| Section oneAnalysis of the clinical data about the patients of intracranial aneurysmObjective To investigate and conclude the proportion of aneurysm in various location and different clinical types, imaging findings and clinical representation, make the methods of clinical classification in reason.To summarize the therapeutic methods of endovascular embolization for the treatment of aneurysms in various location and clinical types,the relativity between the size of aneurym and the length of coils ,and apply to clinic.meanwhile, establish our characteristic cases group of intracranial aneurysms.To observe the short-term and the long-term effectiveness after endovascular embolization for the treatment of aneurysm, and to handle recovery outcome of patients clinical therapy. The results of the study could direct the treatment and determine the prognosis for endovascular embolization of aneurysm.Methods 343 patients with intracranial aneurysm were analyzed retrospectively from March 1999 to March 2005,all patients with aneurysms were confirmed by DSA and treated in our department during the past 6 years.The clinical data will be analyzed according various clinical classification into different results. Sexal ratio,age of patients, the first symptom of patient, thetimes of SAH, the time between two times of SAH,CT or MRI fingding, Hunt and Hess grading scale, the size of aneurysm, the length of coils,the occlusion rate, complications during procedure(include coils escaped, thrombus associated with coils and aneurysm ruptured during procedure ), hydrocephalus after SAH, days in hospital, Rankin' s scale at leaving hospital, times of follow up by DSA, interval of follow up(m), recurrent ratio after coiling. All the information of patients were filled in clinical questionnaires and tabled with Excel ,all the data were statisted with SPSS10.0 statistical software package.Results 343 patients with 402 intracranial aneurysms were treated in our department during the past 6 years, male 146 cases, femalel97 cases, female/male radio equal to 2.7/2, the average age of male is 45.05 years old and female is 50.94, the average age of male and female is 48.58 years old . 48 patients with more than two aneurysms, male 14 cases, female34 cases, female/male radio equal to 2.4/1,10 patients with more man three aneurysms, female 9 cases, male 1 cases female/male radio equal to 9/1.Aneurysms arise from internal carotid and posterior communicating artery are 202 cases, account for 50.25%, from anterior communicating artery are 112 cases, account for 27.86%, from anterior cerebral artery are 14 cases, account for 3.48% , from middle cerebral artery are 32 cases, account for 7.96%, from vertebral and basilar artery are 42 cases, account forlO.45%. In this cases of group,small aneurysms account for more than half of all, 203 cases,about 50.50%,middle aneurysms are 166 cases,account for 41.29%, larg aneurysms are 19 cases,account for 4.79%, giant aneurysms are 14 cases,account for 3.48%.More statistical results present:the symptom of patients with aneurysm associates with the size and sites of aneurysm, in the group of aneurysms being occluded in grade I ° , the length of coils was counted by four multiple formula.Conclusion This group of clinic patients with aneurysms have natural random,the statistical results of baseline characteristics are close to the results of a large series of cases which were reported by articles.The statistical results are confident according to the data. We redefined the size of aneurysm and reclassified the degree of occlusion, and thereout a simple four multiple formula was made, it will be applied for helping aneurysms embolizing in saft and efficiency.Section two Evaluation of intra-aneurysmal blood flow dynamics change throughanalyzing DSA imagesObjective To establish a new method to evaluate the blood flow dynamics change of intra-aneurysms through analyzing the images of digital subtraction angiography( DSA). To evaluate blood flow change within parent artery and aneurysm while the procedure was going on, after contrasting tintra-aneurysm blood flow from their size, investigate the cause of intra-aneurysmal recurrences after embolizing, The results of the study could be applied for consulting aneurysms embolizing in saft and efficiency.Methods The video signal of serial DSA images of 15 aneurysms in 15 patients was stored on a personal computer, and initial time-density curves were obtained for each individual pixel. The formula, determined by a two-exponential model, was fitted to the timedensity curve 1000 times by least square approximation for each individual pixel. We indirectly substituted the coefficient of the flow-in curve for the blood flow. We were therefore able to display the distribution of intra-aneurysmal blood flow in color. We could compare the blood flow in each portion of the cerebral aneurysm and parent artery during coil embolization.Results The outcome of study present that the intra-aneurysm blood flow index ka submits negative correlation, namely blood flow in a small aneurysm was faster than that in a large aneurysm, and in the centre of aneurysm it will get slower and slower in accordance with the coil embolization. The blood flow in a large aneurysm was sometimes accelerated by incomplete coil embolization, it may be the cause of intra-aneurysmal recurrences after embolizing.Conclusion We can detect the flow distribution in cerebral aneurysms and the flow change during coil embolization, using existing equipment. Our method would be useful in elucidating the natural history of cerebral aneurysms, treating cerebralaneurysms with coils, and following patients after treatment.Evaluation of clinical technique for endovascular embolization ofintranacial aneurysmObjective To study and summarize the representative clinical technique forendovascular embolization of intranacial aneurysm,introduce the information about GDC. To estimate the characteristic of occlusive material according to the clinical data. To introduce the technique of reconstructing parent artery and neck of aneurysm, and raise it in systemic theoretics, it will be applied for helping aneurysms embolization.Methods In this section, we will summarize and analyze three pivotal techniques for clinical application according as the clinical data. First, to discuss GDC technique for endovascular embolization of aneurysms, include microcatheter tip steam reconstruction, microcatheter is tracked and delivery for secure positioning of the catheter tip within aneurysms. Second, appliances technique of embolic materials, we will estimate indications in using different materials through retrospecting the clinical data. At last,we will discuss the technique of reconstructing parent artery and neck of aneurysm in endovascular embolization of aneurysms. Include traditional technique of Remodeling namely Balloon and Coils, the othe techniques are Neuroform and Coils, Balloon and Onyx, Stent and Balloon and Onyx, Coils and Balloon and Onyx and cover Stent only .to estimate impersonality the value of application of this material in clinic, advance the new concept of reconstructing parent artery and neck of aneurysm.Results In this group of cases, 50 aneuryams were treated by endovascular embolization among patients who were older than 60 years with anterior communicating artery aneurysms, thereinto, superior projection 18 cases,anterior projection 15 cases, inferior projection 17 cases, the rate of ideal positioning of the microcatheter tip in anterior and inferior aneurysms were 100%, while the superiorprojection aneurysms were only 88.98%, 2 cases failed for ideal positioning. In the group of 402 aneurysms, 303 aneurysms were treated by endo vascular embolization , the kinds of embolism materials were more than 10, according as different conditions, one aneurysm may use more than one material, we have statisticed it exactly, namely, 277 aneurysms were embolized by coils(see tablel-13). Wide neck aneurysms were mainly treated with Neuroform and Coils, 10 cases in all, one case was follow up ,no recrudescence was found.Conclusion During procedure, the angle of microcatheter tip must be steamed according as artery tracking in different condition, it is very important to keep the microcatheter steady within aneurysms. Different materials were use in different conditions, it must be personal choose. The advangtage of biocoils still were observed in follow up. the technique of reconstructing parent artery and neck of aneurysm in endovascular embolization of aneurysms was not only applied in wide neck aneurysms,but also applied in fusiform and giant aneurysms, reconstruction of parent artery was not only for the saccular,but for the parent artery near the aneurysms' neck, because blood dynamics was changed within parent artery after the neck of aneurysms reconstructing. |
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