Cho Young Dae, Rhim Jong Kook, Kang Hyun-Seung, Park Jeong Jin, Jeon Jin Pyeong, Kim Jeong Eun, Cho Won Sang, Han Moon Hee
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
Korean J Radiol. 2015 Sep-Oct;16(5):1109-18. doi: 10.3348/kjr.2015.16.5.1109. Epub 2015 Aug 21.
The dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms.
Data accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment.
The triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 ± 22.7 months).
The outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations.
由于安全性和有效性，双微导管技术是宽颈动脉瘤弹簧圈栓塞的常用方法。然而，一些复杂结构的技术局限性可能需要额外的微导管来增强弹簧圈的稳定性、压实弹簧圈或提供保护。本文介绍一种用于宽颈颅内动脉瘤血管内治疗的三微导管技术。
回顾2006年1月至2014年10月期间对38例囊状动脉瘤同时进行三微导管弹簧圈栓塞手术的前瞻性收集的数据。评估临床和形态学结果，重点关注治疗的技术方面。
三微导管技术成功应用于所有38例囊状动脉瘤，包括后交通动脉（n = 13）、大脑中动脉（n = 10）、基底动脉尖（n = 7）、大脑前动脉（n = 5）和颈内动脉（n = 3）。4例患者加用了支架保护，1例患者采用了球囊重塑。通常使用双微导管（n = 24）在动脉瘤囊内输送弹簧圈，额外的微导管用于保护。否则，使用三微导管输送弹簧圈（n = 11）或通过单微导管输送弹簧圈，使用双微导管进行保护（n = 3）。89.5%的病例实现了动脉瘤的成功闭塞，无手术相关的发病率或死亡率。在最后一次随访（平均间隔30.2±22.7个月）时，72.2%（26/36）的动脉瘤保持稳定闭塞。
这项有限研究的结果表明，三微导管技术可能是一种治疗宽颈动脉瘤的有效且安全的治疗选择，采用针对复杂血管解剖结构定制的技术策略。
