瘤属于Ⅰ型,86个(60.6％)动脉瘤属于Ⅱ型.24个(16.9％)动脉瘤采用单纯弹簧圈栓塞,118个(83.1％)动脉瘤采用支架辅助弹簧圈栓塞.初始栓塞程度:完全栓塞62个(43.7％),瘤颈残留47个(33.1％),部分栓塞33个(23.2％).各型动脉瘤微导管的可操作性难度为Ⅰb＞Ⅱa＞ Ⅰa＞Ⅱb.Ⅰb型动脉瘤微导管的可操作性最差(P＜0.01).结论 改良分类指导的微导管塑形可用于床突旁动脉瘤的血管内治疗.
目的 採用床突徬動脈瘤的改良分類指導微導管塑形,根據介入治療結果分析該方法的有效性.方法 北京天罈醫院神經介入科2009年1月至2011年12月連續介入治療126例142箇囊性床突徬動脈瘤.術前將動脈瘤分為Ⅰ型(眼動脈動脈瘤)和Ⅱ型(垂體上動脈動脈瘤).每一類動脈瘤被眼動脈和後交通動脈間的假想等分線分為兩類,Ⅰ a和Ⅱa是位于等分線的近心耑,Ⅰb和Ⅱb是位于等分線的遠心耑.每一種動脈瘤的分型都有相應的微導管塑形形態,Ⅰ a使用直管,Ⅰb使用“S”型導管,Ⅱa使用“C”型(＜90°)導管,Ⅱb使用大彎型(≥90°)導管.塑形後導管的可操作性使用1～5分評級.分析微導管的可操作性與介入治療效果的關繫.結果 142箇動脈瘤中,有56箇(39.4％)動脈瘤屬于Ⅰ型,86箇(60.6％)動脈瘤屬于Ⅱ型.24箇(16.9％)動脈瘤採用單純彈簧圈栓塞,118箇(83.1％)動脈瘤採用支架輔助彈簧圈栓塞.初始栓塞程度:完全栓塞62箇(43.7％),瘤頸殘留47箇(33.1％),部分栓塞33箇(23.2％).各型動脈瘤微導管的可操作性難度為Ⅰb＞Ⅱa＞ Ⅰa＞Ⅱb.Ⅰb型動脈瘤微導管的可操作性最差(P＜0.01).結論 改良分類指導的微導管塑形可用于床突徬動脈瘤的血管內治療.
목적 채용상돌방동맥류적개량분류지도미도관소형,근거개입치료결과분석해방법적유효성.방법 북경천단의원신경개입과2009년1월지2011년12월련속개입치료126례142개낭성상돌방동맥류.술전장동맥류분위Ⅰ형(안동맥동맥류)화Ⅱ형(수체상동맥동맥류).매일류동맥류피안동맥화후교통동맥간적가상등분선분위량류,Ⅰ a화Ⅱa시위우등분선적근심단,Ⅰb화Ⅱb시위우등분선적원심단.매일충동맥류적분형도유상응적미도관소형형태,Ⅰ a사용직관,Ⅰb사용“S”형도관,Ⅱa사용“C”형(＜90°)도관,Ⅱb사용대만형(≥90°)도관.소형후도관적가조작성사용1～5분평급.분석미도관적가조작성여개입치료효과적관계.결과 142개동맥류중,유56개(39.4％)동맥류속우Ⅰ형,86개(60.6％)동맥류속우Ⅱ형.24개(16.9％)동맥류채용단순탄황권전새,118개(83.1％)동맥류채용지가보조탄황권전새.초시전새정도:완전전새62개(43.7％),류경잔류47개(33.1％),부분전새33개(23.2％).각형동맥류미도관적가조작성난도위Ⅰb＞Ⅱa＞ Ⅰa＞Ⅱb.Ⅰb형동맥류미도관적가조작성최차(P＜0.01).결론 개량분류지도적미도관소형가용우상돌방동맥류적혈관내치료.
Objective To develop a modified classification to guide microcatheter shaping in endovascular management for paraclinoid aneurysms and to evaluate the efficiency of this technique.Methods From January 2009 to December 2011,consecutive 126 patients with 142 saccular paraclinoid aneurysms were treated with endovascular embolization at our institute.Paraclinoid aneurysms were classified as Type Ⅰ (ophthalmic artery aneurysms) and Type Ⅱ (superior hypophyseal artery aneurysm).Each type was further divided into two subtypes according to their relative position to an imaginary bisector that separated the origin of ophthalmic artery and posterior communicating artery.Ⅰ a and Ⅱ a referred to aneurysms arising from ICA proximal to the bisector,and Ⅰ b and Ⅱb referred to those aneurysms arising distal to the bisector.Recommended shapes of microcatheter for each subtype of the aneurysins were Ⅰ astraight,Ⅰ b-S shaped,Ⅱ a-C shaped (＜ 90 °) and Ⅱ b-primary curve (≥ 90°).The maneuverability of microcatheters was evaluated with an arbitrary score system.Results Of the 142 aneurysms,56 (39.4％)aneurysms were Type Ⅰ,while 86 (60.6％) were Type Ⅱ.24 aneurysms (16.9％) were managed with coil embolization,and 118 (83.1％) with stent-assisted coiling technique.Immediate angiography demonstrated complete occlusion in 62 (43.7％),neck remnant occlusion in 47 (33.1％) and residual aneurysm occlusion in 33 (23.2％) aneurysms.The microcatheter maneuverability scores ranked as Ⅰ b ＞Ⅱ a ＞ Ⅰ a ＞ Ⅱ b.The maneuverability of microcatheters in Type Ⅰ b was the least satisfactory (P ＜ 0.01).Conclusions A modified classification system of paraclinoid aneurysms may be used to guide microcatheter shaping during endovascular treatment.
