支架輔助血管分叉部位顱內(nèi)動脈瘤栓塞對血管形態(tài)改變的研究
發(fā)布時間：2018-09-18 10:37
【摘要】：研究背景與目的：顱內(nèi)動脈瘤是神經(jīng)外科常見的腦血管疾病,動脈瘤破裂引起蛛網(wǎng)膜下腔出血致殘致死率高,死亡率可高達25-60%。隨著技術(shù)的進步,采用記憶合金制作血管內(nèi)微支架逐漸應(yīng)用于顱內(nèi)動脈瘤的治療,尤其是在顱內(nèi)寬頸動脈瘤的栓塞過程中,采用支架輔助栓塞能起到滿意的栓塞效果。血管內(nèi)支架的植入,可以對彈簧圈起到很好的支撐作用,在填塞寬頸動脈瘤過程中,可以有效的防止彈簧圈脫出,起到穩(wěn)定彈簧圈的作用,使彈簧圈在瘤內(nèi)達到致密填塞。與此同時,由于血管內(nèi)栓塞材料的植入,局部血管的相關(guān)參數(shù)將會受到一定的影響。然而,目前臨床上缺少能證實支架治療動脈瘤安全性和療效的大宗病例報道,支架在顱內(nèi)的應(yīng)用還有一些安全性問題需要研究評估。本次研究是通過對支架輔助栓塞血管分叉部位顱內(nèi)動脈瘤短期和長期的隨訪,研究血管內(nèi)支架的植入對局部血管的幾何構(gòu)型及分叉部位血管角度改變。臨床中發(fā)現(xiàn)血管內(nèi)支架的植入會明顯的改變植入部位血管的形狀,因此希望通過本研究,探究支架引起的血管變形與血管分叉部位動脈瘤患者預后之間的相關(guān)性。研究方法：回顧分析2011年～2014年在我院接受介入治療的顱內(nèi)寬頸動脈瘤患者資料,選取接受血管內(nèi)支架輔助栓塞治療的30例顱內(nèi)動脈分叉部位動脈瘤患者,應(yīng)用了31枚自膨式支架,輔助栓塞31個動脈分叉部動脈瘤,應(yīng)用13枚Solitaire支架和18枚Enterprise支架。采用三維腦血管造影圖像處理技術(shù),測量血管分叉部位主干血管與分支血管之間的夾角,采用統(tǒng)計學分析術(shù)前與術(shù)后及術(shù)后隨訪的腦血管造影結(jié)果,觀察血管幾何構(gòu)型的改變,及與動脈瘤復發(fā)之間相關(guān)性。研究結(jié)果：血管內(nèi)支架的植入明顯改變了血管分叉部位的角度,且遠端血管的變化較近端血管的變化更明顯(AcoAMCABAICA-PcoA)。隨著隨訪時間的延長,血管的角度改變越明顯。在血管分叉部位動脈瘤的栓塞治療過程中,支架輔助栓塞可以降低動脈瘤的復發(fā)率。研究結(jié)論：血管內(nèi)支架的植入可以改變動脈分叉部位血管的形態(tài),引起主干血管與分支血管之間的夾角改變,這種改變與血管分叉的位置及應(yīng)用的支架類型有關(guān)。另外,血管內(nèi)支架的應(yīng)用可以有效的降低動脈瘤的復發(fā)率,在治療顱內(nèi)動脈分叉部位動脈瘤方面安全可靠。
[Abstract]:Background & objective: intracranial aneurysm is a common cerebrovascular disease in neurosurgery. With the development of technology, the use of memory alloy to make intravascular microstent gradually used in the treatment of intracranial aneurysms, especially in the embolization process of intracranial wide-necked aneurysms, stent-assisted embolization can play a satisfactory embolization effect. The implantation of intravascular stent can support the coil very well. In the process of packing wide neck aneurysm, it can effectively prevent the coils from coming out and stabilize the coils, so that the coils can be tightly packed in the tumor. At the same time, the parameters of local vessels will be affected due to the implantation of endovascular embolization materials. However, there is a lack of clinical evidence of the safety and efficacy of stenting for aneurysms, and there are still a number of safety issues to be studied and evaluated for the use of stents in intracranial aneurysms. The purpose of this study was to investigate the effects of stent-assisted embolization of intracranial aneurysms on local vascular geometry and the angle of the branched vessels. It is hoped that the relationship between angioplasty induced by stents and the prognosis of patients with aneurysms at the bifurcation site will be explored through this study. Methods: the data of patients with intracranial wide-necked aneurysms received interventional therapy in our hospital from 2011 to 2014 were retrospectively analyzed. Thirty patients with intracranial artery bifurcation aneurysms received endovascular stent-assisted embolization. 31 self-expandable stents were used to embolize 31 artery bifurcation aneurysms, 13 Solitaire stents and 18 Enterprise stents were used. Three-dimensional angiography image processing technique was used to measure the angle between the main vessel and the branch vessel in the bifurcation part of the blood vessel. The results of cerebral angiography before and after operation were statistically analyzed to observe the changes of the geometric configuration of the blood vessel. And its association with aneurysm recurrence. Results: the angle of vascular bifurcation was significantly changed by the implantation of endovascular stent, and the change of distal vessel was more obvious than that of proximal vessel (AcoAMCABAICA-PcoA). With the extension of follow-up time, the change of the angle of blood vessel became more obvious. Stent-assisted embolization can reduce the recurrence rate of aneurysms. Conclusion: endovascular stent implantation can change the shape of the artery and cause the change of the angle between the main vessel and the branch vessel, which is related to the position of the vascular bifurcation and the type of stent used. In addition, the application of endovascular stent can effectively reduce the recurrence rate of aneurysms and is safe and reliable in the treatment of intracranial artery bifurcation aneurysms.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1
本文編號：2247635
[Abstract]:Background & objective: intracranial aneurysm is a common cerebrovascular disease in neurosurgery. With the development of technology, the use of memory alloy to make intravascular microstent gradually used in the treatment of intracranial aneurysms, especially in the embolization process of intracranial wide-necked aneurysms, stent-assisted embolization can play a satisfactory embolization effect. The implantation of intravascular stent can support the coil very well. In the process of packing wide neck aneurysm, it can effectively prevent the coils from coming out and stabilize the coils, so that the coils can be tightly packed in the tumor. At the same time, the parameters of local vessels will be affected due to the implantation of endovascular embolization materials. However, there is a lack of clinical evidence of the safety and efficacy of stenting for aneurysms, and there are still a number of safety issues to be studied and evaluated for the use of stents in intracranial aneurysms. The purpose of this study was to investigate the effects of stent-assisted embolization of intracranial aneurysms on local vascular geometry and the angle of the branched vessels. It is hoped that the relationship between angioplasty induced by stents and the prognosis of patients with aneurysms at the bifurcation site will be explored through this study. Methods: the data of patients with intracranial wide-necked aneurysms received interventional therapy in our hospital from 2011 to 2014 were retrospectively analyzed. Thirty patients with intracranial artery bifurcation aneurysms received endovascular stent-assisted embolization. 31 self-expandable stents were used to embolize 31 artery bifurcation aneurysms, 13 Solitaire stents and 18 Enterprise stents were used. Three-dimensional angiography image processing technique was used to measure the angle between the main vessel and the branch vessel in the bifurcation part of the blood vessel. The results of cerebral angiography before and after operation were statistically analyzed to observe the changes of the geometric configuration of the blood vessel. And its association with aneurysm recurrence. Results: the angle of vascular bifurcation was significantly changed by the implantation of endovascular stent, and the change of distal vessel was more obvious than that of proximal vessel (AcoAMCABAICA-PcoA). With the extension of follow-up time, the change of the angle of blood vessel became more obvious. Stent-assisted embolization can reduce the recurrence rate of aneurysms. Conclusion: endovascular stent implantation can change the shape of the artery and cause the change of the angle between the main vessel and the branch vessel, which is related to the position of the vascular bifurcation and the type of stent used. In addition, the application of endovascular stent can effectively reduce the recurrence rate of aneurysms and is safe and reliable in the treatment of intracranial artery bifurcation aneurysms.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1
【參考文獻】
相關(guān)期刊論文 前1條
1 劉建民,張鑫,周曉平,洪波,許奕,黃清海,張瓏,佘家貴,趙瑞;血管內(nèi)支架結(jié)合電解可脫卸彈簧圈治療犬頸動脈寬頸動脈瘤的實驗研究[J];介入放射學雜志;2004年03期
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