Rahme Ralph, Grande Andrew, Jimenez Lincoln, Abruzzo Todd A, Ringer Andrew J
Department of Neurosurgery, University of Cincinnati (UC) College of Medicine and Comprehensive Stroke Center at UC Neuroscience Institute, 260 Stetson Street, ML 0515, Cincinnati, OH 45267-0515, USA; Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
Department of Neurosurgery, University of Cincinnati (UC) College of Medicine and Comprehensive Stroke Center at UC Neuroscience Institute, 260 Stetson Street, ML 0515, Cincinnati, OH 45267-0515, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
J Clin Neurosci. 2014 Aug;21(8):1383-7. doi: 10.1016/j.jocn.2014.01.004. Epub 2014 Apr 18.
The conventional technique of intracranial aneurysm embolization using Onyx HD-500 (ev3 Neurovascular, Irvine, CA, USA) involves repetitive balloon inflation-deflation cycles under general anesthesia. By limiting parent artery occlusion to 5 minutes, this cyclic technique is thought to minimize cerebral ischemia. However, intermittent balloon deflation may lengthen procedure time and allow balloon migration, resulting in intimal injury or Onyx leakage. We report our experience using a modified technique of uninterrupted Onyx injection with continuous balloon occlusion under conscious sedation. All Onyx embolization procedures for unruptured aneurysms performed by the senior author (A.J.R.) between September 2008 and April 2010 were retrospectively reviewed. Demographic, clinical, angiographic, and procedural data were recorded. Twenty-four embolization procedures were performed in 21 patients with 23 aneurysms, including four recurrences. Twenty aneurysms (87%) involved the paraclinoid or proximal supraclinoid internal carotid artery. Size ranged from 2.5 to 24mm and neck diameter from 2 to 8mm. The modified technique was employed in 19 cases. All but one patient (94.4%) tolerated continuous balloon inflation. Complete occlusion was achieved in 20 aneurysms (83.3%) and subtotal occlusion in three (12.5%). Stable angiographic results were seen in 85%, 94%, 94%, and 100% of patients at 6, 12, 24, and 36months, respectively. There were no deaths. Permanent non-disabling neurological morbidity occurred in one patient (4.2%). Minor, transient, and/or angiographic complications were seen in three patients (12.5%), none related to the technique itself. Onyx embolization of unruptured intracranial aneurysms can be safely and effectively performed using continuous balloon inflation under conscious sedation.
使用Onyx HD - 500（美国加利福尼亚州欧文市ev3神经血管公司）进行颅内动脉瘤栓塞的传统技术，需要在全身麻醉下反复进行球囊充放气循环操作。通过将载瘤动脉闭塞时间限制在5分钟，这种循环技术被认为可使脑缺血降至最低。然而，间歇性球囊放气可能会延长手术时间并导致球囊移位，从而造成内膜损伤或Onyx渗漏。我们报告了在清醒镇静下采用不间断Onyx注射并持续球囊闭塞的改良技术的经验。对2008年9月至2010年4月期间由资深作者（A.J.R.）进行的所有未破裂动脉瘤的Onyx栓塞手术进行了回顾性分析。记录了人口统计学、临床、血管造影和手术数据。对21例患者的23个动脉瘤进行了24次栓塞手术，其中包括4例复发病例。20个动脉瘤（87%）累及床突旁或床突上段颈内动脉。大小范围为2.5至24毫米，颈部直径为2至8毫米。19例采用了改良技术。除1例患者（94.4%）外，所有患者均耐受持续球囊充气。20个动脉瘤（83.3%）实现了完全闭塞，3个（12.5%）实现了次全闭塞。在6、12、24和36个月时，分别有85%、94%、94%和100%的患者血管造影结果稳定。无死亡病例。1例患者（4.2%）发生永久性非致残性神经功能障碍。3例患者（12.5%）出现轻微、短暂和/或血管造影相关并发症，均与技术本身无关。在清醒镇静下采用持续球囊充气可安全有效地进行未破裂颅内动脉瘤的Onyx栓塞。
