coil embolization

线圈栓塞
  • 文章类型: Letter
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  • 文章类型: Case Reports
    引言:这里,我们探讨线圈栓塞(CE)是否有效治疗静脉闭塞功能障碍(VOD)。我们介绍了5例,其中7例CE发作,并进行了叙述性文献综述。方法:2013年至2018年,难治性阳痿促使5名男性寻求阴茎血管剥离术(PVS),尽管其中包括7次CE发作。所有患者均接受了双重海绵体造影,其中记录了与勃起相关的静脉和VOD。PVS需要一条深背静脉和两条海绵体静脉的静脉剥离。使用国际勃起功能指数(IIEF-5)评分系统和勃起硬度量表(EHS)的删节版,每年通过互联网进行术后随访。使用PubMed,本研究对CE治疗VOD或精索静脉曲张进行了叙述性文献综述.结果:插入的线圈沿勃起相关静脉分散,包括深背静脉(n=4),前列腺周围丛(n=5),髂静脉(n=5),右肺动脉(n=2),左肺动脉(n=2),和右心室(n=1)。PVS导致IIEF-5评分和EHS量表的一些改善。六篇文章强烈建议对VOD进行CE治疗。所有人都声称这是精索静脉曲张的微创有效治疗方法。结论:CE作为VOD治疗是不合理的,无论其在精索静脉曲张治疗中的可行性。
    Introduction: Herein, we explore whether coil embolization (CE) is effective in treating veno-occlusive dysfunction (VOD). We present five cases with seven CE episodes and a narrative literature review. Methods: From 2013 to 2018, refractory impotence prompted five men to seek penile vascular stripping (PVS), although seven CE episodes were included. All received dual cavernosography in which erection-related veins and VOD were documented. PVS entailed the venous stripping of one deep dorsal vein and two cavernosal veins. The abridged five-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) were used, and yearly postoperative follow-ups were conducted via the Internet. Using Pub Med, a narrative literature review was performed on CE treatment for VOD or varicocele. Results: Inserted coils were scattered along the erection-related veins, including the deep dorsal veins (n = 4), periprostatic plexus (n = 5), iliac vein (n = 5), right pulmonary artery (n = 2), left pulmonary artery (n = 2), and right ventricle (n = 1). PVS resulted in some improvements in the IIEF-5 score and EHS scale. Six articles highly recommend CE treatment for VOD. All claimed it is a minimally invasive effective treatment for varicocele. Conclusions: CE is not justified as a VOD treatment, regardless of its viability in the treatment of varicocele.
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  • 文章类型: Case Reports
    外伤性寰枢椎后脱位合并Jefferson骨折和齿状突骨折合并椎动脉损伤少见。这种伤害的管理引发了有争议的问题,目前仍有待讨论。一名74岁的中国男性从高处跌落后出现持续的颈部疼痛和僵硬。患者神经完整。术前X光片显示Jefferson爆裂骨折,寰枢关节后脱位,齿状突Anderson和D'alonzoII型骨折。计算机断层扫描血管造影(CTA)显示左椎动脉闭塞。在闭塞的椎动脉的近端部分进行线圈栓塞,以防止由于血栓的远端栓塞而进一步的脑梗死。然后进行第二阶段枕颈融合以重建颈椎稳定性。处理上颈椎骨折时,需要通过CTA对钝性椎动脉损伤进行系统筛查。对于颈椎损伤继发椎动脉闭塞的病例,颈椎手术前的血管内治疗是一种可行且安全的治疗方法。
    Traumatic posterior atlantoaxial dislocation combined with Jefferson fracture and odontoid process fracture with vertebral artery injury is rare. The management of such injury raises controversial issues and is still open to debate. A 74-year-old Chinese male presented with sustained neck pain and stiffness after falling from height. The patient was neurologically intact. Preoperative radiographs demonstrated a Jefferson burst fracture with a posterior dislocation of the atlantoaxial joints and odontoid process Anderson and D\'alonzo type II fracture. A computed tomography angiography (CTA) showed an occluded left vertebral artery. Coil embolization in the proximal portion of the occluded vertebral artery was performed to prevent further cerebral infarction due to distal embolization of the thrombus. Then a second stage occipito-cervical fusion was performed to reconstruct cervical spine stability. A systematic screening of blunt trauma vertebral artery injuries through CTA is required when dealing with upper cervical fracture. For cases with vertebral artery occlusion secondary to cervical spine injury, endovascular treatment preceding cervical spine surgery is a feasible and a safe treatment.
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  • 文章类型: Case Reports
    肠系膜上动静脉瘘是腹部创伤后一种罕见且困难的并发症。利用全面的血管内治疗代表了管理这种状况的有效方法。
    我们报告了一例有外伤史的53岁女性,主诉腹痛,萎靡不振,还有Melena.计算机断层扫描显示存在肠系膜上动静脉瘘。用四个互锁可拆卸线圈封堵瘘管,在肠系膜上动脉的动静脉瘘上方放置了覆膜支架。血管内治疗后,患者的腹痛和黑便症状消失。
    使用覆膜支架和互锁可拆卸线圈对肠系膜上动静脉瘘进行血管内治疗被证明是可行且高效的。
    UNASSIGNED: Superior mesenteric arteriovenous fistula is a rare and difficult complication after abdominal trauma. Utilizing comprehensive endovascular treatment represents an effective approach to managing this condition.
    UNASSIGNED: We report a case involving a 53-year-old female with a history of trauma who presented with complaints of abdominal pain, malaise, and melena. A computed tomographic scan revealed the presence of a superior mesenteric arteriovenous fistula. The fistula was occluded using four Interlock detachable coils, and a covered stent was positioned over the arteriovenous fistula in the superior mesenteric artery. Following endovascular treatment, the patient\'s abdominal pain and melena symptoms disappeared.
    UNASSIGNED: Utilizing covered stents and Interlock detachable coils for endovascular treatment of a superior mesenteric arteriovenous fistula proves to be both feasible and highly effective.
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  • 文章类型: Case Reports
    Behcet病(BD)是一种系统性血管炎,会影响各种大小的血管,表现为静脉血栓形成和动脉假性动脉瘤。BD最严重的表现是升主动脉假性动脉瘤,这与破裂和死亡的高风险有关。
    我们介绍一例50岁BD患者的升主动脉假性动脉瘤。术前评估后,成功地进行了线圈栓塞治疗假性动脉瘤,在1年的随访中取得了令人满意的结果。
    当不适合进行开放式手术修复和支架移植物放置时,线圈栓塞是BD中升主动脉假性动脉瘤的有效治疗选择。
    UNASSIGNED: Behcet\'s disease (BD) is a systematic vasculitis that affects vessels with various sizes, presenting as venous thrombosis and arterial pseudoaneurysms. The most severe manifestation in BD is ascending aortic pseudoaneurysm, which is associated with high risks of rupture and mortality.
    UNASSIGNED: We present a case of ascending aortic pseudoaneurysm in a 50-year-old patient with BD. After preoperative evaluation, coil embolization was successfully performed to treat the pseudoaneurysm, resulting in a satisfactory outcome at the 1-year follow-up.
    UNASSIGNED: Coil embolization serves as an effective treatment option for ascending aortic pseudoaneurysm in BD when open surgical repair and stent graft placement are unsuitable.
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  • 文章类型: Journal Article
    伴有自发性门体分流(SPSS)的胃静脉曲张(GV)对于给予内窥镜氰基丙烯酸酯(CYA)注射构成相当大的风险和挑战。这项研究旨在评估EUS引导的线圈栓塞与CYA注射联合使用SPSS管理GV的常规内镜CYA注射的有效性和安全性。
    这项回顾性分析包括宁波医学中心李惠利医院(浙江,中国)2018年1月至2023年3月。患者人口统计学,程序细节,并对随访结果进行了综述。
    该研究评估了57例患者:联合治疗组21例接受EUS引导的线圈栓塞联合CYA注射,常规组36例接受常规内镜下CYA注射。这两个团队都取得了100%的技术成功率。联合组使用的CYA平均体积(1.64±0.67mL)明显低于常规组(2.38±0.72mL;P<0.001)。早期GV再出血率在两组之间没有显著差异;相反,联合治疗组晚期GV再出血的发生率明显低于常规组(4.8%vs27.8%,P=0.041)。
    EUS引导的弹簧圈栓塞联合CYA注射在减少SPSS治疗GV的晚期GV再出血方面优于常规内镜下CYA注射。
    UNASSIGNED: Gastric varices (GV) with spontaneous portosystemic shunts (SPSS) pose considerable risks and challenges for administering endoscopic cyanoacrylate (CYA) injection. This study aimed to evaluate the efficacy and safety of EUS-guided coil embolization in combination with CYA injection compared to conventional endoscopic CYA injection for managing GV with SPSS.
    UNASSIGNED: This retrospective analysis included patients with SPSS treated with either EUS-guided coil embolization in combination with CYA injection or conventional CYA injection for gastric variceal bleeding at Ningbo Medical Center Lihuili Hospital (Zhejiang, China) between January 2018 and March 2023. Patient demographics, procedural details, and follow-up results were reviewed.
    UNASSIGNED: The study evaluated 57 patients: 21 in the combined treatment group undergoing EUS-guided coil embolization in combination with CYA injection and 36 in the conventional group receiving conventional endoscopic CYA injection. Both cohorts achieved a 100% technical success rate. The mean volume of CYA used was significantly lower in the combined group (1.64 ± 0.67 mL) than in the conventional group (2.38 ± 0.72 mL; P < 0.001). Early GV rebleeding rates did not differ significantly between the groups; in contrast, the combined treatment group exhibited a considerably lower incidence of late GV rebleeding than the conventional group (4.8% vs 27.8%, P = 0.041).
    UNASSIGNED: EUS-guided coil embolization in combination with CYA injection demonstrated superiority over conventional endoscopic CYA injection in reducing late GV rebleeding in treating GV with SPSS.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    血管内卷绕是治疗脑动脉瘤的主要方法。关于选择线圈长度的广泛报告,硬度,和材料是可用的。然而,线圈直径对术后结局的影响尚不清楚.这项研究纳入了六个个性化的颅内动脉瘤几何模型:三个分叉动脉瘤和三个侧壁动脉瘤。通过改变线圈直径构建了四个线圈模型。使用有限元方法模拟了线圈栓塞。使用计算流体动力学来表征栓塞后动脉瘤的血液动力学。评估参数包括速度降低,壁面剪应力(WSS),低WSS(LWSS),振荡剪切指数(OSI),相对停留时间(RRT),和动脉瘤中的残余流量。在峰值时间(t=0.17s),LWSS在分叉动脉瘤中的面积比例随着线圈直径的增加而增加:0.8D,与1D相比,71.28±12.62%,74.97±19.17%与1.2D,78.88±18.56%与1.4D,84.00±11.53%(平均值±SD)。高OSI面积的比例随着线圈直径的增加而减少:0.8D,4.41%±2.82%对1.0D,3.78±3.33%与1.2D,2.28%±1.77%与1.4D,1.58%±1.11%(平均值±SD)。高RRT区域的比例随着线圈直径的增加而增加:0.8D,3.40%±1.68%对1.0D,7.67±4.12%对1.2D,9.84%±9.50%对1.4D,22.29%±14.28%(平均值±SD)。侧壁动脉瘤没有表现出上述趋势。用1.4倍直径的线圈堵塞的分叉动脉瘤在组内具有最大的RFV(<10mm/s)。在侧壁动脉瘤中未发现上述模式。在用线圈治疗动脉瘤时,不同的线圈直径可导致动脉瘤内不同的血液动力学环境。较大的线圈直径改善了分叉动脉瘤的血液动力学性能。然而,对于侧壁动脉瘤,弹簧圈直径与栓塞效果无显著关系。
    Endovascular coiling is the predominant method for treating cerebral aneurysms. Extensive reports on selecting coil length, hardness, and material are available. However, the impact of coil diameter on postoperative outcomes remains unclear. This study enrolled six personalized geometric models of intracranial aneurysms: three bifurcation aneurysms and three sidewall aneurysms. Four coil models were constructed by changing the coil diameter. Coil embolization was simulated using the finite element method. Computational fluid dynamics was used to characterize hemodynamics in the aneurysms after embolization. Evaluation parameters included velocity reduction, wall shear stress (WSS), low WSS (LWSS), oscillatory shear index (OSI), relative residence time (RRT), and residual flow volume in the aneurysms. At the peak time (t = 0.17 s), the proportion of LWSS area in bifurcation aneurysms increase with the rise in coil diameter: 0.8D, 71.28 ± 12.62% versus 1D, 74.97 ± 19.17% versus 1.2D, 78.88 ± 18.56% versus 1.4D, 84.00 ± 11.53% (mean ± SD). The proportion of high OSI area decreases as the coil diameter increases: 0.8D, 4.41% ± 2.82% versus 1.0D, 3.78 ± 3.33% versus 1.2D, 2.28% ± 1.77% versus 1.4D, 1.58% ± 1.11% (mean ± SD). The proportion of high RRT area increases as the coil diameter rises: 0.8D, 3.40% ± 1.68% versus 1.0D, 7.67 ± 4.12% versus 1.2D, 9.84% ± 9.50% versus 1.4D, 22.29% ± 14.28% (mean ± SD). Side wall aneurysms do not exhibit the aforementioned trend. Bifurcation aneurysms plugged with a coil of 1.4 times the diameter have the largest RFVs (<10 mm/s) within the group. Aforementioned patterns are not found in sidewall aneurysms. In the treatment of aneurysms with coiling, varying coil diameters can result in different hemodynamic environments within the aneurysm. Larger coil diameters have improved hemodynamic performance for bifurcation aneurysms. However, coil diameter and embolization effectiveness have no significant relationship for sidewall aneurysms.
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  • 文章类型: Journal Article
    本研究旨在确定颅内动脉瘤(IA)复发的危险因素,并建立预测模型以辅助评估。
    根据数字减影血管造影随访,在2017年9月至2022年10月期间,共302例312例IAs接受线圈栓塞的患者分为两组。临床特征,与运营相关的因素,并测量了形态。采用Cox比例风险回归分析确定危险因素。危险比(HR)用于评分,并建立了预测模型。测试队列由51个IA组成。产生接收器操作特征曲线以确定截止值和曲线下面积(AUC)。进行Delong测试以比较AUC。
    最大直径(Dmax)(p<0.001,HR=1.221),雷蒙德-罗伊闭塞分类(RROC)II或III(p=0.004,HR=2.852),和破裂状态(p<0.001,HR=7.782)是IAs复发的独立危险因素。建立预测模型:Dmax+2*RROC(II或III;是=1,否=0)+6*破裂状态(是=1;否=0)。预测模型的AUC(0.818)显著高于Dmax(0.704),RROC(II或III)(0.645),和破裂状态(0.683),分别(德隆测试,p<0.05)。预测模型的截止值和Dmax分别为9.75点和6.65mm,分别。
    Dmax,RROC(II或III),破裂状态可以独立预测线圈栓塞后IAs的复发。我们的模型可以帮助进行实际评估。
    UNASSIGNED: This study aimed to identify risk factors for intracranial aneurysms (IAs) recurrence and establish a predictive model to aid evaluation.
    UNASSIGNED: A total of 302 patients with 312 IAs undergoing coil embolization between September 2017 and October 2022 were divided into two groups based on digital subtraction angiography follow-up. Clinical characteristics, operation-related factors, and morphologies were measured. Cox proportional hazard regression was used to identify the risk factors. Hazard ratios (HRs) were used to score points, and a predictive model was established. The test cohorts consisted of 51 IAs. Receiver operating characteristic curves were generated to determine the cutoff values and area under the curves (AUCs). A Delong test was performed to compare the AUCs.
    UNASSIGNED: Diameter maximum (D max) (p < 0.001, HR = 1.221), Raymond-Roy occlusion classification (RROC) II or III (p = 0.004, HR = 2.852), and ruptured status (p < 0.001, HR = 7.782) were independent risk factors for the recurrence of IAs. A predictive model was established: D max + 2 * RROC (II or III; yes = 1, no = 0) + 6 * ruptured status (yes = 1; no = 0). The AUC of the predictive model (0.818) was significantly higher than those of D max (0.704), RROC (II or III) (0.645), and rupture status (0.683), respectively (Delong test, p < 0.05). The cutoff values of the predictive model and D max were 9.75 points and 6.65 mm, respectively.
    UNASSIGNED: The D max, RROC (II or III), and ruptured status could independently predict the recurrence of IAs after coil embolization. Our model could aid in practical evaluations.
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  • 文章类型: Case Reports
    颈动脉海绵窦瘘(CCF)是指颅底颈动脉系统与蝶骨海绵窦之间的异常动静脉连通,几乎75%的病例都是由创伤引起的。静脉血液引流到脊髓代表了一种独特的机制,这通常在硬脑膜动静脉瘘(DAVF)中观察到,通常在临床上表现为进行性脊髓病。然而,在临床实践中,创伤性颈动脉海绵窦瘘(TCCF)通过髓周静脉引流引起延迟四肢瘫痪是罕见的。
    我们报告一例29岁男性患者,因突然出现头痛和四肢瘫痪入院。5年前,该患者在一次交通事故中失去了右眼。脑血管造影显示右侧高流量直接CCF,伴有小脑和髓周静脉明显引流。我们成功地为CCF进行了线圈栓塞,术后患者症状逐渐好转。在第六个月的随访中,患者恢复了独立行走的能力。
    我们经历了一例罕见的TCCF伴四肢瘫痪病例。利用线圈栓塞,我们成功地改善了病人的病情。然而,CCF经髓周静脉引流的机制和最佳治疗方法尚不清楚。我们需要进一步探讨CCF静脉引流的病理生理信息。
    UNASSIGNED: Carotid cavernous fistula (CCF) refers to the abnormal arteriovenous communication between the carotid system at the skull base and the sphenoid cavernous sinus, which is caused by trauma in almost 75% of cases. The drainage of venous blood to the spinal cord represents a distinctive mechanism, which is commonly observed in dural arteriovenous fistula (DAVF), and typically manifests clinically as progressive myelopathy. However, it is a rare occurrence in clinical practice that traumatic carotid cavernous fistula (TCCF) causes delayed quadriplegia through perimedullary venous drainage.
    UNASSIGNED: We report the case of a 29-year-old male patient who was admitted to the hospital with a sudden onset of headache and quadriplegia. The patient had previously lost his right eye in a traffic accident 5 years ago. Cerebral angiography showed a high-flow direct CCF on the right side, accompanied by obvious drainage of cerebellar and perimedullary veins. We successfully performed coil embolization for the CCF, and the symptoms of the patient gradually improved after the operation. During follow-up at sixth-months, the patient regained the ability to walk independently.
    UNASSIGNED: We experienced a rare case of TCCF with quadriplegia. Utilizing coil embolization, we achieved successful improvement in the patient\'s condition. However, the mechanism and the best treatment of CCF drainage through the perimedullary vein are still unclear. We need to further explore the pathophysiological information of CCF venous drainage.
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