特殊类型动脉瘤的介入治疗课件

特殊类型动脉瘤的

介入治疗特殊类型动脉瘤的

介入治疗特殊类型动脉瘤特殊部位颈动脉前壁动脉瘤脉络膜前动脉动脉瘤大脑后动脉动脉瘤远端动脉瘤穿支血管动脉瘤特殊类型合并假性成分的动脉瘤夹层动脉瘤外伤性动脉瘤蛇形动脉瘤特殊类型动脉瘤特殊部位脉络膜前动脉动脉瘤脉络膜前动脉动脉瘤（AnteriorChoroidalArteryAneurysm,AChAN）占所有颅内动脉瘤的2-5%AChA颈内动脉的终末分支，其穿支供应了视束、大脑脚、外侧膝状体、苍白球、内囊后肢等重要的结构。AChA发自瘤颈，术后缺血并发症发生率23.8%（5/21）AchA与动脉瘤无关，无缺血并发症（0/17）KimBMetal.Neuroradiology(2008)50:251脉络膜前动脉动脉瘤脉络膜前动脉动脉瘤（AnteriorCh脉络膜前动脉动脉瘤Case151-Y-O-F脉络膜前动脉动脉瘤Case110minlater10minlater术后即刻言语含糊，对侧上肢肌力1级，下肢3级，对侧Babinski征阳性1个月后对侧肢体轻偏瘫术后即刻言语含糊，对侧上肢肌力1级，下肢3级，对侧BabinSubtotalEmbo.Case247-Y-O-FSAHSubtotalEmbo.Case2特殊类型动脉瘤的介入治疗课件FinalFinalStent+coilCase356-Y-O-FSAHStent+coilCase3MESHtechniqueMESHtechnique特殊类型动脉瘤的介入治疗课件15mFU15mFU建议术前3-D重建仔细分析AchA与An的关系术中注意AchA通畅性累及AchA的An，宁愿次全栓塞或瘤颈残留支架有利于AchA的保护和动脉瘤愈合建议术前3-D重建仔细分析AchA与An的关系大脑后动脉动脉瘤占全部颅内动脉瘤的0.7-2.3%多发于P1、P2段发病平均年龄38岁大或巨大动脉瘤常见Drake,42%ofgiantaneurysmsYasargil,50%ofgiantaneurysmsCiceri,24%ofgiantaneurysms分类囊性动脉瘤夹层动脉瘤大脑后动脉动脉瘤占全部颅内动脉瘤的0.7-2.3%大脑后动脉分段ZealAA,RhotonALJr.JNeurosurg,1978,48(4):534CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27大脑后动脉分段ZealAA,RhotonALJr.JThePCAcanbesubdividedintofouranatomicsegments(6–8),asshowninFigure1.TheP1segmentextendsfromthetipofthebasilararterytotheoriginoftheposteriorcommunicatingartery.TheP2segmentextendsfromtheposteriorcommunicatingarterytothedorsalaspectofthemidbrain;thisP2segmentcanbefurthersubdividedintoanterior(P2A)andposterior(P2P)segments.TheP3segmentextendsfromthelateralaspectofthequadrigeminalcisternattheoriginoftheposteriortemporalartery,totheanteriorlimitofthecalcarinefissure.TheP4segmentconsistsoftheterminalcorticalbranchesofthePCA,afterthetakeoffoftheparietooccipitalandcalcarinearteries.Eachofthesesegmentsgivesoffgroupsofbranchesthatsupplydistinctanatomicterritories:brainstemandthalamicbranches,ventricularbranches,andcorticalbranches.ThefoursegmentsofthePCAandtheirrespectivebranchesaredetailedinFigure1.CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27ThePCAcanbesubdividedinto治疗方法手术technicaldifficultiesandhighrisks介入囊性动脉瘤：动脉瘤弹簧圈栓塞夹层动脉瘤：载瘤动脉闭塞（parentvesselocclusion，PVO）riskofinfarctionfromperforatorsand/ordistalbranchocclusion支架辅助栓塞治疗方法手术technicaldifficu囊性动脉瘤Case9男，47岁突发头痛SAH囊性动脉瘤Case9特殊类型动脉瘤的介入治疗课件无再出血，无神经功能缺损无再出血，无神经功能缺损囊性动脉瘤囊性动脉瘤2mFU2mFU囊性动脉瘤PCA-An血流动力学相关的多为囊性动脉瘤AJNRAmJNeuroradiol22:27–34,January2001囊性动脉瘤PCA-An血流动力学相关的多为囊性动脉瘤AJNR夹层动脉瘤P2P段Case1045-Y-O-FSAH&IVH夹层动脉瘤P2P段Case10特殊类型动脉瘤的介入治疗课件Case11男，26岁头痛，神经系统（-）夹层动脉瘤P2P段Case11夹层动脉瘤P2P段特殊类型动脉瘤的介入治疗课件术前R-ICA术后R-ICA术后左侧视野缺损术后3月改善术前R-ICA术后R-ICA术后左侧视野缺损术后3月术后3月特殊类型动脉瘤的介入治疗课件Itisimpossibletobecertainwhetherornotaparentarteryocclusionwillbetolerated.Ingeneral,however,weavoidparentarteryocclusionattheP1orP2segmentsgiventherichvascularsupplytothebrainstemthatoriginatesfromtheseanatomiclocationsandthepossibleneurologicdeficitsthatmayoccurasaresultofsuchtreatment.CiceriEFetal.

AJNRAmJNeuroradiol2001,22:27–34Itisimpossibletobecertain夹层动脉瘤P2A段Case1258-year-oldmaleincidentalfound夹层动脉瘤P2A段Case12Enterprise4.5/22Enterprise4.5/22特殊类型动脉瘤的介入治疗课件11MFU11MFU11MFU11MFU特殊类型动脉瘤的介入治疗课件After2EnterprisestentsABDCAfter2EnterprisestentsABDCPVOTheincidenceofsymptomaticinfarctionafterPAocclusionwas16.3%intheliteraturereview.BOT无效，不常用StentassistedcoilingInliteraturereview,themorbidityandmortalityofstentforPCAaneurysmswas7.9%intotal.Noinfarctionwasreported.Therewerethree(13%)recurrences,butonlyone(4.3%)causedrebleeding.HuangQ,etal.ClinNeuroradiol.2013PVOHuangQ,etal.ClinNeuror建议囊性动脉瘤应单纯栓塞动脉瘤夹层动脉瘤可能需要闭塞载瘤动脉P1、P2段动脉瘤闭塞载瘤动脉可能导致穿支闭塞，尽可能保留载瘤动脉定期随访建议囊性动脉瘤应单纯栓塞动脉瘤幕下远端动脉瘤Distalaneurysmsofcerebellararteriesarerarelesionsaccountingfor0.6%ofalltreatedaneurysms夹层、假性动脉瘤常见一般需要闭塞载瘤动脉PelusoJPP,etal.AJNRAmJNeuroradiol.2007,28:1573TokimuraH,etal.NeurosurgRev.2012,35:497幕下远端动脉瘤DistalaneurysmsofcerDistalPICAAnCase1358-Y-O-FSAH&IVHin4thventricleDistalPICAAnCase13特殊类型动脉瘤的介入治疗课件特殊类型动脉瘤的介入治疗课件Case14DistalAICAAnCase14DistalAICAAnMarathonsuperselectiveangio.Marathonsuperselectiveangio.Onyx-34Onyx-34ControlangiographyafterembolizationControlangiographyafteremboMRI4daysafterembolizationMRI4daysafterembolization特殊类型动脉瘤的介入治疗课件注意事项注意事项Onyx-34intraprocedualleakageOnyx-34intraprocedualleakage特殊类型动脉瘤的介入治疗课件术前术后术前术后评价闭塞动脉瘤及载瘤动脉原位闭塞注意术中破裂风险评价闭塞动脉瘤及载瘤动脉F,52Yrs,Suddenonsetofheadache&nauseaRebleeding20dayslater,HHgradeII2010-10-292010-11-182010-11-22合并假性成分的AnCase15F,52Yrs,SuddenonsetofheadOnyx0.2ml

Endovascular

coiling&Onyxinjection.Hydrosoft2/6SuccessfulsealtestHyperform4/7Onyx0.2mlEndovascular

coiliFinalcontrol6MFollow-upFinalcontrol6MFollow-upCase16Case16特殊类型动脉瘤的介入治疗课件IntralumenonyxIntralumenonyx评价利：栓塞率高、栓塞效果好不利：操作复杂、占位效应、经验较少建议：特殊病例应用，注意并发症评价利：栓塞率高、栓塞效果好椎动脉夹层动脉瘤椎动脉夹层动脉瘤出血性夹层再出血24%~71.4%70%发生在首次出血后24小时内，80%发生在一周内缺血性夹层无症状椎动脉夹层动脉瘤椎动脉夹层动脉瘤治疗手术近端夹闭动脉瘤孤立颅神经麻痹介入夹层动脉瘤孤立夹层近端闭塞血管重建治疗手术Case21SAHVA-V4出血性夹层Case21SAHVA-V4出血性夹层Case2058yFemale,acuteSAH,bilateralVAdissectioninganeurysm.VA-V4出血性夹层Case2058yFemale,acuteSAH,R-VAdissectionworkingprojection,doublemicrocatheterinpositionR-VAdissectionworkingprojecSemi-deploythestentandintroducecoilsSemi-deploythestentandintrFourcoilsintroducedandfullydeploythefirstEnterpriseFourcoilsintroducedandfullAfterdeploying3stents,decreasedcontrastinthedissectioninganeurysmwasoberserved.Afterdeploying3stents,decrL-VAocclusionL-VAocclusion50minafterdeployingthe3rdstent,R-VAreconstructed,R-PICApatent50minafterdeployingthe3rdCase22非出血性夹层Case22非出血性夹层4Enterprisestents4Enterprisestents特殊类型动脉瘤的介入治疗课件8mFU8mFU三维模拟速度场壁面切应力压力场三维模拟速度场壁面切应力压力场支架孔率对血流动力学的效应关系汇聚变发散完全抑制强度变弱金属覆盖率30%-40%支架孔率对血流动力学的效应关系汇聚变发散完全抑制强度变弱金属支架和弹簧圈对于分支血流的影响收缩末期经过分支截面的血流速度。A为治疗前；B-D为植入1-3枚支架，随着支架数量的增加，血流速度无明显变化；E-H为植入1枚支架和不同栓塞密度的弹簧圈，弹簧圈密度分别为2.5%，4.7%，8.5%和14.9%，随着弹簧圈的增加，血流速度进行性下降，当栓塞密度达到14.9%时，血流方向发生改变。I-L为0-3枚支架结合4.7%栓塞密度的弹簧圈,在弹簧圈数量固定的情况下增加支架数量，分支血流速度无明显变化。支架和弹簧圈对于分支血流的影响收缩末期经过分支Tubridge46根镍钛丝（40u）2根Pt显影芯（80u）金属覆盖率35%脉瘤颈处30%～50%其它位置12%～20%Tubridge46根镍钛丝（40u）特殊类型动脉瘤的介入治疗课件6mFU6mFU外伤性假性动脉瘤外伤性假性动脉瘤特殊类型动脉瘤的介入治疗课件特殊类型动脉瘤的介入治疗课件87M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA87M38,4weeksafterheadtrau88M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA88M38,4weeksafterheadtrau89Enterprisestentinposition,firsthydrocoil4/10,followbythree3/10barecoils,twoAxium1.5/2coils89Enterprisestentinposition90Last3/4coil,partialloopsatruptureholeandpartialintheparentvessel,wishingtocovertheruptureholeafterstentdeployment90Last3/4coil,partialloops91Finalresult91Finalresult92ImmediatelyafterOp1weekFU92ImmediatelyafterOp93ImmediatelyafterOp4mFU93ImmediatelyafterOp94ImmediatelyafterOp4mFU94ImmediatelyafterOpNon-intracranialcoveredstents:Jostent(AbbottVascular)Symbiot(BostonScientific)CarotidWallstent(BostonScientific)Autologousvein-coveredstentIntracranialcoveredstentWillis(MicroPort,Shanghai,China)Non-intracranialcoveredstentJostentJostent6mfollowup6mfollowupThanksThanksSAHCalcificationinPcomAarea蛇形动脉瘤SAH蛇形动脉瘤DSADSA3D-DSAMCAICAAchAP2PcomAP13D-DSAMCAICAAchAP2PcomAP1DynaCTP2PcomAP1P2ICAAchAPcomADynaCTP2PcomAP1P2ICAAchAPcomADSAL-CCASlimICA,distalICAfilledbycollateralbranchesofMMAviaretrogradeflowthroughOA,MCAthusfilledICADSAL-CCASlimICA,distalICADSAR-ICAA1DSAR-ICAA1DynaCTCarotidCanalCarotidCanalDynaCTCarotidCanalCarotidCanPreoperativeCTPPreoperativeCTPStrategyStep1STA-MCABypssStep2BOTinBAStep3OcclusionofPcomA&AnStrategyStep1PosterativeCTPrCBV↑rCBF↑TTP-MTT-ComparedwithpreoperativeCTPPosterativeCTPrCBV↑10dayslaterAngio.&BOTviaL-CCA10dayslaterAngio.&BOT3DDSA3DDSACBVbasedon8sDSAPre-BOTCBVbasedon8sDSAPre-BOTBOTinBAPCABOTinBAPCABOTinBAICABOTinBAICACBVwhenBOTinBANosignificantdifferencewithpreviousCTPCBVwhenBOTinBANosignificaEmbolizationofPcomA&AnEmbolizationofPcomA&AnPost-embolizationPost-embolizationPost-embolizationPost-embolizationPost-embolizationPost-embolizationPost-embolizationCoilsContrastinPcomAPost-embolizationCoilsContrast特殊类型动脉瘤的介入治疗课件特殊类型动脉瘤的

介入治疗特殊类型动脉瘤的

介入治疗特殊类型动脉瘤特殊部位颈动脉前壁动脉瘤脉络膜前动脉动脉瘤大脑后动脉动脉瘤远端动脉瘤穿支血管动脉瘤特殊类型合并假性成分的动脉瘤夹层动脉瘤外伤性动脉瘤蛇形动脉瘤特殊类型动脉瘤特殊部位脉络膜前动脉动脉瘤脉络膜前动脉动脉瘤（AnteriorChoroidalArteryAneurysm,AChAN）占所有颅内动脉瘤的2-5%AChA颈内动脉的终末分支，其穿支供应了视束、大脑脚、外侧膝状体、苍白球、内囊后肢等重要的结构。AChA发自瘤颈，术后缺血并发症发生率23.8%（5/21）AchA与动脉瘤无关，无缺血并发症（0/17）KimBMetal.Neuroradiology(2008)50:251脉络膜前动脉动脉瘤脉络膜前动脉动脉瘤（AnteriorCh脉络膜前动脉动脉瘤Case151-Y-O-F脉络膜前动脉动脉瘤Case110minlater10minlater术后即刻言语含糊，对侧上肢肌力1级，下肢3级，对侧Babinski征阳性1个月后对侧肢体轻偏瘫术后即刻言语含糊，对侧上肢肌力1级，下肢3级，对侧BabinSubtotalEmbo.Case247-Y-O-FSAHSubtotalEmbo.Case2特殊类型动脉瘤的介入治疗课件FinalFinalStent+coilCase356-Y-O-FSAHStent+coilCase3MESHtechniqueMESHtechnique特殊类型动脉瘤的介入治疗课件15mFU15mFU建议术前3-D重建仔细分析AchA与An的关系术中注意AchA通畅性累及AchA的An，宁愿次全栓塞或瘤颈残留支架有利于AchA的保护和动脉瘤愈合建议术前3-D重建仔细分析AchA与An的关系大脑后动脉动脉瘤占全部颅内动脉瘤的0.7-2.3%多发于P1、P2段发病平均年龄38岁大或巨大动脉瘤常见Drake,42%ofgiantaneurysmsYasargil,50%ofgiantaneurysmsCiceri,24%ofgiantaneurysms分类囊性动脉瘤夹层动脉瘤大脑后动脉动脉瘤占全部颅内动脉瘤的0.7-2.3%大脑后动脉分段ZealAA,RhotonALJr.JNeurosurg,1978,48(4):534CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27大脑后动脉分段ZealAA,RhotonALJr.JThePCAcanbesubdividedintofouranatomicsegments(6–8),asshowninFigure1.TheP1segmentextendsfromthetipofthebasilararterytotheoriginoftheposteriorcommunicatingartery.TheP2segmentextendsfromtheposteriorcommunicatingarterytothedorsalaspectofthemidbrain;thisP2segmentcanbefurthersubdividedintoanterior(P2A)andposterior(P2P)segments.TheP3segmentextendsfromthelateralaspectofthequadrigeminalcisternattheoriginoftheposteriortemporalartery,totheanteriorlimitofthecalcarinefissure.TheP4segmentconsistsoftheterminalcorticalbranchesofthePCA,afterthetakeoffoftheparietooccipitalandcalcarinearteries.Eachofthesesegmentsgivesoffgroupsofbranchesthatsupplydistinctanatomicterritories:brainstemandthalamicbranches,ventricularbranches,andcorticalbranches.ThefoursegmentsofthePCAandtheirrespectivebranchesaredetailedinFigure1.CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27ThePCAcanbesubdividedinto治疗方法手术technicaldifficultiesandhighrisks介入囊性动脉瘤：动脉瘤弹簧圈栓塞夹层动脉瘤：载瘤动脉闭塞（parentvesselocclusion，PVO）riskofinfarctionfromperforatorsand/ordistalbranchocclusion支架辅助栓塞治疗方法手术technicaldifficu囊性动脉瘤Case9男，47岁突发头痛SAH囊性动脉瘤Case9特殊类型动脉瘤的介入治疗课件无再出血，无神经功能缺损无再出血，无神经功能缺损囊性动脉瘤囊性动脉瘤2mFU2mFU囊性动脉瘤PCA-An血流动力学相关的多为囊性动脉瘤AJNRAmJNeuroradiol22:27–34,January2001囊性动脉瘤PCA-An血流动力学相关的多为囊性动脉瘤AJNR夹层动脉瘤P2P段Case1045-Y-O-FSAH&IVH夹层动脉瘤P2P段Case10特殊类型动脉瘤的介入治疗课件Case11男，26岁头痛，神经系统（-）夹层动脉瘤P2P段Case11夹层动脉瘤P2P段特殊类型动脉瘤的介入治疗课件术前R-ICA术后R-ICA术后左侧视野缺损术后3月改善术前R-ICA术后R-ICA术后左侧视野缺损术后3月术后3月特殊类型动脉瘤的介入治疗课件Itisimpossibletobecertainwhetherornotaparentarteryocclusionwillbetolerated.Ingeneral,however,weavoidparentarteryocclusionattheP1orP2segmentsgiventherichvascularsupplytothebrainstemthatoriginatesfromtheseanatomiclocationsandthepossibleneurologicdeficitsthatmayoccurasaresultofsuchtreatment.CiceriEFetal.

AJNRAmJNeuroradiol2001,22:27–34Itisimpossibletobecertain夹层动脉瘤P2A段Case1258-year-oldmaleincidentalfound夹层动脉瘤P2A段Case12Enterprise4.5/22Enterprise4.5/22特殊类型动脉瘤的介入治疗课件11MFU11MFU11MFU11MFU特殊类型动脉瘤的介入治疗课件After2EnterprisestentsABDCAfter2EnterprisestentsABDCPVOTheincidenceofsymptomaticinfarctionafterPAocclusionwas16.3%intheliteraturereview.BOT无效，不常用StentassistedcoilingInliteraturereview,themorbidityandmortalityofstentforPCAaneurysmswas7.9%intotal.Noinfarctionwasreported.Therewerethree(13%)recurrences,butonlyone(4.3%)causedrebleeding.HuangQ,etal.ClinNeuroradiol.2013PVOHuangQ,etal.ClinNeuror建议囊性动脉瘤应单纯栓塞动脉瘤夹层动脉瘤可能需要闭塞载瘤动脉P1、P2段动脉瘤闭塞载瘤动脉可能导致穿支闭塞，尽可能保留载瘤动脉定期随访建议囊性动脉瘤应单纯栓塞动脉瘤幕下远端动脉瘤Distalaneurysmsofcerebellararteriesarerarelesionsaccountingfor0.6%ofalltreatedaneurysms夹层、假性动脉瘤常见一般需要闭塞载瘤动脉PelusoJPP,etal.AJNRAmJNeuroradiol.2007,28:1573TokimuraH,etal.NeurosurgRev.2012,35:497幕下远端动脉瘤DistalaneurysmsofcerDistalPICAAnCase1358-Y-O-FSAH&IVHin4thventricleDistalPICAAnCase13特殊类型动脉瘤的介入治疗课件特殊类型动脉瘤的介入治疗课件Case14DistalAICAAnCase14DistalAICAAnMarathonsuperselectiveangio.Marathonsuperselectiveangio.Onyx-34Onyx-34ControlangiographyafterembolizationControlangiographyafteremboMRI4daysafterembolizationMRI4daysafterembolization特殊类型动脉瘤的介入治疗课件注意事项注意事项Onyx-34intraprocedualleakageOnyx-34intraprocedualleakage特殊类型动脉瘤的介入治疗课件术前术后术前术后评价闭塞动脉瘤及载瘤动脉原位闭塞注意术中破裂风险评价闭塞动脉瘤及载瘤动脉F,52Yrs,Suddenonsetofheadache&nauseaRebleeding20dayslater,HHgradeII2010-10-292010-11-182010-11-22合并假性成分的AnCase15F,52Yrs,SuddenonsetofheadOnyx0.2ml

Endovascular

coiling&Onyxinjection.Hydrosoft2/6SuccessfulsealtestHyperform4/7Onyx0.2mlEndovascular

coiliFinalcontrol6MFollow-upFinalcontrol6MFollow-upCase16Case16特殊类型动脉瘤的介入治疗课件IntralumenonyxIntralumenonyx评价利：栓塞率高、栓塞效果好不利：操作复杂、占位效应、经验较少建议：特殊病例应用，注意并发症评价利：栓塞率高、栓塞效果好椎动脉夹层动脉瘤椎动脉夹层动脉瘤出血性夹层再出血24%~71.4%70%发生在首次出血后24小时内，80%发生在一周内缺血性夹层无症状椎动脉夹层动脉瘤椎动脉夹层动脉瘤治疗手术近端夹闭动脉瘤孤立颅神经麻痹介入夹层动脉瘤孤立夹层近端闭塞血管重建治疗手术Case21SAHVA-V4出血性夹层Case21SAHVA-V4出血性夹层Case2058yFemale,acuteSAH,bilateralVAdissectioninganeurysm.VA-V4出血性夹层Case2058yFemale,acuteSAH,R-VAdissectionworkingprojection,doublemicrocatheterinpositionR-VAdissectionworkingprojecSemi-deploythestentandintroducecoilsSemi-deploythestentandintrFourcoilsintroducedandfullydeploythefirstEnterpriseFourcoilsintroducedandfullAfterdeploying3stents,decreasedcontrastinthedissectioninganeurysmwasoberserved.Afterdeploying3stents,decrL-VAocclusionL-VAocclusion50minafterdeployingthe3rdstent,R-VAreconstructed,R-PICApatent50minafterdeployingthe3rdCase22非出血性夹层Case22非出血性夹层4Enterprisestents4Enterprisestents特殊类型动脉瘤的介入治疗课件8mFU8mFU三维模拟速度场壁面切应力压力场三维模拟速度场壁面切应力压力场支架孔率对血流动力学的效应关系汇聚变发散完全抑制强度变弱金属覆盖率30%-40%支架孔率对血流动力学的效应关系汇聚变发散完全抑制强度变弱金属支架和弹簧圈对于分支血流的影响收缩末期经过分支截面的血流速度。A为治疗前；B-D为植入1-3枚支架，随着支架数量的增加，血流速度无明显变化；E-H为植入1枚支架和不同栓塞密度的弹簧圈，弹簧圈密度分别为2.5%，4.7%，8.5%和14.9%，随着弹簧圈的增加，血流速度进行性下降，当栓塞密度达到14.9%时，血流方向发生改变。I-L为0-3枚支架结合4.7%栓塞密度的弹簧圈,在弹簧圈数量固定的情况下增加支架数量，分支血流速度无明显变化。支架和弹簧圈对于分支血流的影响收缩末期经过分支Tubridge46根镍钛丝（40u）2根Pt显影芯（80u）金属覆盖率35%脉瘤颈处30%～50%其它位置12%～20%Tubridge46根镍钛丝（40u）特殊类型动脉瘤的介入治疗课件6mFU6mFU外伤性假性动脉瘤外伤性假性动脉瘤特殊类型动脉瘤的介入治疗课件特殊类型动脉瘤的介入治疗课件207M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA87M38,4weeksafterheadtrau208M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA88M38,4weeksafterheadtrau209Enterprisestentinposition,firsthydrocoil4/10,followbythree3/10barecoils,twoAxium1.5/2coils89Enterprisestentinposition210Last3/4coil,partialloopsatruptureholeandpartialintheparentvessel,wishingtocovertheruptureholeafterstentdeployment90Last3/4coil,partialloops211Finalre