Complicated Intracranial Aneurysm: Angioarchitecture Imaging And Endovascular Treatment

[Abstract] Objective To restrospectively analyse the imaging data of CT,MRI,CTA,MRA and 2D-DSA on complicated intracranial aneurysm.To summarize diagnosis significance of variable methods on angioarchitecture and its relation to circum-structure for selecting management methods. On the basis of our experiences in endovascular intervention management, we summarized and analysed its curative experience, curative effect and influential factor for instituting rational therapic strategy and optimal treatment.Methods Gathering 36 cases of illness medical history materials on complicated intracranial aneurysm, to analyse their major radiological appearances. 20 aneurysms were detected with both 64-slice MSCTA and DSA in 19 cases, measuring theirs size and width of aneurysm-neck evaluating their morphous, three diamensions relation, smooth condition, showing grades and overall condition. To apply Paired-Samples t test and Rank-Sum test.32 patients were carried on interventional therapies including simple-coil embolism technology, balloon remodeling combined coil embolism technology, stent-assited coiling technology, pure stent technology, balloon remodeling combined coil embolism and stent shaping technology, blocked parent artery and aneurysm embolism technology, blocked parent artery technology. 13 cases were followed up clinicaly and imagely. Analyse their curative effect and influential factors of variable methods.Results In 36 cases of complicated intracranial aneurysm (totally 45 aneurysms),6 cases were multiple aneurysm,38 examples were complicated intracranial aneurysm. 24 aneurysms in 24 cases were detected with CTA and DSA respectively, false-positive and false-negative rate in CTA are 8．3% and 4．2%, false-positive and false-negative rate in DSA are 4．2% and 12．5%. 29 cases were diagnosed as spontaneous SAH with CT. In 33 cases, 9 cases were detected with CT(including 2 cases of calcification). 9 cases were detected with MRI and MRA,2 cases were only found haematocele signs in 3 cases appearing as SAH,6 cases appearing as no-haemorrhage were diagnosed directly(including 2 cases dissecting aneurysm, 2 cases giant aneurysm,2 cases wide-neck grant aneurysm,3 cases thrombogenesis). In the size measure of aneurysm, there are no statistics difference between MIP and VR, MPR and DSA (P>0．05) ; there are statistics difference between MIP or VR and MPR or DSA (P<0．05) In the neck-width of aneurysm, there are no statistics difference between MIP and VR and DSA (P>0．05) ,there are statistics difference between MIP or VR or DSA and MPR technology(P<0．05) . In the showing morphology and 3D of aneurysm, there are no statistics difference between VR and MIP imaging technology(P>0．05) ,there are statistics difference between VR,MIP and DSA technology(P<0．05) . In smooth condition of aneurysm, there are no statistics difference between MIP and DSA technology(P>0．05) ,there are statistics difference between VR and MIP,DSA technology(P<0．05) . In showing grade of aneurysm, there are no statistics difference between VR and MIP technology(P >0．05) ,there are significant statistics difference between DSA and VR,MIP technology(P<0．01) . Totally there are significant statistics difference among several technology(P < 0．01) . After endovascular treatment, instantly angiography demonstrates compact embolisms in 7 general aneurysms. In 32 complicated intracranial aneurysms which were treated, 17 aneurysms (53．1%) were totally embolized(nonvisulization),7 aneurysms (21．9%) were near-totally embolized(neck been visualizated),3 aneurysms (9．4%)were partly embolized, 1 aneurysm (3．l%)was failed. 2 aneurysms which were treated with pure stent technology demonstrated negative acceleration in blood flow,which need two-stage embolism. 1 aneurysm which was treated with blocked parent artery technology demonstrated parent artery was complete occlusion. 1 serpiform aneurysm only was treated with Mata's test. 6 aneurysms weren't treatmented.8 cases had complications in surgery or after surgery, including 1 case in disruption of aneurysm, 1 case in angiorrhexis of aneurysm,2 cases in angiospasm, 1 case in stent shifting,l case in coil fragmentation and collapse,l case in coil prolapse and 1 case in failure of surgery. 2 cases in temporary nerve loss of function,2 cases in permanent nerve loss of function,l case in death. 13 patients were followed up for 3-12 months(average 7．6 months),no bleeding or rebleeding happen in this time.Conclution The diagnosis value of evaluating in medical imaging including CT,MRI,CTA,MRA and 2D-DSA on angioarchitecture imaging and its relation to circum-structure of complicated intracranial aneurysm has advantage and disadvantage itself,which has a closed relation to individual selection of interventional treatment and curative effect. Regarding to complex intracranial aneurysm patients, especially having the rehaemorrhagia risk, endovascular management should be applied as soon as possible. Curative effect and prognosis will be directly affected by treamentical strategy of uniting angioarchitecture and its relation to circum-structure, selecting rational endovascular treatment and interventional material.