颅内动脉瘤的介入治疗-课件.ppt

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1、IMAGE GUIDEDTHERAPIESMedia BriefingJune 19,2003S p o n s o r e d b y t h eRadiological Societyof North AmericaBrain Aneurysms Successfully Treated Without Open SurgeryV A S C U L A R D I S E A S EJacques E.Dion,M.D.Emory University HospitalS p o n s o r e d b y t h eRadiological Societyof North Amer

2、icaBrain Aneurysms Successfully Treated Without Open SurgeryJacques E.Dion,M.D.,FRCP(C)Professor of Radiology&NeurosurgeryDirector,Interventional NeuroradiologyEmory University HospitalAtlanta,GAHistory of Coilingn1987-1989:Dr Guido Guglielmi(University of Rome)visits Dr Viuela(Interventional Neuror

3、adiologist)at UCLA and research work on coiling concept startsn1989:Dr Guglielmi comes permanently to UCLAn1989-1990:Bench and animal researchnMarch 6,1990:First clinical use of Guglielmi Detachable Coil nFDA approval in 1995ISATnA recent large prospective study of 2143 patients with ruptured aneury

4、sms 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 and dependency as compared to clipped patients(6.9%absolute difference,22.6%relative difference)and it wo

5、uld have been unethical to continue the study What Is An Aneurysm?A cerebral aneurysm is a bubble like outpouching from an artery which predisposes its carrier to cerebral hemorrhage and stroke Images Frank H.Netter,CIBA Collection of Medical IllustrationsAneurysm DemographicsnAneurysms are found in

6、 2-5%of the populationnThere are as many as 27,000 aneurysms that could be diagnosed and treated per year in the U.S.nThey are more common in women(Sharon Stone had an aneurysm that was treated with coils by an interventional neuroradiologist)nThe annual rupture rate is approximately 1.5%nRupture of

7、 an aneurysm results in approximately 50%mortality and 25%stroke incidence Aneurysm FactsnSymptoms of ruptured aneurysms:nThe worst headache of your lifenLocalized and intense headachenNausea and vomitingnStiff neck or neck painnBlurred or double visionnPain above and behind eyenDilated pupilsnSensi

8、tivity to lightnLoss of sensation Aneurysm TherapynSurgical clipping(approximately 60-65%in the United States)nEndovascular coiling(approximately 30-35%in the United States)nIn certain countries such as Finland,Great Britain and France,close to 90%of aneurysms are treated with endovascular coilingnA

9、fter the release of the ISAT results,the percentage of aneurysm patients treated with coiling in England went from 40%to 90%ANEURYSM COILING nA minimally invasive procedure usually performed under general anesthesia by an interventional neuroradiologistnA very small plastic tube(microcatheter)is thr

10、eaded 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 potholenThe catheter is then removed and the small groin incision covered with a Band-AidnFor an unruptured aneurysm,the patient is discharg

11、ed home within 24 to 48 hours Pros and Cons of CoilingPROSnMinimally invasive nShort recoverynSafer than surgerynCheaper than surgery CONS nShorter track record nPossibly less durablenRequirement for follow-up angiography The FuturenIncreased percentage of patients treated with coiling,in large volu

12、me referral centersnUse of adjunctive maneuvers increases the percentage of aneurysms treatable with endovascular techniquesnIncreased efficacy of coiling therapy(new,bioactive materials,tissue healing strategies)nDevelopment of non-invasive follow-up techniques with CT or MR scanningnBetter educate

13、d population will actually demand availability and discussion of both endovascular coiling and surgical clipping optionsStent+CoilWide neck mid basilar aneurysmHydrocoilMatrix Bioactive CoilTake Home PointsnEndovascular coiling of aneurysms is available in over 200 hospitals in this country nApproxi

14、mately 200,000 patients in the world have benefited from endovascular coiling since its inception in 1990 Take Home PointsnAll patients with aneurysms should be informed of the availability of both endovascular coiling and surgical clipping by a neurosurgeon and an interventional neuroradiologistnThe death and complication rate for aneurysm therapy is dramatically reduced in high volume centers that offer both surgical clipping and endovascular coiling Information and LinksAmerican Society of Interventional andTherapeutic Neuroradiology(ASITN)