特殊类型动脉瘤的介入治疗
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– 占所有颅内动脉瘤的2-5%
• AChA
– 颈内动脉的终末分支，其穿支供应了视束、大脑脚、外侧膝状体、 苍白球、内囊后肢等重要的结构。 – AChA发自瘤颈，术后缺血并发症发生率 23.8%（5/21） – AchA与动脉瘤无关，无缺血并发症（0/17）
Kim BM et al. Neuroradiology (2008) 50:251
夹层动脉瘤 P2P段
Case 11 男，26岁 头痛，神经系统（-）
术前 R-ICA
术后左侧视野缺损 术后3月改善
术后R-ICA
• 术后3月
• It is impossible to be certain whether or not a parent artery occlusion will be tolerated. • In general, however, we avoid parent artery occlusion at the P1 or P2 segments given the rich vascular supply to the brain stem that originates from these anatomic locations and the possible neurologic deficits that may occur as a result of such treatment.
特殊类型动脉瘤的 介入治疗
特殊类型动脉瘤
• 特殊部位
– 颈动脉前壁动脉瘤 – 脉络膜前动脉动脉瘤 – 大脑后动脉动脉瘤 – 远端动脉瘤
– 穿支血管动脉瘤
• 特殊类型
– 合并假性成分的动脉瘤
– 夹层动脉瘤
– 外伤性动脉瘤 – 蛇形动脉瘤
脉络膜前动脉动脉瘤
• 脉络膜前动脉动脉瘤（Anterior Choroidal Artery Aneurysm, AChAN）
MESH technique
15m FU
建议
• 术前3-D重建仔细分析AchA与An的关系
• 术中注意AchA通畅性
• 累及AchA的An，宁愿次全栓塞或瘤颈残留
• 支架有利于AchA的保护和动脉瘤愈合
大脑后动脉动脉瘤
• 占全部颅内动脉瘤的0.7-2.3%
• 多发于P1、P2段
• 发病平均年龄38岁 • 大或巨大动脉瘤常见
Huang Q, et al. Clin Neuroradiol. 2013
建议
• 囊性动脉瘤应单纯栓塞动脉瘤
• 夹层动脉瘤可能需要闭塞载瘤动脉
• P1、P2段动脉瘤闭塞载瘤动脉可能导致穿 支闭塞，尽可能保留载瘤动脉 • 定期随访
幕下远端动脉瘤
• Distal aneurysms of cerebellar arteries are rare lesions accounting for 0.6% of all treated aneurysms • 夹层、假性动脉瘤常见 • 一般需要闭塞载瘤动脉
治疗方法
• 手术
technical difficulties and high risks
• 介入
– 囊性动脉瘤：
• 动脉瘤弹簧圈栓塞
– 夹层动脉瘤：
• 载瘤动脉闭塞（parent vessel occlusion，PVO）
– risk of infarction from perforators and/or distal branch occlusion
Βιβλιοθήκη Baidu
• PVO
– The incidence of symptomatic infarction after PA occlusion was 16.3 % in the literature review.
– BOT 无效，不常用
• Stent assisted coiling
– In literature review, the morbidity and mortality of stent for PCA aneurysms was 7.9 % in total. No infarction was reported. There were three (13 %) recurrences, but only one (4.3 %) caused rebleeding.
• 支架辅助栓塞
囊性动脉瘤
Case 9 男，47岁 突发头痛 SAH
无再出血，无神经功能缺损
囊性动脉瘤
2m FU
囊性动脉瘤
• PCA-An血流动力学相关的多为囊性动脉瘤
AJNR Am J Neuroradiol 22:27–34, January 2001
夹层动脉瘤 P2P段
Case 10 45-Y-O-F SAH & IVH
脉络膜前动脉动脉瘤
Case 1
51-Y-O-F
10min later
• 术后即刻言语含糊，对侧上肢肌力1级，下肢3级，对侧Babinski征阳性 • 1个月后对侧肢体轻偏瘫
Subtotal Embo.
Case 2 47-Y-O-F SAH
Final
Stent + coil
Case 3 56-Y-O-F SAH
– Drake, 42% of giant aneurysms – Yasargil, 50% of giant aneurysms – Ciceri, 24% of giant aneurysms
• 分类
– 囊性动脉瘤 – 夹层动脉瘤
大脑后动脉分段
Zeal AA,Rhoton AL Jr. J Neurosurg,1978,48(4):534 Ciceri EF, et al.AJNR Am J Neuroradiol, 2001,22:27
Ciceri EF et al. AJNR Am J Neuroradiol 2001,22:27–34
夹层动脉瘤 P2A段
Case 12 58-year-old male incidental found
Enterprise 4.5/22
11M FU
11M FU
A
B
C
D
After 2 Enterprise stents
Peluso JPP, et al. AJNR Am J Neuroradiol. 2007, 28:1573 Tokimura H, et al. Neurosurg Rev. 2012,35:497
• AChA
– 颈内动脉的终末分支，其穿支供应了视束、大脑脚、外侧膝状体、 苍白球、内囊后肢等重要的结构。 – AChA发自瘤颈，术后缺血并发症发生率 23.8%（5/21） – AchA与动脉瘤无关，无缺血并发症（0/17）
Kim BM et al. Neuroradiology (2008) 50:251
夹层动脉瘤 P2P段
Case 11 男，26岁 头痛，神经系统（-）
术前 R-ICA
术后左侧视野缺损 术后3月改善
术后R-ICA
• 术后3月
• It is impossible to be certain whether or not a parent artery occlusion will be tolerated. • In general, however, we avoid parent artery occlusion at the P1 or P2 segments given the rich vascular supply to the brain stem that originates from these anatomic locations and the possible neurologic deficits that may occur as a result of such treatment.
特殊类型动脉瘤的 介入治疗
特殊类型动脉瘤
• 特殊部位
– 颈动脉前壁动脉瘤 – 脉络膜前动脉动脉瘤 – 大脑后动脉动脉瘤 – 远端动脉瘤
– 穿支血管动脉瘤
• 特殊类型
– 合并假性成分的动脉瘤
– 夹层动脉瘤
– 外伤性动脉瘤 – 蛇形动脉瘤
脉络膜前动脉动脉瘤
• 脉络膜前动脉动脉瘤（Anterior Choroidal Artery Aneurysm, AChAN）
MESH technique
15m FU
建议
• 术前3-D重建仔细分析AchA与An的关系
• 术中注意AchA通畅性
• 累及AchA的An，宁愿次全栓塞或瘤颈残留
• 支架有利于AchA的保护和动脉瘤愈合
大脑后动脉动脉瘤
• 占全部颅内动脉瘤的0.7-2.3%
• 多发于P1、P2段
• 发病平均年龄38岁 • 大或巨大动脉瘤常见
Huang Q, et al. Clin Neuroradiol. 2013
建议
• 囊性动脉瘤应单纯栓塞动脉瘤
• 夹层动脉瘤可能需要闭塞载瘤动脉
• P1、P2段动脉瘤闭塞载瘤动脉可能导致穿 支闭塞，尽可能保留载瘤动脉 • 定期随访
幕下远端动脉瘤
• Distal aneurysms of cerebellar arteries are rare lesions accounting for 0.6% of all treated aneurysms • 夹层、假性动脉瘤常见 • 一般需要闭塞载瘤动脉
治疗方法
• 手术
technical difficulties and high risks
• 介入
– 囊性动脉瘤：
• 动脉瘤弹簧圈栓塞
– 夹层动脉瘤：
• 载瘤动脉闭塞（parent vessel occlusion，PVO）
– risk of infarction from perforators and/or distal branch occlusion
Βιβλιοθήκη Baidu
• PVO
– The incidence of symptomatic infarction after PA occlusion was 16.3 % in the literature review.
– BOT 无效，不常用
• Stent assisted coiling
– In literature review, the morbidity and mortality of stent for PCA aneurysms was 7.9 % in total. No infarction was reported. There were three (13 %) recurrences, but only one (4.3 %) caused rebleeding.
• 支架辅助栓塞
囊性动脉瘤
Case 9 男，47岁 突发头痛 SAH
无再出血，无神经功能缺损
囊性动脉瘤
2m FU
囊性动脉瘤
• PCA-An血流动力学相关的多为囊性动脉瘤
AJNR Am J Neuroradiol 22:27–34, January 2001
夹层动脉瘤 P2P段
Case 10 45-Y-O-F SAH & IVH
脉络膜前动脉动脉瘤
Case 1
51-Y-O-F
10min later
• 术后即刻言语含糊，对侧上肢肌力1级，下肢3级，对侧Babinski征阳性 • 1个月后对侧肢体轻偏瘫
Subtotal Embo.
Case 2 47-Y-O-F SAH
Final
Stent + coil
Case 3 56-Y-O-F SAH
– Drake, 42% of giant aneurysms – Yasargil, 50% of giant aneurysms – Ciceri, 24% of giant aneurysms
• 分类
– 囊性动脉瘤 – 夹层动脉瘤
大脑后动脉分段
Zeal AA,Rhoton AL Jr. J Neurosurg,1978,48(4):534 Ciceri EF, et al.AJNR Am J Neuroradiol, 2001,22:27
Ciceri EF et al. AJNR Am J Neuroradiol 2001,22:27–34
夹层动脉瘤 P2A段
Case 12 58-year-old male incidental found
Enterprise 4.5/22
11M FU
11M FU
A
B
C
D
After 2 Enterprise stents
Peluso JPP, et al. AJNR Am J Neuroradiol. 2007, 28:1573 Tokimura H, et al. Neurosurg Rev. 2012,35:497