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Endovascular treatment of wide-necked intracranial aneurysms using of ＂remodeling technique＂ with the HyperForm balloon

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Chinese Medical Journal 2008年第8期121卷 725-729页

作者： MU Shi-qing YANG Xin-jian LI You-xiang ZHANG You-ping LU Ming WU Zhong-xue department of neuroradiosugery Beijing Neurosurgical Institute Capital Medical University Beijing 100053 China

Background Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the ＂remodeling technique＂ with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result. Methods From June 2004 to September 2006, forty-two patients （20 men, 22 women） with wide-necked or large neck/fundus ratio aneurysms were treated by using the ＂remodeling technique＂ with the HyperForm balloon. Results Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases （80.9%）, subtotal in 4 （9.5%） and incomplete in 2 （4.8%）. One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months. Conclusions The ＂remodeling technique＂ with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms - located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurvsms when the standard remodelina techniaue miaht have failed.

关键词： aneurysms remodeling technique HyperForm balloon endovascular treatment

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Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer： technical aspects

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Chinese Medical Journal 2009年第16期122卷 1851-1856页

作者： GAO Kun YANG Xin-jian MU Shi-qing LI You-xiang ZHANG You-ping LU Ming WU Zhong-xue department of neuroradiosugery Beijing Neurosurgery Institute Beijing Tiantan Hospital Capital Medical University Beijing 100050 China

Background Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations （BAVMs）. Ethylene vinyl alcohol copolymer （Onyx） is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique. Methods From September 2003 to November 2007, 115 patients （43 women and 72 men, with a mean age of 29 years） with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment： type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed. Results The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients （26.1%）, near-total （〉80% of the original volume） occlusion was obtained in 35 patients （39.8%） and partial occlusion （〈80% of the original volume） was obtained in 30 patients （34.1%） using embolization as the sole therapeutic technique. Mean volume reduction was 72% （range 30%-100%） in 115 patients. Thirty four patients （38.6%, 34/88） underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients （16.5%, 19/115）, leading to death in one patient （mortality 0.9%） and permanent disabling in 3 patients （morbidity 2.6%）. Conclusions Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.

关键词： brain arteriovenous malformations endovascular treatment Onyx copolymer

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Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula

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Chinese Medical Journal 2008年第17期121卷 1651-1655页

作者： HE Hong-wei JIANG Chu-han WU Zhong-xue LI You-xiang LU Xian-li WANG Zhong-cheng department of neuroradiosugery Beijing Neurosurgery Institute Beijing Tiantan Hospital Capital Medical University Beijing 100050 China

Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach. Methods From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins. Results Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a f

关键词： transvenous cavernous dural arteriovenous fistula embolization Onyx detachable coils

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Endovascular treatment of cerebral arteriovenous malformations with Onyx embolization

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Chinese Medical Journal 2005年第24期118卷 2041-2045页

作者： HE Hong-wei JIANG Chu-han LIU Hong-bing LI You-xiang ZHANG Jing-bo WU Zhong-xue department of Neurosurgery Qilu Hospital Shandong UniversityJinan 250012 China department of neuroradiosugery Beijing Neurosurgery Institute Beijing 100050China

Background In the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations （CAVMs）. The aim of this study was to assess the endovascular treatment of CAVMs by using a liquid embolic material, Onyx （ Micro Therapeutics. Inc. , Irvine, CA, USA）. Methods From September 2003 to September 2004, Onyx was used to treat 22 patients with CAVMs. Ten AVMS were located in functional areas, 8 in deep cerebral areas, and 4 in the cerebellar hemisphere. The size of CAVMs was about 3 cm in diameter in 5 patients, 3 -6 cm in 11, and more than 6 cm in 6. Results In the 22 patients, Onyx embolization was successful. Nidus occlusion was complete in 3 patients, 〉 90% in 8, 〉 80% and 〈 90% in 6, and 〉 50% and 〈 80% in 5. Complications included transient neurological deficits in 2 patients, and adherence of microcatheter to the site of injection in 2. Conclusions Being non-adhesiveness, Onyx is a safe and satisfactory embolic material in the treatment of CAVMs. But its long-term efficacy awaits further follow-up.

关键词： cerebral arteriovenous malformations embolization, therapeutic Onyx copolymer

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