Hayashi Kentaro, Kitagawa Naoki, Morikawa Minoru, Kawakubo Jun-ichi, Hiu Takeshi, Horie Nobutaka, Tsutsumi Keisuke, Nagata Izumi
Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki-city, Nagasaki 852-8501, Japan.
No Shinkei Geka. 2006 Oct;34(10):1035-40.
Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows attenuated packing of the coils. However, during the course of the embolization, coils project over and obscure the parent vessel. Here we report a novel technique for endovascular parent vessel reconstruction with aneurysm embolization. A 73-year-old male had an incidental fusiform aneurysm at the V4 segment of the left vertebral artery. The size of the aneurysm increased from 7 mm to 8 mm in diameter. Since the right vertebral artery was hypoplastic, endovascular parent vessel reconstruction with coil embolization was performed. A flexible balloon-expandable coronary stent was navigated to the lesion and deployed successfully followed by coil embolization using a microcatheter through the stent. The balloon was inflated intermittently during coil insertion avoiding coil migration to inside the stent. Furthermore, the angle of the image intensifier was manipulated to visualize the inside of the stent. Postoperative course was uneventful and follow-up MRI three moths later demonstrated obliteration of the aneurysm and patency of the parent artery. This technique provides a practical treatment strategy for the management of a circumferential aneurysm.
在动脉瘤颈部放置支架并进行二次弹簧圈栓塞可防止弹簧圈移位，并允许更稀疏地填充弹簧圈。然而，在栓塞过程中，弹簧圈会突出并遮挡载瘤血管。在此，我们报告一种用于动脉瘤栓塞的血管内载瘤血管重建新技术。一名73岁男性在左椎动脉V4段发现一个偶然的梭形动脉瘤。动脉瘤直径从7毫米增大到8毫米。由于右侧椎动脉发育不良，遂进行了血管内载瘤血管重建并联合弹簧圈栓塞。将一个可通过球囊扩张的柔性冠状动脉支架输送至病变部位并成功释放，随后通过支架使用微导管进行弹簧圈栓塞。在插入弹簧圈期间间歇性地充盈球囊，避免弹簧圈移入支架内部。此外，调整影像增强器的角度以观察支架内部情况。术后过程顺利，三个月后的随访磁共振成像显示动脉瘤闭塞且载瘤动脉通畅。该技术为治疗环形动脉瘤提供了一种切实可行的治疗策略。
