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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3733_Библиотеки_им_академика_М_И_Перельмана.pdf
Procedure
1. Femoral access: Depending on the devices used, either a 6-Fr or 8-Fr
sheath is placed in the groin.
2. Guiding catheter: We commonly use the 0.070-in Neuron and 0.071-in
Chaperon guiding catheters and the 0.088-in Neuron Max sheath. Our
goal is safe distal access, ideally to at least the petrous segment of the
internal carotid artery.
3. Working views: Orthogonal views that demonstrate the aneurysm neck
and dome are ideal. When balloon remodeling, views may be modified
with the balloon inflated and the first coil partially deployed to achieve a
“down the barrel” view and an orthogonal view that lays out the dome.
4. Adjunctive device access: If an adjunctive device is used, it is advanced
first before the coiling microcatheter across the aneurysm ostium.
5. Coiling microcatheter access: The coiling microcatheter is advanced into
the aneurysm sac.
6. Control angiograms in working and anteroposterior (AP) and lateral
projections are performed. Working to determine residual filling of
aneurysm and AP and lateral to demonstrate patency of all vessels
unchanged from the initial angiograms.
COMPLICATIONS
Potential complications can be divided into two main types: hemorrhagic and
ischemic. Ischemic complications are more common and can be caused by
vasospasm from guide catheter access, cessation of antegrade flow with use
of a balloon catheter, and thromboembolic events from clot formation along
the coil mass, which tends to occur when there is a large coil mass/parent
vessel interface. Many of these issues can be avoided by preprocedure
prophylactic antiplatelet therapy and systemic anticoagulation during the
procedure. Hemorrhagic complications are uncommon but feared as they tend
to result in major morbidity and mortality. Most commonly, this is a result of
aneurysm perforation either from coil or microcatheter herniation through the
wall of the aneurysm. Less common, microguidewire perforations can occur
either during access of the parent vessel, distal wire access for balloons or
other adjunctive devices, and wire perforation of the aneurysm dome.
TIPS AND TRICKS
REFERENCES
1. Aletich VA, Debrun GM, Misra M, et al. The remodeling technique of
balloon-assisted Guglielmi detachable coil placement in wide-necked
aneurysms: experience at the University of Illinois at Chicago. J
Neurosurg. 2000;93(3):388–396.
2. Fiorella D, Albuquerque FC, Han P, et al. Preliminary experience using
the Neuroform stent for the treatment of cerebral aneurysms.
Neurosurgery. 2004;54(1):6–16.
3. Lefkowitz MA, Gobin YP, Akiba Y, et al. Balloon-assisted Guglielmi
detachable coiling of wide-necked aneurysm: part II—clinical results.
Neurosurgery. 1999;45(3):531–537.
4. Malek AM, Halbach VV, Phatouros CC, et al. Balloon-assisted
technique for endovascular coil embolization of geometrically difficult
intracranial aneurysms. Neurosurgery. 2000;46(6):1397–1406.
5. Moret J, Cognard C, Weill A, et al. Reconstruction technic in the
treatment of wide-neck intracranial aneurysms. Long-term angiographic
and clinical results. Apropos of 56 cases [in French]. J Neuroradiol.
1997;24(1):30–44.
6. Raymond J, Guilbert F, Roy D. Neck-bridge device for endovascular
treatment of wide-neck bifurcation aneurysms: initial experience.
Radiology. 2001;221(2):318–326.
7. Spiotta AM, Hui FK, Moskowitz SI. Trends in device-assisted aneurysm
treatment at a single high-volume tertiary care center. J NeuroInterv
Surg. 2013;5(2):117–120.
8. Guglielmi G, Vinuela F, Dion J, et al. Electrothrombosis of saccular
aneurysms via endovascular approach. Part 2: preliminary clinical
experience. J Neurosurg. 1991;75(1):8–14.
9. Johnston SC, Dowd CF, Higashida RT, et al. Predictors of rehemorrhage
after treatment of ruptured intracranial aneurysms: the Cerebral
Aneurysm Rerupture After Treatment (CARAT) study. Stroke.
2008;39(1):120–125.
10. Moret J, Cognard C, Weill A, et al. The “remodelling technique” in the
treatment of wide neck intracranial aneurysms. Angiographic results and
clinical follow-up in 56 cases. Interv Neuroradiol. 1997;3(1):21–35.
11. Cottier JP, Pasco A, Gallas S, et al. Utility of balloon-assisted Guglielmi
detachable coiling in the treatment of 49 cerebral aneurysms: a
retrospective, multicenter study. AJNR Am J Neuroradiol.
2001;22(2):345–351.
12. Qureshi AI, Luft AR, Sharma M, et al. Prevention and treatment of
thromboembolic and ischemic complications associated with
endovascular procedures. Part II—clinical aspects and
recommendations. Neurosurgery. 2000;46(6):1360–1375.
13. Shapiro M, Babb J, Becske T, et al. Safety and efficacy of adjunctive
balloon remodeling during endovascular treatment of intracranial
aneurysms: a literature review. AJNR Am J Neuroradiol.
2008;29(9):1777–1781.
14. Nelson PK, Levy DI. Balloon-assisted coil embolization of wide-necked
aneurysms of the internal carotid artery: medium-term angiographic and
clinical follow-up in 22 patients. AJNR Am J Neuroradiol.
2001;22(1):19–26.
15. Rordorf G, Bellon RJ, Budzik RE Jr, et al. Silent thromboembolic events
associated with the treatment of unruptured cerebral aneurysms by use
of Guglielmi detachable coils: prospective study applying diffusionweighted imaging. AJNR Am J Neuroradiol. 2001;22(1):5–10.
16. Soeda A, Sakai N, Murao K, et al. Thromboembolic events associated
with Guglielmi detachable coil embolization with use of diffusionweighted MR imaging. Part II. Detection of the microemboli proximal
to cerebral aneurysm. AJNR Am J Neuroradiol. 2003;24(10):2035–2038.
17. Brooks NP, Turk AS, Niemann DB, et al. Frequency of thromboembolic
events associated with endovascular aneurysm treatment: retrospective
case series. J Neurosurg. 2008;108(6):1095–1100.
18. Lubicz B, Lefranc F, Bruneau M, et al. Balloon-assisted coiling of
intracranial aneurysms is not associated with a higher complication rate.
Neuroradiology. 2008;50(9):769–776.
19. Ross IB, Dhillon GS. Complications of endovascular treatment of
cerebral aneurysms. Surg Neurol. 2005;64(1):12–18.
20. Spiotta AM, Bhalla T, Hussain MS, et al. An analysis of inflation times
during balloon-assisted aneurysm coil embolization and ischemic
complications. Stroke. 2011;42(4):1051–1055.
21. Higashida RT, Smith W, Gress D, et al. Intravascular stent and
endovascular coil placement for a ruptured fusiform aneurysm of the
basilar artery. Case report and review of the literature. J Neurosurg.
1997;87(6):944–949.
22. Wanke I, Forsting M. Stents for intracranial wide-necked aneurysms:
more than mechanical protection. Neuroradiology. 2008;50(12):991–
998.
23. Aenis M, Stancampiano AP, Wakhloo AK, et al. Modeling of flow in a
straight stented and nonstented side wall aneurysm model. J Biomech
Eng. 1997;119(2):206–212.
24. Phatouros CC, Sasaki TY, Higashida RT, et al. Stent-supported coil
embolization: the treatment of fusiform and wide-neck aneurysms and
pseudoaneurysms. Neurosurgery. 2000;47(1):107–113.
25. Benitez RP, Silva MT, Klem J, et al. Endovascular occlusion of widenecked aneurysms with a new intracranial microstent (Neuroform) and
detachable coils. Neurosurgery. 2004;54(6):1359–1367.
26. Biondi A, Janardhan V, Katz JM, et al. Neuroform stent-assisted coil
embolization of wide-neck intracranial aneurysms: strategies in stent
deployment and midterm follow-up. Neurosurgery. 2007;61(3):460–
468.
27. Fiorella D, Albuquerque FC, Deshmukh VR, et al. Usefulness of the
Neuroform stent for the treatment of cerebral aneurysms: results at
initial 3-6 months follow-up. Neurosurgery. 2005;56(6):1191–1201.
28. Lee YJ, Kim DJ, Suh SH, et al. Stent-assisted coil embolization of
intracranial wide-necked aneurysms. Neuroradiology. 2005;47(9):680–
689.
29. Liang G, Gao X, Li Z, et al. Neuroform stent-assisted coiling of
intracranial aneurysms: a 5-year single-center experience and follow-up.
Neurol Res. 2010;32(7):721–727.
30. Mocco J, Snyder KV, Albuquerque FC, et al. Treatment of intracranial
aneurysms with the Enterprise stent: a multicenter registry. J Neurosurg.
2009;110(1):35–39.
31. Ogilvy CS, Natarajan SK, Jahshan S, et al. Stent-assisted coiling of
paraclinoid aneurysms: risks and effectiveness. J Neurointerv Surg.
2011;3(1):14–20.
32. Piotin M, Blanc R, Spelle L, et al. Stent-assisted coiling of intracranial
aneurysms: clinical and angiographic results in 216 consecutive
aneurysms. Stroke. 2010;41(1):110–115.
33. Raslan AM, Oztaskin M, Thompson EM, et al. Neuroform stent-assisted
embolization of incidental anterior communicating artery aneurysms:
long-term clinical and angiographic follow-up. Neurosurgery.
2011;69(1):27–37.
34. Sedat J, Chau Y, Mondot L, et al. Endovascular occlusion of intracranial
wide-necked aneurysms with stenting (Neuroform) and coiling: midterm and long-term results. Neuroradiology. 2009;51(6):401–409.
35. Akpek S, Morsi H, Benndorf G, et al. Reconstruction of the basilar tip
with T stent configuration for treatment of a wide-neck aneurysm. J
Vasc Interv Radiol. 2004;15(9):1024–1026.
36. Chow MM, Woo HH, Masaryk TJ, et al. A novel endovascular
treatment of a wide-necked basilar apex aneurysm by using a Yconfiguration, double-stent technique. AJNR Am J Neuroradiol.
2004;25(3):509–512.
37. Perez-Arjona E, Fessler RD. Basilar artery to bilateral posterior cerebral
artery “Y stenting” for endovascular reconstruction of wide-necked
basilar apex aneurysms: report of three cases. Neurol Res.
2004;26(3):276–281.
38. Sani S, Lopes DK. Treatment of a middle cerebral artery bifurcation
aneurysm using a double Neuroform stent “Y” configuration and coil
embolization: technical case report. Neurosurgery. 2005;57(1)
(suppl):E209.
39. Spiotta AM, Gupta R, Fiorella D, et al. Mid-term results of endovascular
coiling of wide-necked aneurysms using double stents in a Y
configuration. Neurosurgery. 2011;69(2):421–429.
40. Thorell WE, Chow MM, Woo HH, et al. Y-configured dual intracranial
stent-assisted coil embolization for the treatment of wide-necked basilar
tip aneurysms. Neurosurgery. 2005;56(5):1035–1040.
41. Spiotta AM, Miranpuri A, Chaudry MI, et al. Combined balloon stent
technique with the Scepter C balloon and low-profile visualized
intraluminal stent for the treatment of intracranial aneurysms. J
Neurointerv Surg. 2013;5(suppl 3):iii79–iii82.
42. Benndorf G, Klucznik RP, Meyer D, et al. “Cross-over” technique for
horizontal stenting of an internal carotid bifurcation aneurysm using a
new self-expandable stent: technical case report. Neurosurgery.
2006;58(1)(suppl):ONS–E172.
43. Cross DT, Moran CJ, Derdeyn CP, et al. Neuroform stent deployment
for treatment of a basilar tip aneurysm via a posterior communicating
artery route. AJNR Am J Neuroradiol. 2005;26(10):2578–2581.
44. Fiorella D, Albuquerque FC, Masaryk TJ, et al. Balloon-in-stent
technique for the constructive endovascular treatment of “ultra-wide
necked” circumferential aneurysms. Neurosurgery. 2005;57(6):1218–
1227.
45. Kelly ME, Turner R, Gonugunta V, et al. Stent reconstruction of widenecked aneurysms across the circle of Willis. Neurosurgery. 2007;61(5)
(suppl 2):249–254.
46. Moret J, Ross IB, Weill A, et al. The retrograde approach: a
consideration for the endovascular treatment of aneurysms. AJNR Am J
Neuroradiol. 2000;21(2):262–268.
47. Gruber TJ, Ogilvy CS, Hauck EF, et al. Endovascular treatment of a
large aneurysm arising from a basilar trunk fenestration using the
waffle-cone technique. Neurosurgery. 2010;67(3)(suppl):140–144.
48. Padalino DJ, Singla A, Jacobsen W, et al. Enterprise stent for wafflecone stent-assisted coil embolization of large wide-necked arterial
bifurcation aneurysms. Surg Neurol Int. 2013;4:9.
E
Section B Head and Neck Embolization
15
Epistaxis
Long Chen • Ali Akber Hazari • Laura MacNeil • Kieran
Murphy
pistaxis, commonly known as a nosebleed, is the most common
otolaryngologic emergency.1 It is estimated that 60% of people have
experienced at least one episode of epistaxis, with 6% requiring
medical attention.2 Although this medical condition is not always recognized
as life-threatening, there have been incidences where epistaxis has led to
serious complications, and if not treated effectively, it can be fatal. Therefore,
it is crucial that the techniques and treatments used in prevention are well
understood.
Many studies indicate that the severity of the epistaxis depends on where
the bleed originates. Clinically, anterior bleeds are usually less severe than
posterior bleeds, and in about 80% of cases, epistaxis originates from the
anterior septal area.
1,3
Kiesselbach plexus, an “anastomosis with branches
from both the internal and external carotid artery systems,” is responsible for
most anterior septal nosebleeds, for example, those which children
experience in the winter time.3 Anterior septal nosebleeds would also include
epistaxis resulting from trauma, digital irritation, and dryness.3 The posterior
septal area is where epistaxis can be severe, more specifically the Woodruff
area where the “anastomoses of the sphenopalatine and pharyngeal arteries is
found.”
3
In a case of epistaxis, the aim of treatment is to do at least one of the
following: reduce bleeding through decreasing arterial inflow pressure,
reduce mucosal irritation, or reduce blood flow by inducing clot formation.
The initial treatment of epistaxis is based on nasal packing and chemical or
electrocautery.4 This is usually successful for the anterior septal area and is
also a first-line therapy for posterior epistaxis.
4,5
However, the posterior nasal
vault is located in an inaccessible region, causing this method to prove
ineffective 25% to 50% of times.
6,7
Nasal packing can also be painful for the
patient.6 Patients with preexisting pulmonary or cardiac problems are at
serious risk for hypoxia, cardiac arrhythmias, or sepsis when treated with
nasal packing.8 This is a particular risk in patients with heart disease where
the mucosal absorption of epinephrine can result in ischemia.
If the prior proves unsuccessful, patients are treated with nasal packing
along with transantral maxillary artery and ethmoid artery ligation.8 The aim
of this treatment is to surgically achieve homeostasis at the affected area by
decreasing arterial blood flow so epithelial repair and clotting may occur.
8
However, this procedure is not always successful in achieving the desired
homeostatic result and also puts the patient at risk for anesthetic problems,
septal perforation, infraorbital nerve dysfunction, ophthalmoplegia,
blindness, or myocardial infarction.8 Rarely, postsurgical pseudoaneurysms
develop.
Therefore, both these methods have been proven to carry a relatively
high number of risks and possible complications, making alternative
therapies more favorable for patients with severe cases of epistaxis.
One such alternative therapy, which has proven to be very effective, is