| BackgroundIntracranial aneurysm is degenerative changes of cerebral arterial wall in congenital or acquired factors, present with mainly local cystic dilatation, but can also be manifested as long periods of cable shape expansion. Previous studies have reported that the rate of autopsy findings of intracranial aneurysms is about 0.2-4.5%, while the rate of discovery in the prospective imaging examination can reach 3-8%. The prevalence rate of intracranial aneurysm in the survey of the community of Shanghai in our country by Li MH is about 7%. The incidence of spontaneous subarachnoid hemorrhage(SAH) in the general population is about 10/10 million, the main cause of SAH is the rupture of aneurysm, which accounts for about 80% of the total. Mortality rate of SAH caused by intracranial aneurysm rupture is up to 30-40%, about half of the patients in 2 weeks will occur bleeding again, the mortality rate rises to as high as 60-70%. Factors such as hemodynamic factors, vascular factors and environmental factors may influence the pathological process of aneurysm, such as the formation or rupture of aneurysm. Because the etiology of intracranial aneurysm has not been fully explained, there is no treatment for the cause of intracranial aneurysm. In addition to the conservative treatment, there are mainly two kinds of methods: craniotomy clipping and endovascular treatment. There is no consistent definition for Complicated intracranial aneurysms, but often due to some aneurysms relatively complex characteristics, such as wide necked aneurysms, very small aneurysms, dissecting aneurysm, aneurysm associated with arteriovenous malformation, pseudoaneurysm, recrudescent aneurysms, multiple aneurysms and special location of the aneurysm. Endovascular treatment showed a unique advantage, but there are also a variety of technical difficulties. With the development of imaging and material science, the endovascular treatment of complicated aneurysm becomes increasingly common.PurporseTo evaluate the importance of three dimensional DSA in endovascular treatment of intracranial complicated aneurysms and summarize the clinical significance of multiple strategies treatment for complicated aneurysms.MethodsSummary the treatment of 567 complicated aneurysm of our department from October 2012 to April 2015. Before the operation, rotational frontal and lateral angiography were performed, and the VR was reconstructed according to the results of 3D rotational angiography. The comparison among two-dimensional DSA, DSA and 3D DSA was made in the following aspects: display of aneurysm, aneurysm neck, aneurysm shape, quality of 2D image, and the parent artery. The reference image for endovascular embolization treatment was chosen and determined. The interventional embolization treatment plan was made according to the classification and measurement of the aneurysm. Endovascular treatment of the most common type of complicated intracranial aneurysms was analysis, such as wide neck aneurysms, very small aneurysms, posterior circulation aneurysms, aneurysms associated with arteriovenous malformations. The choice of endovascular treatment options include: conventional sole coil emblization technology, double microcatheters technology, stent assisted coiling technology, balloon assisted coiling technology, covered stents, the occlusion of parent artery, etc.This article will summarize the experience of endovascular treatment of complicated intracranial aneurysms from the following aspects: firstly, establishment of the guiding road; secondly, in the treatment of wide-necked aneurysms with traditional methods; thirdly, treatment of very small aneurysms; fourthly, endovascular treatment of vertebrobasilar artery dissection aneurysm; fifthly, LVIS stent assisted treatment of intracranial aneurysms; sixthly, endovascular treatment of aneurysms associated with arteriovenous malformations; seventhly, preliminary experience of FD stents in treatment of intracranial aneurysms. Based on the results of the different groups, the comparison of different treatment methods in the treatment of wide-necked aneurysms and large aneurysms were analyzed.ResultsThe detection rate of three dimensional DSA on intracranial aneurysms and the tiny branch rise from aneurysms was slightly higher than that of DSA, but there was no statistical significance. The display rate of DSA and the display rate of the shape of the aneurysms sac were significantly better than that of the DSA. The reference images can be obtained from DSA 3D for all the intracranial complicated aneurysms treated with endovascular embolization. Endovascular embolization was successfully for all of the 567 complex intracranial aneurysms, success rate of 100%, complete embolization in 404 cases, nearly complete embolization in 97 cases, and incomplete embolization in 66 cases. 14 aneurysms ruptured in the embolization procedure, ischemic complications occurred in 15 cases, and 9 cases died. In the clinical follow up of 523 cases, no rebleeding occurred, 3 cases of postoperative limb hemiplegic patients were not fully recovered. For wide neck aneurysms, a new type of LVIS stent and FD stent showed great advantages, they significantly improved the complete embolization rate of aneurysm, reduce the recurrence of aneurysm. For large and giant aneurysms, compared with traditional methods, FD stent has obvious advantages in improving the total embolization rate and reducing the complications of surgery.Conclusion3D DSA can detect more intracranial aneurysms and better display the shape, size, aneurysm neck, adjacent and other parameters of complicated intracranial aneurysm. Application of stent can expanded the indications of endovascular treatment of intracranial aneurysms; reasonable and effective treatment strategies, improved treatment methods and ideas, cures the most of the complicated intracranial aneurysms by radiographic and clinical evaluation with reduced complications; novel stent can significantly improve the treatment effects on the long-term for wide-necked and large aneurysms. |
PDF Full Text Request