Interventional Therapy Of Intracranial Vascular Disease

IntroductionNeurointervention is a rising discipline which developed rapidly in the late 30 years. With the development of microcatheter and embolic agents, the therapeutic techniques of neurointervention has become more and more, and it has become progressively one kind of important approaches in treating intracranial vascular disease, but the applicapable indication of embolic agents and the factors which influence the results of embolization have not been realized consistently. The relationship between the form of lesion and the selection of embolic agents or the degree of embolization has been studied tentatively in this subject.ObjectTo study tentatively the applicapable indication of various embolic agents and the relationship between the form of lesion and the dgree of embolization in embolotherapy of intraceanial vascular disease which included cranial aneurysms, arteriovenous malformation(AVM), carotid-cavernous fistula(CCF).Materials and Methods The clinical and imageological findings of 32 cases of intracranialvascular disease were collected. These patients were consisted of 15 cases of4cranial aneurysms, 16 cases of AVM, 1 case of CCF. They were all made definite diagnosis by digital subtraction angiography(DSA), then underwent endovascular embolization respectively with suture, Polyvinyl(PVA), n-butyl-2-cyanoactylate(NBCA), Machenical Detachable Spiral (MDS), Guglielmi Detachable Coil(GDC) or detachable balloon in accordance with DSA findings.Results1 .Cranial aneurysms 15 cases.These aneurysms were fed by the anterior communicating cerebral artery, the middle cerebral artery (MCA), the posterior communicating cerebral artery and the vertebro-artery, respectively. DSA showed the findings of aneurysms in earlier arterial phase were sac which protruding from vessels, the sac were filled with contrast medium, they could last to late during arterial or parenchyma! phase. The shape of sac were regular or not. In such cases, 1 case was treated with 1 detachable balloon by embolizing its feeding artery. 14 cases were underwent endovascular embolization in sac with embolic agents. Among these patients, 1 was embolized with MDS, the others with GDC. Of all these patients, posterior embolization DSA shows 10 cases were densely embolized, 1 was over, 3 were incompletely.2.Cerebral vascular malformation 16 cases.These vascular malformation were supplied by the anterior cerebral artery (ACA), the middle cerebral artery (MCA), the posterior cerebral artery(PCA), the vertebroartery and the external carotid artery, respectively.5DSA showed AVM nidus of various size, dilatant feeding arteries and drainaging veins during earlier arterial phase. They were all underwent endovascular embolization with suture, PVA, NBCA, respectively. Among these patients , 14 cases was treated 1 time.l case 2 times, 1 case several times.3.CCF 1 case.Internal carotid artery angiography showed internal carotid artery, meanwhile, cavernous sinus and ophthalmic vein were presented too, with drainage into internal carotid vein via supeior and inferior petrosal sinus, cavernous sinus and ophthalmic vein became dilatant and twisting significantly.Conclusion1 .The form of cranial aneurysm has greatly inflence on the degree of embolization in embolotherapy of cranial aneurysm.2..The operation of GDC is simpler and safer than MDS in embolotherapy of cranial aneurysm. The embolization of feeding artery with balloon in treatment of cranial aneurysm should be applied after carefully cosideration.3. NBCA is the fittest agents for the endotherapy of intracranial AVM of small size, it can be cured. To the embolization of DAVM , suture or PVA is effective, it may even be recovered completely.4.To the intracranial AVM of big size, the endovascular treatment should be proceeded in several stages. The interval should be depended on the complaint of patient, thus it does not affect the effection of embolotherapy ,6moreover, the cost of treatment should be save...