Kazekawa K, Oka K, Aikawa H, Tomonaga M, Yoshimura S, Yoshioka T, Hosoda H
Department of Neurosurgery, Fukuoka University School of Medicine; Fukuoka, Japan.
Interv Neuroradiol. 1999 Nov;5 Suppl 1:103-8. doi: 10.1177/15910199990050S119. Epub 2001 May 15.
Novel endovascular approaches are needed for safer and more definitive treatment of wide-necked aneurysms, to overcome the limitations of the Guglielmi detachable coil (GDC) system and further, the application of this technique. The double GDC technique (DGT), for embolization of wide-necked aneurysms, and the combination of stent placement and coil deposition(CTSC) for management of fusiform aneurysms have been developed and their usefulness is reviewed. The DGT involves scaffolding of a GDC coil to form a stabilizing frame inside the aneurysmal neck and then positioning of a second coil to reinforce the first coil. After confirming the absence of coil herniation in the parent artery, both coils are released together. A patient with a wide-necked large aneurysm of the left internal carotid artery was treated using this technique, and followed up angiographically and clinically for a period of three months. The follow-up angiograms revealed complete embolization of the aneurysm. The patient had no neurological changes or adverse events during the procedure. The CTSC involves reconstructing the artery with a stent and packing the aneurysm lumen with GDCs through the stent interstices. A patient with a dissecting fusiform aneurysm of the vertebral artery associated with hypoplasia of the contralateral vertebral artery was treated using this technique to prevent rebleeding. His clinical course was uneventful over a six-month follow-up period. Angiography performed two months after the procedure confirmed excellent flow through the right vertebral artery and absence offilling of the daughter aneurysm.
为了更安全、更确切地治疗宽颈动脉瘤，克服 Guglielmi 可脱卸弹簧圈（GDC）系统的局限性以及该技术的进一步应用，需要新的血管内治疗方法。已开发出用于宽颈动脉瘤栓塞的双 GDC 技术（DGT）以及用于梭形动脉瘤治疗的支架置入与弹簧圈填塞联合技术（CTSC），并对其有效性进行了综述。DGT 包括用一个 GDC 弹簧圈搭建支架，在动脉瘤颈部内部形成一个稳定框架，然后放置第二个弹簧圈以加固第一个弹簧圈。在确认母动脉中无弹簧圈疝出后，将两个弹簧圈一起释放。一名患有左颈内动脉宽颈大动脉瘤的患者采用该技术进行了治疗，并进行了为期三个月的血管造影和临床随访。随访血管造影显示动脉瘤完全栓塞。患者在手术过程中没有神经功能改变或不良事件。CTSC 包括用支架重建动脉，并通过支架间隙用 GDC 填充动脉瘤腔。一名患有椎动脉夹层梭形动脉瘤且对侧椎动脉发育不全的患者采用该技术进行治疗以预防再出血。在六个月的随访期内，他的临床病程平稳。术后两个月进行的血管造影证实右椎动脉血流良好，子动脉瘤无造影剂充盈。
