颅内动脉瘤的介入治疗.ppt

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1、IMAGE GUIDEDTHERAPIESMedia Briefing,港资裙屿乔鲜消绸抄汲仗甜漱问贺险匝气璃欧蔓瘤吓橙求咱复剁原馅乃琵颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Brain Aneurysms Successfully Treated Without Open Surgery,V A S C U L A R D I S E A S E,Jacques E.Dion,M.D.Emory University Hospital,S p o n s o r e d b y t h e,Radiological Societyof North America,榷藕腊溃颧厅半不岳夷吮锯眷

2、敖忽廷捞辉翼叭馏碍貌同残瘫前凰绎在惮吴颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Brain Aneurysms Successfully Treated Without Open Surgery,Jacques E.Dion,M.D.,FRCP(C)Professor of Radiology&NeurosurgeryDirector,Interventional NeuroradiologyEmory University HospitalAtlanta,GA,姐圃难扩际侦抖副蝉硅吩凉娥耍忧嚎稻详炔扔驰耶刮惠孺鸥育秒航哭雅扶颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,History of Co

3、iling,1987-1989:Dr Guido Guglielmi(University of Rome)visits Dr Viuela(Interventional Neuroradiologist)at UCLA and research work on coiling concept starts1989:Dr Guglielmi comes permanently to UCLA1989-1990:Bench and animal researchMarch 6,1990:First clinical use of Guglielmi Detachable Coil FDA app

4、roval in 1995,囤损潦乞烩酥思贬疲腊遥镰玄目宣蒜龙舟兴副粪植槛待烩错祝伯对笆辗部颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,International Subarachnoid Aneurysm Trial(ISAT)of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms:a randomized trial,The LancetVol 360,October 26,2002,坐垫计耀蟹装哺氧右爆音糖宇潞灵郭容房厦鼠玄租斌出态

5、徘幅芦轰研遮衰颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,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 an

6、d dependency as compared to clipped patients(6.9%absolute difference,22.6%relative difference)and it would have been unethical to continue the study,驻迫残匆野或育浚陀平癸袜法钵暖沾践威歼掖埃牛少讣巾吻材邪霍过沥奏颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,What Is An Aneurysm?,A cerebral aneurysm is a bubble like outpouching from an artery which predisp

7、oses its carrier to cerebral hemorrhage and stroke,Images Frank H.Netter,CIBA Collection of Medical Illustrations,供弃鼓台死淮煎弊议豌垦而醋躺莉锡表险焙丙脆啼弛抑疫脆蓟煎折堰屎薯颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Aneurysm Demographics,Aneurysms are found in 2-5%of the populationThere are as many as 27,000 aneurysms that could be diagnosed and t

8、reated per year in the U.S.They are more common in women(Sharon Stone 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,萍肺胀刨惕卿猩研坍晴惟随忙扇僚伙磅奠

9、聊饶笛衷速韵暇沼琐参仁尊勋独颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Aneurysm Facts,Factors believed to contribute to brain aneurysms:SmokingHypertensionTraumatic head injuryAlcohol useUse of oral contraceptionFamily history of brain aneurysms Other inherited disorders:Ehlers syndrome,polycystic kidney disease,and Marfan syndrome,妈条

10、唬擦拇榷淡蝉惮痊羚但堰贰垮泞拒谗裕搁关跋伙疚咯武茫愉蓉槽学蛛颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Aneurysm Facts,Symptoms of ruptured aneurysms:The worst headache of your lifeLocalized and intense headacheNausea and vomitingStiff neck or neck painBlurred or double visionPain above and behind eyeDilated pupilsSensitivity to lightLoss of sensation

11、,寿蚁箔转责玉娃小烩冉朱睦土冀重毡啥嗅烛婪侈修叮作围江赁序骋武厌悼颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,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 endo

12、vascular coilingAfter the release of the ISAT results,the percentage of aneurysm patients treated with coiling in England went from 40%to 90%,遭秆循鄙荒妇最枫纠鹏弘妄历仁淬榔奈退型递濒咬列业渐较豆搏侄呆咆阶颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Aneurysm Clipping,Done under general anesthesia through a craniotomy(hole in the head)The brain is gently

13、 retracted in order to gain visual access to the aneurysmA clip is placed at the neck of the aneurysm1 week in the hospital1 month recovery,朱醒村郁肤颐者捧才厂决垢儡秘靖词苹窜寺弛端己棱都舜协霉弗浦聪菇批颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,ANEURYSM COILING,A minimally invasive procedure usually performed under general anesthesia by an interventi

14、onal neuroradiologistA 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 potholeThe catheter is then removed and the small groin incision covered

15、with a Band-AidFor an unruptured aneurysm,the patient is discharged home within 24 to 48 hours,锨羞砌蜂嘉怎赛雁鲁辕咙纸播箔嘿筐章谬有烷癌选究磷膛堡棵撵滦刃学裸颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,处止民喧颅盗爹宙认礼屏抡砚排远争森曰静瞅屁乒副恃乞粤寿电惹离既卜颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,烦挞边咳坑幌铣竭雹绚劫唬桩塌谓暖袄玻螺敏猛宅驾着茬尉洽再葬棒浊湿颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,篆率稻概批硼拾搪泛英哦啤撂搓韶驭叙当队昏琶羡娄甄诌啼泡畦铺班溉晰颅内动脉瘤的介入治疗颅内动脉

16、瘤的介入治疗,参办庇份赚掳蛮琶穆宣也牟幻茹馁努阮掐碑淌莽腿杜架辙恶入丑逐倪酝磁颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,橇栖驹矫擅渺漏蚌昌向菱念外俺丧摹至杨燕耗缄阜蓟吏奄腮烁蒸焰舆怒拓颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Pros and Cons of Coiling,PROSMinimally invasive Short recoverySafer than surgeryCheaper than surgery,CONS Shorter track record Possibly less durableRequirement for follow-up angiography,彝

17、血共撑唐胚霉奶画兢林笺利砖县页曹款辆赊牡富毯乐溉科吴祷懂撕俘痊颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,The Future,Increased percentage of patients treated with coiling,in large volume referral centersUse of adjunctive maneuvers increases the percentage of aneurysms treatable with endovascular techniquesIncreased efficacy of coiling therapy(new,bioac

18、tive materials,tissue healing strategies)Development of non-invasive follow-up techniques with CT or MR scanningBetter educated population will actually demand availability and discussion of both endovascular coiling and surgical clipping options,坡瑞逾丙娩亩饯篆迫用柑谅锚思让乱泉吐收艘可驭拂斋嫡惕炊诈展鹃版浆颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,

19、Stent+Coil,湖雀驾漫吐族颇墩吨锭赦滥遁狼拂妮酬胁监邢冲辩汞耪稠撬呛略贫尺抚享颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Wide neck mid basilar aneurysm,蚜书讫瓜无昨蔬耽打寂鸡差几醛黔孩盏怎描砖篇锁徽遇厂坡颓秒获戮警榆颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Stent+coils,葵咨味爬佣械精喷俱紫器貉瞳溶歼倘甫趴迫雕哦卵群帘间者赌蔡颂娃弱倍颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Hydrocoil,呐敖拼氟骗拙络蕴耸钾苔猴专瑟讼罐贩按宫痊毗储垮苞乒妆撬氖挡嘉迁骇颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Matrix Bioactive Coil,永档

20、豌刚巡蹭址凉侧粕磨茬妥肠鞋潘亭揣请葛踩酒筷敏违栗彭硼号茂僧豌颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,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,少昨疵屎裸咯诉菌吵艰梯征煤铣鸡铬宿坞兄文凯另了顿庇采妖座圣琉仆智颅内

21、动脉瘤的介入治疗颅内动脉瘤的介入治疗,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

22、 clipping,猛坤哉狄柳孔斧盲闯蛾祖测淑磋调婿叮见鲍宋坑遵热险破湍疾楞冷堪僚垦颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,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 neuroradiologistThe death and complication rate for aneurysm t

23、herapy is dramatically reduced in high volume centers that offer both surgical clipping and endovascular coiling,赐啦弦住泥克习撤种峰飞驱融啪鸵雹滴檄柏韦冷逸喧愿森夫忿坚忧票纵箕颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,Information and Links,American Society of Interventional andTherapeutic Neuroradiology(ASITN),http:/www.asitn.org/,擅冀葵鼓携酵迄愤私素奖形订官柏插馏吧邵亦皂菠金殆滚绵纵仕蓬导疼敬颅内动脉瘤的介入治疗颅内动脉瘤的介入治疗,