Cho Young Dae, Rhim Jong Kook, Park Jeong Jin, Jeon Jin Pyeong, Kang Hyun-Seung, Kim Jeong Eun, Cho Won-Sang, Han Moon Hee
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
Neuroradiology. 2015 Jul;57(7):705-11. doi: 10.1007/s00234-015-1516-6. Epub 2015 Mar 28.
Although various protective techniques for treating wide-necked intracranial aneurysms currently exist and continue to evolve, their utility may be limited in some lesions with complex configurations, small-caliber channels, or inherently tortuous vascular patterns. Described herein is a modified coil protection technique as a novel adjunct for proper coil frame configuration.
Initially, a microcatheter is passed into aneurysmal sac, and the first coil is inserted to build a frame. Inevitably, some coils may abut opposite poles of aneurysms and protrude into parent arteries. Should this happen, a second microcatheter may be placed at the site of coil protrusion, so that a separate and smaller coil may be partially deployed for protection. A framing coil may then be configured within aneurysmal sac, under protection of the secondary coil. Once the first coil is entirely in place, the remainder of second coil is carefully inserted, and additional coil may be inserted as needed via dual microcatheters.
This technique was successfully applied to 23 saccular intracranial aneurysms of internal carotid (n = 8), middle cerebral (n = 6), anterior cerebral (n = 6), and superior cerebellar artery (n = 3), combining stent protection in two patients and balloon remodeling in one. Selective endovascular treatment was effective as a result. Excellent outcomes were achieved in all patients, with no morbidity or mortality directly related to the modified procedure.
As suggested by outcomes of this small study, our modified coil protection method may be a safe option if traditional coiling strategies are not feasible, enabling stable coil frame configuration in wide-necked aneurysms.
尽管目前存在多种治疗宽颈颅内动脉瘤的保护技术且这些技术仍在不断发展，但在一些具有复杂结构、小口径通道或固有迂曲血管形态的病变中，它们的效用可能有限。本文描述了一种改良的弹簧圈保护技术，作为一种用于正确构建弹簧圈框架的新型辅助方法。
首先，将微导管送入动脉瘤囊内，插入第一个弹簧圈以构建框架。不可避免地，一些弹簧圈可能会抵靠动脉瘤的相对两极并突入载瘤动脉。如果发生这种情况，可以在弹簧圈突出部位放置第二个微导管，以便可以部分释放一个单独的较小弹簧圈用于保护。然后可以在第二个弹簧圈的保护下在动脉瘤囊内构建一个成篮弹簧圈。一旦第一个弹簧圈完全就位，小心插入第二个弹簧圈的其余部分，并可根据需要通过双微导管插入额外的弹簧圈。
该技术成功应用于23个囊状颅内动脉瘤，其中颈内动脉8个、大脑中动脉6个、大脑前动脉6个、小脑上动脉3个，2例患者联合使用支架保护，1例患者联合使用球囊重塑。选择性血管内治疗因此有效。所有患者均取得了良好的结果，没有与改良手术直接相关的发病率或死亡率。
正如这项小型研究的结果所示，如果传统的弹簧圈栓塞策略不可行，我们改良的弹簧圈保护方法可能是一种安全的选择，能够在宽颈动脉瘤中实现稳定的弹簧圈框架构建。
