Hoya Katsumi, Hyodo Akio
Department of Neurosurgery, Teikyo University, Chiba Medical Center, 3426 3 Anesaki, Ichihara shi, Chiba 299 0111, Japan.
Brain Nerve. 2009 Sep;61(9):1029-41.
Endovascular therapy for cerebral aneurysms has been possible since the advent of Guglielmi detachable coils. The International Subarachnoid Aneurysm Trial (ISAT) showed that the 1-year outcome of endovascular coiling for ruptured aneurysms was significantly better than that of neurosurgical clipping. After the ISAT study, remarkably high numbers of aneurysms have been treated using coils across the world. Digital subtraction angiography (DSA) system and its road map function are also essential for endovascular therapy. Three-dimensional DSA is helpful in understanding the anatomy of an aneurysm that has to be treated and determining the working angle for coiling. The biplane system is also useful for embolization. Many kinds of coils such as three-dimensional shaped coils and stretch-resistant coils have been invented. These coils, in combination with balloon-or stent-assisted techniques, enable the treatment of difficult aneurysms such as those with wide necks. Bioactive coils allow the healing of aneurysm by promoting tissue reaction. However, it is difficult to cure very large and giant aneurysms even with the new coils. Hence flow-diverting stents and Onyx are being clinically tested for the treatment of such cases.
自从 Guglielmi 可脱卸弹簧圈问世以来，颅内动脉瘤的血管内治疗成为可能。国际蛛网膜下腔动脉瘤试验（ISAT）表明，破裂动脉瘤血管内弹簧圈栓塞治疗的 1 年预后显著优于神经外科夹闭术。ISAT 研究之后，全球范围内使用弹簧圈治疗的动脉瘤数量显著增加。数字减影血管造影（DSA）系统及其路径图功能对于血管内治疗也至关重要。三维 DSA 有助于了解待治疗动脉瘤的解剖结构并确定弹簧圈栓塞的工作角度。双平面系统对栓塞治疗也很有用。已经发明了多种弹簧圈，如三维形状弹簧圈和抗拉伸弹簧圈。这些弹簧圈与球囊或支架辅助技术相结合，能够治疗诸如宽颈动脉瘤等复杂动脉瘤。生物活性弹簧圈可通过促进组织反应实现动脉瘤愈合。然而，即使使用新型弹簧圈，治疗非常大的动脉瘤和巨大动脉瘤仍很困难。因此，血流导向支架和 Onyx 正在针对此类病例进行临床试验。
