Department of Neurosurgery, Nagoya University Graduate School of Medicine.
Neurol Med Chir (Tokyo). 2021 Apr 15;61(4):284-291. doi: 10.2176/nmc.tn.2020-0329. Epub 2021 Feb 26.
Internal trapping with coils is an established treatment of symptomatic large non-branching thrombosed fusiform vertebral artery aneurysms (VAA). However, when perforators arise near the aneurysm neck, parent artery occlusion has a high risk of causing medullary infarction. As an alternative treatment, we performed short-segment internal trapping of the artery using n-butyl-2-cyanoacrylate (NBCA) and coils (bird's nest trapping). Before treatment, perianeurysmal perforators are carefully detected using high-resolution three-dimensional rotational angiography (3DRA). Double microcatheters are advanced to the distal portion of the aneurysm through a balloon guiding catheter where coils are deployed without tight packing. Then, NBCA is injected into the coil mass, taking care to preserve perforators and significant branches. The same maneuver is repeated in the proximal portion of the aneurysm. Coil placement is avoided within the middle of the aneurysm; however, if necessary, only a small number of coils are placed to prevent worsening of mass effect. Two quinquagenarian males presented with a large thrombosed fusiform VAA that caused symptoms due to mass effect. In each case, perforators arose from the parent artery and short-segment internal trapping with NBCA and coils was performed. Symptoms improved after treatment and follow-up imaging confirmed aneurysm shrinkage with no long-time recurrence. In symptomatic large fusiform VAAs where the distance from the lesion to important perforators is extremely short, internal trapping using a combination of NBCA and coils can be more useful than conventional internal trapping.
血管内线圈内圈技术是治疗有症状的大型非分支梭形椎动脉动脉瘤（VAA）的成熟方法。然而，当穿支动脉起源于瘤颈附近时，动脉闭塞会导致延髓梗死的风险很高。作为一种替代治疗方法，我们使用 n-丁基-2-氰基丙烯酸酯（NBCA）和线圈（鸟巢式圈套）进行短节段动脉内圈闭。在治疗前，使用高分辨率三维旋转血管造影（3DRA）仔细检测瘤周穿支动脉。双微导管通过球囊引导导管推进到动脉瘤的远端，在那里不进行紧密填塞而部署线圈。然后，将 NBCA 注入线圈团中，注意保护穿支动脉和重要分支。在动脉瘤的近端重复同样的操作。线圈放置避开动脉瘤的中部；但是，如果有必要，仅放置少量线圈，以防止肿块效应恶化。两名 50 多岁的男性均因大型血栓性梭形 VAA 引起的症状而就诊，该动脉瘤因肿块效应而导致症状。在每种情况下，均从母动脉发出穿支动脉，并用 NBCA 和线圈进行短节段内圈闭。治疗后症状改善，随访影像学证实动脉瘤缩小，无长时间复发。在有症状的大型梭形 VAA 中，病变与重要穿支动脉之间的距离极短，使用 NBCA 和线圈的联合内圈闭术可能比传统的内圈闭术更有用。
