Clinical Applied Study Of Endovascular Interventional Treatment For Intracranial Aneurysm

Section one Analysis of the clinical data about the patients of intracranial aneurysmObjective To investigate and conclude the proportion of aneurysm in variouslocation and different clinical types, imaging findings and clinical representation, makethe methods of clinical classification in reason.To summarize the therapeutic methods ofendovascular embolization for the treatment of aneurysms in various location and clinicaltypes,the relativity between the size of aneurysm and the length of coils, and apply toclinic.Meanwhile,we will establish our characteristic cases group of intracranialaneurysms.We observed the short-term and the long-term effectiveness after endovascularembolizing for the treatment of aneurysm, and handled recovery outcome of patientsclinical therapy. The results of the study could direct the treatment and determine theprognosis for endovascular embolization of aneurysm.Methods 215 patients with intracranial aneurysms were analyzed retrospectively fromOctober 1999 to October 2006.All patients with aneurysms were confirmed by DSA andtreated in our department during the past 7 years.The clinical data will be analyzedaccording to various clinical classification into different results. The data includes sexalratio,age of patients, relative diseases history, Hunt and Hess grading scale, the size ofaneurysm, the length of coils, complications during procedure(include coils escaped, thrombus associated with coils and aneurysm ruptured during procedure), hydrocephalusafter SAH, days in hospital. All the information of patients were filled in clinicalquestionnaires and tabled with Excel.Results 215 patients with 231 intracranial aneurysms were treated in our departmentduring the past 7 years, male 78 cases, female96 cases, female/male radio equal to 4/3,the average age of male is 41 years old and female is 49.12 patients with more than twoaneurysms, male 4 cases, female 8 cases, female/male radio equal to 2/1.Aneurysmsarise from internal carotid and posterior communicating artery are 116 cases, account for50.2%, from anterior communicating artery are 41 cases, account for 17.8%, fromanterior cerebral artery are 7 cases, account for 3.0%, from middle cerebral artery are 28cases, account for 12.2%, from vertebral and basilar artery are 39 cases, account for16.8%. In this cases of group,small aneurysms account for more than half of all, 119cases,about 51.6%,middle aneurysms are 99 cases,account for 43%, larg aneurysms are11 cases,account for 4.7%, giant aneurysms are 2 cases,account for 0.8%.More statistical results present:The earlier embolization of aneurysm and drainagingof blooding CSF were performed,the less hydrocephalus would happen, the symptomsof patients with aneurysm had no correlation with the size and sites of aneurysms.Conclusion This group of clinic patients with aneurysms have natural random,thestatistical results of baseline characteristics are close to the results of a large series ofcases which were reported by articles.The statistical results are confident according to thedata.We redefined the size of aneurysm and reclassified the degree of occlusion, andthereout a simple four multiple formula was made, it will be applied for helpinganeurysms embolizing in saft and efficiency.Section two Evaluation of clinical technique for endovascular embolization of intranacial aneurysmObjective To study and summarize the representative clinical technique forendovascular embolization of intracranial aneurysm,introduce the information aboutGDC. To estimate the characteristic of occlusive material according to the clinical data.To introduce the technique of reconstructing parent artery and neck of aneurysm, andraise 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 forendovascular embolization of aneurysms, include microcatheter tip steam reconstruction,microcatheter is tracked and delivery for secure positioning of the catheter tip withinaneurysms. Second, appliances technique of embolic materials, we will estimateindications in using different materials through retrospecting the clinical data.Results In this group of cases, all of aneurysms were treated by endovascularembolization, the kinds of embolism materials were more than 10, according as differentconditions, one aneurysm may use more than one material, we have statisticed it exactly,namely, 206 aneurysms were embolized by coils(see table1-13). Wide neck aneurysmswere mainly treated with Neuroform and Coils, 37 cases in all, 2 cases were followedup, no recrudescence was found.Conclusion During procedure, the angle of microcatheter tip must be steamedaccording as artery tracking in different condition, it is very important to keep themicrocatheter steady within aneurysms.For the narrow-neck aneurysms,we embolizedthem with coils.It's important to construct the microcatheter tip,and avoid to go deep intoaneurysms.Otherwise,the aneurysms would tend to be ruptured.For the wide-neckaneurysms,its best to use coils with assistant of stents.If the next placement of coils aredifficult, we got the good outcome by placing one stent or using double-stenttechnique.We can embolize aneurysms wholely or part by part for the unregularaneurysms.In the course of embolization wholely, basket forming is veryimportant.Different materials were use in different conditions, it must be personal choose.The advangtage of biocoils still were observed in follow up. the technique ofreconstructing parent artery and neck of aneurysm in endovascular embolization ofaneurysms was not only applied in wide neck aneurysms,but also applied in fusiform andgiant aneurysms, reconstruction of parent artery was not only for the saccular, but for theparent artery near the aneurysms' neck, because blood dynamics was changed withinparent artery after the neck of aneurysms reconstructing.