颅内动脉瘤的介入治疗
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Requirement for follow-up angiography
The Future
Increased percentage of patients treated with coiling, in large volume referral centers
Use of adjunctive maneuvers increases the percentage of aneurysms treatable with endovascular techniques
Increased efficacy of coiling therapy (new, bioactive materials, tissue healing strategies)
Development of non-invasive follow-up techniques with CT or MR scanning
Stent + coils
Hydrocoil
Matrix Bioactive Coil
Take Home Points
Endovascular coiling of aneurysms is available in over 200 hospitals in this country
Approximately 200,000 patients in the world have benefited from endovascular coiling since its inception in 1990
Take Home Points
All patients with aneurysms should be informed of the availability of both endovascular coiling and surgical clipping by a neurosurgeon and an interventional neuroradiologist
ANEURYSM COILING
A minimally invasive procedure usually performed under general anesthesia by an interventional neuroradiologist
A very small plastic tube (microcatheter) is threaded from the groin to the aneurysm in the brain, and fine platinum threads (coils) are inserted into the aneurysm to fill it from the inside, much like filling a pothole
The brain is gently retracted in order to gain visual access to the aneurysm
A clip is placed at the neck of the aneurysm
1 week in the hospital 1 month recovery
Aneurysm Therapy
Surgical clipping (approximately 60-65% in the United States)
Endovascular coiling (approximately 30-35% in the United States)
In certain countries such as Finland, Great Britain and France, close to 90% of aneurysms are treated with endovascular coiling
1989: Dr Guglielmi comes permanently to UCLA
1989-1990: Bench and animal research
March 6, 1990: First clinical use of Guglielmi Detachable Coil
FDA approval in 2019
The Lancet
Vol 360, October 26, 2019
ISAT
A recent large prospective study of 2143 patients with ruptured aneurysms who could equally be treated with clipping or coiling had to be prematurely stopped short of planned enrollment of 2500 patients because the coiled patients suffered significantly less death and dependency as compared to clipped patients (6.9% absolute difference, 22.6% relative difference) and it would have been unethical to continue the study
After the release of the ISAT results, the percentage of aneurysm patients treated with coiling in England went from 40% to 90%
Aneurysm Clipping
Done under general anesthesia through a craniotomy (hole in the head)
Aneurysm Facts
Factors believed to contribute to brain aneurysms:
Smoking Hypertension Traumatic head injury Alcohol use Use of oral contraception Family history of brain aneurysms Other inherited disorders: Ehler’s syndrome,
Brain Aneurysms Successfully Treated Without Open Surgery
Jacques E. Dion, M.D., FRCP (C)
Professor of Radiology & Neurosurgery Director, Interventional Neuroradiology Emory University Hospital Atlanta, GA
Take Home Points
The ISAT study recently demonstrated a substantially better clinical outcome (22.6% less death and dependency relative difference, 6.9% absolute difference) in patients with ruptured aneurysms treated with endovascular coiling compared to patients treated with surgical clipping
What Is An Aneurysm?
A cerebral aneurysm is a bubble like outpouching
from an artery which predisposes its carrier to
cerebral hemorrhage and stroke
Images © Frank H. Netter, CIBA Collection of Medical Illustrations
had an aneurysm that was treated with coils by an interventional neuroradiologist) The annual rupture rate is approximately 1.5% Rupture of an aneurysm results in approximately 50% mortality and 25% stroke incidence
Better educated population will actually demand availability and discussion of both endovascular coiling and surgical clipping options
Stent + Coil
Wide neck mid basilar aneurysm
History of Coiling
1987-1989: Dr Guido Guglielmi (University of Rome) visits Dr Viñuela (Interventional Neuroradiologist) at UCLA and research work on coiling concept starts
polycystic kidney disease, and Marfan syndrome
Aneurysm Facts
Symptoms of ruptured aneurysms:
The worst headache of your life
Localized and intense headache Nausea and vomiting Stiff neck or neck pain Blurred or double vision Pain above and behind eye Dilated pupils Sensitivity to light Loss of sensation
Aneurysm Demographics
Aneurysms are found in 2-5% of the population There are as many as 27,000 aneurysms that could
be diagnosed and treated per year in the U.S. They are more common in women (Sharon Stone
The catheter is then removed and the small groin incision covered with a Band-Aid
For an unruptured aneurysm, the patient is discharged home within 24 to 48 hours
International Subarachnoid Aneurysm Trial (ISAT) of
neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial
Pros and Cons of Coiling
PROS
CONS
Minimally invasive Short recovery Safer than surgery Cheaper than surgery
Shorter track record
Possibly le
The Future
Increased percentage of patients treated with coiling, in large volume referral centers
Use of adjunctive maneuvers increases the percentage of aneurysms treatable with endovascular techniques
Increased efficacy of coiling therapy (new, bioactive materials, tissue healing strategies)
Development of non-invasive follow-up techniques with CT or MR scanning
Stent + coils
Hydrocoil
Matrix Bioactive Coil
Take Home Points
Endovascular coiling of aneurysms is available in over 200 hospitals in this country
Approximately 200,000 patients in the world have benefited from endovascular coiling since its inception in 1990
Take Home Points
All patients with aneurysms should be informed of the availability of both endovascular coiling and surgical clipping by a neurosurgeon and an interventional neuroradiologist
ANEURYSM COILING
A minimally invasive procedure usually performed under general anesthesia by an interventional neuroradiologist
A very small plastic tube (microcatheter) is threaded from the groin to the aneurysm in the brain, and fine platinum threads (coils) are inserted into the aneurysm to fill it from the inside, much like filling a pothole
The brain is gently retracted in order to gain visual access to the aneurysm
A clip is placed at the neck of the aneurysm
1 week in the hospital 1 month recovery
Aneurysm Therapy
Surgical clipping (approximately 60-65% in the United States)
Endovascular coiling (approximately 30-35% in the United States)
In certain countries such as Finland, Great Britain and France, close to 90% of aneurysms are treated with endovascular coiling
1989: Dr Guglielmi comes permanently to UCLA
1989-1990: Bench and animal research
March 6, 1990: First clinical use of Guglielmi Detachable Coil
FDA approval in 2019
The Lancet
Vol 360, October 26, 2019
ISAT
A recent large prospective study of 2143 patients with ruptured aneurysms who could equally be treated with clipping or coiling had to be prematurely stopped short of planned enrollment of 2500 patients because the coiled patients suffered significantly less death and dependency as compared to clipped patients (6.9% absolute difference, 22.6% relative difference) and it would have been unethical to continue the study
After the release of the ISAT results, the percentage of aneurysm patients treated with coiling in England went from 40% to 90%
Aneurysm Clipping
Done under general anesthesia through a craniotomy (hole in the head)
Aneurysm Facts
Factors believed to contribute to brain aneurysms:
Smoking Hypertension Traumatic head injury Alcohol use Use of oral contraception Family history of brain aneurysms Other inherited disorders: Ehler’s syndrome,
Brain Aneurysms Successfully Treated Without Open Surgery
Jacques E. Dion, M.D., FRCP (C)
Professor of Radiology & Neurosurgery Director, Interventional Neuroradiology Emory University Hospital Atlanta, GA
Take Home Points
The ISAT study recently demonstrated a substantially better clinical outcome (22.6% less death and dependency relative difference, 6.9% absolute difference) in patients with ruptured aneurysms treated with endovascular coiling compared to patients treated with surgical clipping
What Is An Aneurysm?
A cerebral aneurysm is a bubble like outpouching
from an artery which predisposes its carrier to
cerebral hemorrhage and stroke
Images © Frank H. Netter, CIBA Collection of Medical Illustrations
had an aneurysm that was treated with coils by an interventional neuroradiologist) The annual rupture rate is approximately 1.5% Rupture of an aneurysm results in approximately 50% mortality and 25% stroke incidence
Better educated population will actually demand availability and discussion of both endovascular coiling and surgical clipping options
Stent + Coil
Wide neck mid basilar aneurysm
History of Coiling
1987-1989: Dr Guido Guglielmi (University of Rome) visits Dr Viñuela (Interventional Neuroradiologist) at UCLA and research work on coiling concept starts
polycystic kidney disease, and Marfan syndrome
Aneurysm Facts
Symptoms of ruptured aneurysms:
The worst headache of your life
Localized and intense headache Nausea and vomiting Stiff neck or neck pain Blurred or double vision Pain above and behind eye Dilated pupils Sensitivity to light Loss of sensation
Aneurysm Demographics
Aneurysms are found in 2-5% of the population There are as many as 27,000 aneurysms that could
be diagnosed and treated per year in the U.S. They are more common in women (Sharon Stone
The catheter is then removed and the small groin incision covered with a Band-Aid
For an unruptured aneurysm, the patient is discharged home within 24 to 48 hours
International Subarachnoid Aneurysm Trial (ISAT) of
neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial
Pros and Cons of Coiling
PROS
CONS
Minimally invasive Short recovery Safer than surgery Cheaper than surgery
Shorter track record
Possibly le