August 17, 2022

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Interventional treatment of cerebral aneurysm

 

Interventional treatment of cerebral aneurysm.

Cerebral aneurysm is often described as an “untime bomb” buried in the brain. The wall of the cerebral aneurysm is very fragile and prone to rupture and bleeding, that is, subarachnoid hemorrhage occurs.

 

Interventional treatment of cerebral aneurysm


Cerebral aneurysm is caused by the local congenital defect of the cerebral artery wall and the increase of intraluminal pressure. It looks like a balloon growing on a blood vessel, which is filled with blood.

It is a cerebrovascular disease. Although it is called an aneurysm, it is not a tumor and does not spread, and does not require radiotherapy or chemotherapy.

It is mostly found by magnetic resonance angiography (MRA) or CT angiography (CTA).

 

Cerebral aneurysms are often described as “untimely bombs” buried in the brain.

The walls of cerebral aneurysms are very fragile and prone to rupture and bleeding, that is, subarachnoid hemorrhage occurs. Such as rupture and bleeding, the disability rate is as high as 33%, and the fatality rate is as high as 40%.

For untreated patients, if rupture and bleeding occurs again, the mortality rate can be as high as 60%.

 

For ruptured aneurysms, emergency surgery is required. For unruptured aneurysms, since the risk of long-term rupture is high, surgical treatment is required to prevent the risk of long-term rupture.

 

 

 

Treatment of cerebral aneurysms

Intracranial aneurysm is one of the most difficult diseases to treat. The current conventional treatment methods include: open surgical treatment (clamping treatment, etc.), intravascular interventional treatment (coils, blood flow guides, liquid embolic agents, stents, etc.) ), conservative treatment and control of risk factors, etc.

 

Craniotomy:

  1. Intracranial aneurysm neck clipping: According to the orientation of the aneurysm and the length of the neck of the aneurysm, it is a common method for the treatment of intracranial aneurysms to choose an appropriate aneurysm clip to clip the aneurysm.
  2. Aneurysm wrapping: If the patient’s neck is relatively wide and fusiform aneurysms are not suitable for clipping, aneurysm wrapping can be used.

 

Interventional therapy:

1. Aneurysm embolization: It is currently the main treatment method, mainly using a microcatheter to send the coil to the aneurysm cavity to occlude the aneurysm.

2. Embolization of aneurysm-carrying artery: It is mostly used for patients who are difficult to embolize the aneurysm cavity or fail to embolize the aneurysm-carrying artery, and it is evaluated that embolization of the aneurysm-carrying artery will not cause obvious occlusion of the blood supply area of ​​the artery.

3. Vascular reconstruction device surgery: It is mainly to place dense mesh stents at the aneurysm site to reduce the impact of eddy current on the aneurysm and achieve the purpose of restoring normal blood flow and curing the aneurysm.

 

At present, the above conventional treatment methods for intracranial aneurysms have many difficulties for huge intracranial aneurysms.

For example, the aneurysm is huge and thin, and it is easy to rupture and hemorrhage; the aneurysm neck is wide and it is difficult or impossible to clamp; Space-occupying effect is not suitable for packing, or the pituitary gland is still compressed after packing, and it is difficult to improve the patient’s symptoms.

 

In response to the above difficulties, the Fang Chun team of Tongji Hospital affiliated to Tongji University actively used the most advanced intracranial aneurysm isolation technology in the world to treat patients.

Under the condition of no craniotomy, the intraluminal isolation technology of the tumor-bearing artery is used to block the blood flow in the aneurysm, and successfully treat the patient’s giant aneurysm.

This method has light postoperative space-occupying effect, the aneurysm gradually shrinks, does not significantly compress the surrounding normal brain tissue, the risk of intraoperative bleeding is small, and it is not easy to relapse after surgery, reaching the international advanced level, and significantly reducing the treatment cost compared with traditional methods.

 

As the team that currently applies the most endovascular isolation technology to treat giant intracranial aneurysms in China, Fang Chun’s medical department has also formed coil packing, stent/balloon assisted packing, and intraluminal isolation for aneurysms of different sizes.

A variety of stepped technical reserves can provide patients with safe, effective and personalized treatment.

 

 

 

Indications and contraindications for interventional therapy?

 

Interventional treatment of aneurysm is suitable for:

1. Huge aneurysms that are difficult to remove or access by surgery (such as aneurysms of the cavernous sinus segment, the beginning of the ophthalmic artery, and the vertebral base artery system).

2. The elderly or other systemic diseases cannot tolerate surgery.

3. The failure of surgical clipping.

4. Fusiform wide neck or no carotid aneurysm or saccular aneurysm.

5. All aneurysms except for contraindications can be treated with embolization first, and surgery can still be considered when embolization is unsuccessful.

 

Contraindications

1. Very small aneurysm.

2. Small and wide-necked aneurysms.

3. The inability to pass the aneurysm neck stenosis balloon is a contraindication for detachable balloon embolization.

 

Interventional treatment process:

Through puncture on one side of the femoral artery, a thick catheter, a guiding catheter, is inserted, and the guiding catheter is sent through the abdominal aorta and the thoracic aorta into the cerebral artery (carrying artery) of the long aneurysm.

Then a microcatheter (a thin catheter whose tip end is not much thicker than the sewing thread) is fed into the artery carrying the tumor through this thick catheter, and the tip of the microcatheter is carefully guided into the aneurysm cavity under the guidance of the microwire , Carrying out the delivery and packing of the spring coil. Withdraw the catheter. wrap the wound.

 

What checks should be done before interventional surgery:

1. Preoperative routine preparation: four items of infectious diseases, blood, urine, stool routine, blood sugar, electrolytes, orthographic chest radiograph, liver function, kidney function, coagulation complete set and electrocardiogram.

 

2. Preoperative special preparations: transcranial Doppler ultrasound examination of the blood flow of intracranial arteries; head and neck vessels MRA or CTA, detailed understanding of internal and external carotid arteries, aneurysm morphology, aneurysm neck width and tumor-bearing artery; people with abnormal vision Perform optic nerve electrophysiological examination and intraocular pressure measurement.

 

 

What should I pay attention to after surgery?

1. After the operation, the thigh puncture point needs to be immobilized for 8 hours, and pressure is applied with an elastic bandage for 24 hours. When the consciousness is restored, you can raise the head of the bed 15˚, eat soft and rotten food, avoid milk, soy milk and other gas-producing foods, and avoid cold, spicy foods. Drink plenty of water to promote the discharge of contrast agent. Head pain will not disappear immediately after surgery. Intracranial hemorrhage needs a period of absorption. If severe headache occurs again, be wary of aneurysm rupture and bleeding again.

 

2. After cerebral aneurysm interventional surgery, some patients may have increased blood viscosity. When the head vasoconstriction and spasm, the blood flow slows down, which may put the head blood vessels at risk of infarction. Patients may have hemiplegia, aphasia, mental retardation, and movement disorders.

 

3. After interventional surgical treatment of cerebral aneurysm, some patients may have psychiatric and neurological symptoms, and the patients may experience depression, depression, etc., severe depression may cause the risk of suicide.

 

 

 

 

Interventional treatment of cerebral aneurysm

(source:internet, reference only)


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