伴腦血管痙攣破裂腦動脈瘤血管內治療課件

伴有腦血管痙攣破裂腦動脈瘤的血管內治療林東胡錦清沈建康上海交通大學醫(yī)學院附屬瑞金醫(yī)院神經(jīng)外科1醫(yī)學ppt伴有腦血管痙攣破裂腦動脈瘤的血管內治療1醫(yī)學ppt男12例、女12例年齡32-77歲，平均53歲Hunt&Hess分級：Ⅰ級2例、Ⅱ級8例、Ⅲ級7例、Ⅳ級4例、Ⅴ級3例一般資料2醫(yī)學ppt一般資料2醫(yī)學pptCase139-year-oldmaleH&HⅠ3醫(yī)學pptCase139-year-oldmaleH&HⅠ3Case252-year-oldfemaleH&HⅡACA0.3%Papaverine60mg4醫(yī)學pptCase252-year-oldfemaleH&H入院當天行CTA，確診動脈瘤無栓塞禁忌，全麻，造影，確定最佳工作角度根據(jù)CTA所示動脈瘤部位把6F導引導管置入患側載瘤動脈。微導管超選插管到達動脈瘤囊內，行彈簧圈栓塞栓塞結束后，采用動脈內灌注、球囊血管成性形術?！叭摺敝委煼椒?醫(yī)學ppt方法5醫(yī)學ppt100%閉塞17個、閉塞>90%的5個CVS位于一側13例，雙側6例，彌漫性5例。CVS位于動脈瘤近端9例，遠端5例，兩端均有10例。術后3月時GOS優(yōu)良17例、中重殘3例、死亡2例（5級）結果6醫(yī)學ppt結果6醫(yī)學ppt討論7醫(yī)學ppt討論7醫(yī)學ppt

8醫(yī)學ppt8醫(yī)學ppt動脈瘤破裂后殘廢和死亡的主要原因

動脈瘤再破裂腦血管痙攣9醫(yī)學ppt動脈瘤破裂后殘廢和死亡的主要原因9醫(yī)學pptAfter5daysAfter3hoursAfter16days10醫(yī)學pptAfter5daysAfter3hoursAf腦血管痙攣好發(fā)動脈瘤破裂后的4～12天發(fā)生率30%～70%，其中癥狀性20%～30%血管內治療可在造影的同時栓塞動脈瘤，防止再出血，并可對痙攣的血管進行有效的治療11醫(yī)學ppt腦血管痙攣好發(fā)動脈瘤破裂后的4～12天11醫(yī)學ppt1984年Zubkov首先用球囊導管擴張痙攣的動脈治療SAH后腦血管痙攣，處理常規(guī)方法無法解除的近側段較大的腦動脈痙攣，并發(fā)癥有動脈破裂和發(fā)生載瘤動脈閉塞。12醫(yī)學ppt1984年Zubkov首先用球囊導管擴張12Case341-year-oldmaleH&HⅣ13醫(yī)學pptCase341-year-oldmaleH&HⅣPre-emboPost-embo14醫(yī)學pptPre-emboPost-embo14醫(yī)學pptCordisBartoy2.5*1012atm15醫(yī)學pptCordisBartoy2.5*1012atm15醫(yī)R-ICAPost-EmboR-ICA+MCAPost-PTA16醫(yī)學pptR-ICAPost-Embo16醫(yī)學pptL-ICA+MCAPTACordisBartoy2.5*108atm

17醫(yī)學pptL-ICA+MCAPTA17醫(yī)學pptPost-embo2wPost-emboPre-embo18醫(yī)學pptPost-embo2wPost-emboPre-embo1Follow-up4m19醫(yī)學pptFollow-up4m19醫(yī)學ppt1992年Kaku等用超選擇插管灌注罌粟堿以治療腦血管痙攣，缺點擴血管作用短暫，易引起顱壓增高和癲癇。20醫(yī)學ppt1992年Kaku等用超選擇插管灌注20醫(yī)學16dCase432-year-oldfemaleH&HⅡ21醫(yī)學ppt16dCase432-year-oldfemaleH22醫(yī)學ppt22醫(yī)學pptL-ACAPapaverine210mg23醫(yī)學pptL-ACAPapaverine210mg23醫(yī)學ppFollow-up4.5m24醫(yī)學pptFollow-up4.5m24醫(yī)學ppt32-year-oldfemaleH&HⅡ25醫(yī)學ppt32-year-oldfemaleH&HⅡ25醫(yī)學Post-emboFasudil60mg26醫(yī)學pptPost-emboFasudil60mg26醫(yī)學pptTREATMENTOFCEREBRALVASOSPASMWITHINTRA-ARTERIALFASUDILHYDROCHLORIDETanakaKetal,Neurosurgery56:214-223,200527醫(yī)學pptTREATMENTOFCEREBRALVASOSPAS28醫(yī)學ppt28醫(yī)學pptLowpressure(0.5atm,380mmHg)MTI29醫(yī)學pptLowpressure(0.5atm,380mm54-year-oldmale30醫(yī)學ppt54-year-oldmale30醫(yī)學ppt61-year-oldH&HⅢ31醫(yī)學ppt61-year-oldH&HⅢ31醫(yī)學pptFollow-up3m32醫(yī)學pptFollow-up3m32醫(yī)學pptCase554-year-oldmaleH&HⅣ33醫(yī)學pptCase554-year-oldmaleH&HⅣ34醫(yī)學ppt34醫(yī)學pptR-ACAA2Papaverine60mgL-ICAPapaverine150mgPost-embo35醫(yī)學pptR-ACAA2Papaverine60mgPoTITAN2.5*136atmR-MCAStent+Papaverine36醫(yī)學pptTITAN2.5*136atmR-MCAStePost-5d37醫(yī)學pptPost-5d37醫(yī)學pptCase73D-CTA38醫(yī)學pptCase73D-CTA38醫(yī)學ppt0Days39醫(yī)學ppt0Days39醫(yī)學pptDay

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1Day3Day

5Day7Drainage7daysUK700000U40醫(yī)學pptDay0Day1Day3Day5Day7Drain71-year-oldfemaleHHGr3,Fisher441醫(yī)學ppt71-year-oldfemale41醫(yī)學pptThankyou42醫(yī)學pptThankyou42醫(yī)學ppt此課件下載可自行編輯修改，供參考！感謝您的支持，我們努力做得更好！此課件下載可自行編輯修改，供參考！伴有腦血管痙攣破裂腦動脈瘤的血管內治療林東胡錦清沈建康上海交通大學醫(yī)學院附屬瑞金醫(yī)院神經(jīng)外科44醫(yī)學ppt伴有腦血管痙攣破裂腦動脈瘤的血管內治療1醫(yī)學ppt男12例、女12例年齡32-77歲，平均53歲Hunt&Hess分級：Ⅰ級2例、Ⅱ級8例、Ⅲ級7例、Ⅳ級4例、Ⅴ級3例一般資料45醫(yī)學ppt一般資料2醫(yī)學pptCase139-year-oldmaleH&HⅠ46醫(yī)學pptCase139-year-oldmaleH&HⅠ3Case252-year-oldfemaleH&HⅡACA0.3%Papaverine60mg47醫(yī)學pptCase252-year-oldfemaleH&H入院當天行CTA，確診動脈瘤無栓塞禁忌，全麻，造影，確定最佳工作角度根據(jù)CTA所示動脈瘤部位把6F導引導管置入患側載瘤動脈。微導管超選插管到達動脈瘤囊內，行彈簧圈栓塞栓塞結束后，采用動脈內灌注、球囊血管成性形術?！叭摺敝委煼椒?8醫(yī)學ppt方法5醫(yī)學ppt100%閉塞17個、閉塞>90%的5個CVS位于一側13例，雙側6例，彌漫性5例。CVS位于動脈瘤近端9例，遠端5例，兩端均有10例。術后3月時GOS優(yōu)良17例、中重殘3例、死亡2例（5級）結果49醫(yī)學ppt結果6醫(yī)學ppt討論50醫(yī)學ppt討論7醫(yī)學ppt

51醫(yī)學ppt8醫(yī)學ppt動脈瘤破裂后殘廢和死亡的主要原因

動脈瘤再破裂腦血管痙攣52醫(yī)學ppt動脈瘤破裂后殘廢和死亡的主要原因9醫(yī)學pptAfter5daysAfter3hoursAfter16days53醫(yī)學pptAfter5daysAfter3hoursAf腦血管痙攣好發(fā)動脈瘤破裂后的4～12天發(fā)生率30%～70%，其中癥狀性20%～30%血管內治療可在造影的同時栓塞動脈瘤，防止再出血，并可對痙攣的血管進行有效的治療54醫(yī)學ppt腦血管痙攣好發(fā)動脈瘤破裂后的4～12天11醫(yī)學ppt1984年Zubkov首先用球囊導管擴張痙攣的動脈治療SAH后腦血管痙攣，處理常規(guī)方法無法解除的近側段較大的腦動脈痙攣，并發(fā)癥有動脈破裂和發(fā)生載瘤動脈閉塞。55醫(yī)學ppt1984年Zubkov首先用球囊導管擴張12Case341-year-oldmaleH&HⅣ56醫(yī)學pptCase341-year-oldmaleH&HⅣPre-emboPost-embo57醫(yī)學pptPre-emboPost-embo14醫(yī)學pptCordisBartoy2.5*1012atm58醫(yī)學pptCordisBartoy2.5*1012atm15醫(yī)R-ICAPost-EmboR-ICA+MCAPost-PTA59醫(yī)學pptR-ICAPost-Embo16醫(yī)學pptL-ICA+MCAPTACordisBartoy2.5*108atm

60醫(yī)學pptL-ICA+MCAPTA17醫(yī)學pptPost-embo2wPost-emboPre-embo61醫(yī)學pptPost-embo2wPost-emboPre-embo1Follow-up4m62醫(yī)學pptFollow-up4m19醫(yī)學ppt1992年Kaku等用超選擇插管灌注罌粟堿以治療腦血管痙攣，缺點擴血管作用短暫，易引起顱壓增高和癲癇。63醫(yī)學ppt1992年Kaku等用超選擇插管灌注20醫(yī)學16dCase432-year-oldfemaleH&HⅡ64醫(yī)學ppt16dCase432-year-oldfemaleH65醫(yī)學ppt22醫(yī)學pptL-ACAPapaverine210mg66醫(yī)學pptL-ACAPapaverine210mg23醫(yī)學ppFollow-up4.5m67醫(yī)學pptFollow-up4.5m24醫(yī)學ppt32-year-oldfemaleH&HⅡ68醫(yī)學ppt32-year-oldfemaleH&HⅡ25醫(yī)學Post-emboFasudil60mg69醫(yī)學pptPost-emboFasudil60mg26醫(yī)學pptTREATMENTOFCEREBRALVASOSPASMWITHINTRA-ARTERIALFASUDILHYDROCHLORIDETanakaKetal,Neurosurgery56:214-223,200570醫(yī)學pptTREATMENTOFCEREBRALVASOSPAS71醫(yī)學ppt28醫(yī)學pptLowpressure(0.5atm,380mmHg)MTI72醫(yī)學pptLowpressure(0.5atm,380mm54-year-oldmale73醫(yī)學ppt54-year-oldmale30醫(yī)學ppt61-year-oldH&HⅢ74醫(yī)學ppt61-year-oldH&HⅢ31醫(yī)學pptFollow-up3m75醫(yī)學pptFollow-up3m32醫(yī)學pptCase554-year-oldmaleH&HⅣ