Tone Osamu, Sato Yohei, Tamaki Masashi, Takada Yoshiaki
Stroke Center, Ome Municipal General Hospital, Ome, Tokyo, Japan.
Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan.
J Neuroendovasc Ther. 2022;16(6):313-319. doi: 10.5797/jnet.cr.2021-0082. Epub 2021 Oct 1.
Morphologically challenging cerebral aneurysms cannot be treated through standard endovascular procedures. We report two cases of ruptured aneurysms treated using coils and n-butyl cyanoacrylate (NBCA).
Case 1 was an 80-year-old woman diagnosed with a subarachnoid hemorrhage (SAH). An angiogram revealed a large and wide-necked basilar artery bifurcation aneurysm. Bilateral superior cerebellar and posterior cerebral arteries (PCAs) originated from the aneurysmal wall. A 3-mm-diameter bleb was detected on the aneurysmal fundus. The bleb enlarged 1 month following coil insertion. During the second treatment, we infused a small volume of 33% NBCA into the coil-framed bleb following proximal flow control of the bilateral vertebral arteries (VAs). The complete bleb obliteration was confirmed by the angiogram at 6 months later. The coil shape was followed up via plane X-ray for 5 years. No rebleeding occurred. Case 2 was a 41-year-old woman diagnosed with SAH. An angiogram revealed a dissecting aneurysm of the left PCA (P1 and P2 segments) accompanying a bleb on the P1 segment. Endovascular treatment was performed, and a coil was inserted into the bleb, infusing 33% NBCA into the coil frame following proximal flow control of bilateral VAs and the right internal carotid artery. Angiograms conducted at 3 months, 1 year, and 9 years and an MRA conducted 12 years later revealed a lack of bleb recanalization.
We developed a Coil and NBCA technique to obliterate ruptured blebs following proximal flow control. This technique can be considered an effective alternative for treating morphologically challenging cerebral aneurysms.
形态复杂的脑动脉瘤无法通过标准的血管内手术进行治疗。我们报告两例使用弹簧圈和正丁基氰基丙烯酸酯（NBCA）治疗的破裂动脉瘤病例。
病例1是一名80岁女性，诊断为蛛网膜下腔出血（SAH）。血管造影显示为一个大型宽颈基底动脉分叉动脉瘤。双侧小脑上动脉和大脑后动脉（PCA）起源于动脉瘤壁。在动脉瘤底部检测到一个直径3毫米的小泡。弹簧圈置入1个月后小泡增大。在第二次治疗中，在双侧椎动脉（VA）近端血流控制后，我们将少量33%的NBCA注入弹簧圈构筑的小泡内。6个月后的血管造影证实小泡完全闭塞。通过平面X线对弹簧圈形态进行了5年的随访。未发生再出血。病例2是一名41岁女性，诊断为SAH。血管造影显示左侧PCA（P1和P2段）夹层动脉瘤，P1段伴有一个小泡。进行了血管内治疗，将一个弹簧圈置入小泡内，在双侧VA和右侧颈内动脉近端血流控制后，将33%的NBCA注入弹簧圈框架内。在3个月、1年和9年时进行的血管造影以及12年后进行的磁共振血管造影（MRA）显示小泡未再通。
我们开发了一种弹簧圈和NBCA技术，用于在近端血流控制后闭塞破裂的小泡。该技术可被视为治疗形态复杂脑动脉瘤的一种有效替代方法。
