支架结合弹簧圈栓塞治疗颅内复杂动脉瘤临床研究
|
摘要
目的：回顾性分析研究支架结合弹簧圈栓塞治疗颅内复杂动脉瘤的病例资料,总结支架辅助技术的方法及要点；评价该技术治疗颅内动脉瘤的近、远期疗效,对其并发症的处置情况进行讨论；探讨支架辅助技术治疗颅内动脉瘤的临床经验、效果及安全性；探讨栓塞术后动脉瘤复发的影响因素,为今后临床工作中颅内动脉瘤病人的个性化介入治疗提供理论支持。
方法：对经血管内栓塞治疗的54位颅内动脉瘤患者的临床资料进行整理归纳,包括男女比例、发病年龄、临床主要症状、影像学表现、术前Hunt-Hess分级、动脉瘤大小、栓塞方法及材料、并发症、术后临床与影像学随访情况等,建立血管内介入治疗颅内动脉瘤病人档案库,整理其中26位行支架置入术患者的资料,与单纯行弹簧圈栓塞治疗和球囊结合弹簧圈栓塞治疗的两组病例进行对比分析,研究得出术后即刻栓塞程度、术后长期随访情况等结果。
结果：54例患者成功栓塞治疗动脉瘤63例,无治疗失败病例。63枚动脉瘤介入治疗即时效果：瘤腔完全栓塞47枚(74.6%),次全栓塞12枚(19.0%),不完全栓塞4枚(6.3%)。其中单纯可脱弹簧圈栓塞的20枚动脉瘤中,完全栓塞13枚,次全栓塞5枚,不完全栓塞2枚；球囊再塑形弹簧圈栓塞的13枚动脉瘤中,完全栓塞9枚,次全栓塞3枚,不完全栓塞1枚；支架结合弹簧圈栓塞治疗的19枚中,完全栓塞16枚,次全栓塞3枚；球囊再塑形弹簧圈栓塞结合支架成形技术治疗5枚,瘤腔完全栓塞；单纯支架载瘤动脉成形瘤腔闭塞术治疗6枚,完全栓塞4枚,次全栓塞1枚,不完全栓塞1枚；54例术后临床随访结果：改良RS：0分45例(83.5%)；1-2分6例(11.4%)；3-5分3例(5.1%)；无死亡病例(6分)。术后1年随访动脉瘤未复发63枚(91.3%),动脉瘤复发6枚(8.7%)。不完全栓塞的颅内动脉瘤术后复发率较高；
结论：血管内栓塞治疗颅内动脉瘤是一种微创、安全、有效的治疗方法。对于颅内复杂动脉瘤,血管内栓塞具有更大优势,应作为首选治疗方案。致密栓塞动脉瘤是防止动脉瘤再破裂和复发的首要原则。支架结合弹簧圈栓塞治疗动脉瘤更易于致密栓塞,且更利于促进动脉瘤的解剖学治愈。
Objective:To summarize the method and technique keys of treatment for complex intracranial aneurysms of combining Neuroform stent and coil, evaluate the near and long—term efficacy; To discuss how to deal with its complications, and investigate its Clinical experience, efficacy and safety. To discuss the influential factor of aneurismal recurrence in order to institute rational therapic strategy.
Methods:Sum up and clear up the clinical data of 54 cases of intracranial aneurisms which had been treated by the endovascular therapy. including sex ratio, onset age,Clinical symptoms, imaging display, the way of embolism, treatment results, clinical and imaging follow-up results. Establish the archivalrepository of them. Pick up the cases of treatment for complex intracranial aneurysms of combining Neuroform stent and coil, Compared with another two group (first group:treatment with GDC, second group:Treatment of combining ball and coil), To show the results of immediate embolism degree, post-operative long-term follow-up situation and so on.
Results:Among 54 cases of intracranial aneurysms (totally 63 aneurysms), have no treatment failure cases. After endovascular treatment, instantly angiography demonstrate that 47 aneurysms (74.6%) were totally embolized,12 aneurysms(19.1%) were near-totally embolized,4 aneurysms (6.3%) were partly embolized. Among 20 cases of treatment with GDC,13 aneurysms (65.0%) were totally embolized,5 aneurysms(25.0%) were near-totally embolized,2 aneurysms (10%) were partly embolized. Among 13 cases of treatment of combining ball and coil,9 aneurysms (69.2%) were totally embolized,3 aneurysms(23.1%) were near-totally embolized, 1 aneurysms (7.7%) were partly embolized. For the 30 cases of treatment of combining Neuroform stent and coil,25 aneurysms (83.3%) were totally embolized, 4 aneurysms(13.3%) were near-totally embolized,1 aneurysms (3.3%) were partly embolized. Clinical follow-up was graded using the modified Rankin score (RS) and revealed 45 patients (83.5%) in the RS 0 category,6 patients (11.4%) in the RS 1-2 category,3 patients (5.1%) in the RS 3-5 category, no patients died (RS 6 category). Follow-up result demonstrate 63 aneurysms (91.3%) were not recurrent,6 aneurysms (8.7%) were recurrent. Incomplete embolization of intracranial aneurysms were with a High recanalization rate.
Conclusion:Endovascular embolization is a minimally invasive, safe, effective modality for the treatment of intracranial aneurysms. For the complex intracranial aneurysms, endovascular embolization with greater advantage, Should be the first treatment Method. Dense and complete occlusion is a primary principal to prevent the recurrence and rerupture of aneurysms. It is easy to densely embolize complex intracranial aneurysms with the stent-assisted technique, further more, It have more conducive to promoting the intracranial aneurysms anatomy healing.
方法：对经血管内栓塞治疗的54位颅内动脉瘤患者的临床资料进行整理归纳,包括男女比例、发病年龄、临床主要症状、影像学表现、术前Hunt-Hess分级、动脉瘤大小、栓塞方法及材料、并发症、术后临床与影像学随访情况等,建立血管内介入治疗颅内动脉瘤病人档案库,整理其中26位行支架置入术患者的资料,与单纯行弹簧圈栓塞治疗和球囊结合弹簧圈栓塞治疗的两组病例进行对比分析,研究得出术后即刻栓塞程度、术后长期随访情况等结果。
结果：54例患者成功栓塞治疗动脉瘤63例,无治疗失败病例。63枚动脉瘤介入治疗即时效果：瘤腔完全栓塞47枚(74.6%),次全栓塞12枚(19.0%),不完全栓塞4枚(6.3%)。其中单纯可脱弹簧圈栓塞的20枚动脉瘤中,完全栓塞13枚,次全栓塞5枚,不完全栓塞2枚；球囊再塑形弹簧圈栓塞的13枚动脉瘤中,完全栓塞9枚,次全栓塞3枚,不完全栓塞1枚；支架结合弹簧圈栓塞治疗的19枚中,完全栓塞16枚,次全栓塞3枚；球囊再塑形弹簧圈栓塞结合支架成形技术治疗5枚,瘤腔完全栓塞；单纯支架载瘤动脉成形瘤腔闭塞术治疗6枚,完全栓塞4枚,次全栓塞1枚,不完全栓塞1枚；54例术后临床随访结果：改良RS：0分45例(83.5%)；1-2分6例(11.4%)；3-5分3例(5.1%)；无死亡病例(6分)。术后1年随访动脉瘤未复发63枚(91.3%),动脉瘤复发6枚(8.7%)。不完全栓塞的颅内动脉瘤术后复发率较高；
结论：血管内栓塞治疗颅内动脉瘤是一种微创、安全、有效的治疗方法。对于颅内复杂动脉瘤,血管内栓塞具有更大优势,应作为首选治疗方案。致密栓塞动脉瘤是防止动脉瘤再破裂和复发的首要原则。支架结合弹簧圈栓塞治疗动脉瘤更易于致密栓塞,且更利于促进动脉瘤的解剖学治愈。
Objective:To summarize the method and technique keys of treatment for complex intracranial aneurysms of combining Neuroform stent and coil, evaluate the near and long—term efficacy; To discuss how to deal with its complications, and investigate its Clinical experience, efficacy and safety. To discuss the influential factor of aneurismal recurrence in order to institute rational therapic strategy.
Methods:Sum up and clear up the clinical data of 54 cases of intracranial aneurisms which had been treated by the endovascular therapy. including sex ratio, onset age,Clinical symptoms, imaging display, the way of embolism, treatment results, clinical and imaging follow-up results. Establish the archivalrepository of them. Pick up the cases of treatment for complex intracranial aneurysms of combining Neuroform stent and coil, Compared with another two group (first group:treatment with GDC, second group:Treatment of combining ball and coil), To show the results of immediate embolism degree, post-operative long-term follow-up situation and so on.
Results:Among 54 cases of intracranial aneurysms (totally 63 aneurysms), have no treatment failure cases. After endovascular treatment, instantly angiography demonstrate that 47 aneurysms (74.6%) were totally embolized,12 aneurysms(19.1%) were near-totally embolized,4 aneurysms (6.3%) were partly embolized. Among 20 cases of treatment with GDC,13 aneurysms (65.0%) were totally embolized,5 aneurysms(25.0%) were near-totally embolized,2 aneurysms (10%) were partly embolized. Among 13 cases of treatment of combining ball and coil,9 aneurysms (69.2%) were totally embolized,3 aneurysms(23.1%) were near-totally embolized, 1 aneurysms (7.7%) were partly embolized. For the 30 cases of treatment of combining Neuroform stent and coil,25 aneurysms (83.3%) were totally embolized, 4 aneurysms(13.3%) were near-totally embolized,1 aneurysms (3.3%) were partly embolized. Clinical follow-up was graded using the modified Rankin score (RS) and revealed 45 patients (83.5%) in the RS 0 category,6 patients (11.4%) in the RS 1-2 category,3 patients (5.1%) in the RS 3-5 category, no patients died (RS 6 category). Follow-up result demonstrate 63 aneurysms (91.3%) were not recurrent,6 aneurysms (8.7%) were recurrent. Incomplete embolization of intracranial aneurysms were with a High recanalization rate.
Conclusion:Endovascular embolization is a minimally invasive, safe, effective modality for the treatment of intracranial aneurysms. For the complex intracranial aneurysms, endovascular embolization with greater advantage, Should be the first treatment Method. Dense and complete occlusion is a primary principal to prevent the recurrence and rerupture of aneurysms. It is easy to densely embolize complex intracranial aneurysms with the stent-assisted technique, further more, It have more conducive to promoting the intracranial aneurysms anatomy healing.
引文
1. Horowitz MB,Levy E,Kassam A,et al.Endovascular therapy for intracranial aneurysms:a historical and present status review.Surg Neurol,2002,57:147-158.
2. Molyneux A. International subarachnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured aneurysms:a randomized trial. Lancet, 2002.360:1267—1274.
3. Lubicz B,Lecerc X,Gauvrit J Y, et al.Giant vertebrobasilar aneurysms:endovascular treatmentand long-term follow-up.Neurosurgery,2004,55(2):316.
4. Yahia AM,Gordon V,Whapham J,et al.Complications of Neuroform Stent in Endovascular Treatment of Intracranial Aneurysms.Neurocrit Care.2008,8:19-22
5. Sato Mitsuo MD. Preoperative cerebral aneurysm assessment by three—dimensional magnetic resonance angiography:feasibility of surgery without conventional catheter angiography. Neurosurgery.2005,56:903—912.
6. Vindlacheruvu RR,Mendelow AD,Mitchell P.Risk-benefit analysis of the treatment of unruptured intracranial aneurysms.J Neurol Neurosurg Psychiatry,2005,76:234-239.
7. Weber W,Bendszus M,Kis B,et al.A new self-expanding nitinol stent(Enterprise) for the treatment of wide-necked intracranial aneurysms:initial clinical and angiographic results in 31 aneurysms.Neuroradiology.2007;49:555-61.
8. Hayakawa M,Murayama Y,Duckwilre GR,et al.Natural history of the neck remnant of a cerebral aneurysms treated with the Gugliemi detachable coil system[J].J Neurosurg,2000,93(4):561-568
9. Henkes H, bose A,Felber S,et al.Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (Neuroform). Interv Neuryoradiol,2002,8:107-119.
10. Pouratian N, Oskouian RJ, Jensen ME, etal. Endovascular management of unruptured intracranial aneurysms. J Neurol NeurosurgPsychiatry,2006,77:572-578.
11. Geremia G,Brack T,Brennecke L,Haklin M,Falter R Occlusion of experimentally created fusiform aneurysms with porous metallic stents.AJNR,2000,21:739-745
12. Geremia G.,M.Haklin,..Embolization of experimentally created aneurysms with intravascular stent devices.AJNR,1994,15(7):1223-31.
13. Higashida RT,Smith W,Gress D,et al.Intravascular stents and endovascular coil placement for ruptured fusiform aneurysms of the basilar artery:case report and review of the literature.Neurosurgery,1997;87(6):944-949.)
14. Krex D, Kotteek K, Konig IR, etal. Matrix metalloproteinase-9 coding sequence single-nucleotide polymorphisms in Caucasians with intracranial aneurysms[J]. Neurosurgery,2004,55(1):207
15. Ingebrigtsen T, Morgan MK, Faulder K, et al. Bifurcation geometry and the presence of cerebral artery aneurysms[J]. J Neurosurg,2004,101(1):108—113.
16. Feng Y, Wade S, Tsubota K, etal. The application of computer simulation in the genesis and development of intracranial aneurysms [J]. Technol Health Care,2005,13(4):281—291.
17. ShNima M, Oshima M, Takagi K, et al. Magnitude and role of wall shear stress on cerebral aneurysm; computational fluid dynamic study of 20 middle cerebral artery aneurysms[J]. Stroke,2004,35(11):2500—2505.
18.刘建民,张鑫,周晓平等.血管内支架结合电解可脱卸弹簧圈治疗犬颈动脉宽颈动脉瘤的实验研究.介入放射学杂志,2004；13(3)：258-263
19.赵瑞,刘建明,许奕,等.血管内支架治疗颅内动脉瘤的实验及临床研究.第二军医大学博士学位论文,2007,45—46
20. Abruzzo T,Shengelaia GG,Dawson RC 3rd,et al.Histologic and morphologic comparison of experimental aneurysms with human intracranial aneurysms.AJNR 1998,Aug;19(7):1309-1314
21. Barath KF, Cassot DA, Rufenacht, et al. Anatomically shaped internal carotid artery aneurysm in vitro model for flow analysis to evaluate stent effect[J]. AJNR,2004,25:1750 —1759.
22. Meng HZ, Wang M, Kim, et al. Saceular aneurysms on straight and curved vessels are subject to different hemodynamics:implications of intravascular stenting [J]. MNR,2006,27:1861 —1865.
23.赵庆平,李铁林.颅内动脉瘤血管内治疗临床应用研究.第一军医大学博士学位论文,2005
24. Mu SQ,Yang XJ,Li YX,et al.Endovascular treatment of wide-necked intracranial aneurysms using of"remodeling technique"with the HyperForm balloon[J].Chin Med J(Engl).2008;121(8):725—729.
25. HOIT DA, MALEK AM. Three-dimensional rotational angiographic detection of in-stent stenosis in wide-necked aneurysms treated with a self-expanding intracranial stent (J).Neurosurgery,2005,57(1):1228-1236
26. Lopes DK,Ringer AJ,Boulos AS,et al.Fate of branch arteries after intracranial stenting Neurosurgery,2006(52):1275-1279
27.杨建军,宋雪丹。颅内宽颈动脉瘤的血管内治疗33例分析(J)介入放射学杂志,2009,18(5)：645～648
28.罗剑渊,赵卫,黄建强,等。颅内动脉瘤血管内介入治疗与术后随访研究.昆明医学院硕十学位论文.2009
29. Molyneux AJ,Cekirge S,Saatci I,et al. cerebral Aneurysm Multicenter European Ony x(CAMEO) trial:results of a prospective observational study in 20 European center. AJNR AM J Neuroradiol,2004,25(1):39-51.
30. Fiorella D,Albuquerque FC,Han P,et al.Preliminary experience using the neuronform stent for the treatment of cerebral anurysms.Neurosurgery,2004,54:6-17.
31. Howington JU,Hanel RA,Harrigan MR,et al.The neuroform stent the first microcatheter delivered stent for use in the intracranial circulation. Neurosurgery,2004,54:2-5.
[1]田彦龙,宋冬雷,冷冰等。Neuroform支架辅助栓塞宽颈或夹层颅内动脉瘤临床疗效分析(J)中国脑血管病杂志。2008,5(7)：75～77
[2]程美雄,谢晓东,王朝华等。Neuroform支架结合弹簧圈治疗颅内复杂动脉瘤(J)WEST CHINA MEDICAL JOURNAL,2009,24(2):148-150
[3]BIONDI A, JANARDHAN V, KATZ JM, et al. Neuoform stent-assisted coil embolization of wide-neck intracranial aneurysms:strategies in stent deployment and midterm follow-up (J) Neurosurgery.2007,61(3):460-469
[4]张鑫,刘建民,周晓平,等。血管内支架结合弹簧圈栓塞犬宽颈动脉瘤的病理学研究(J)中华神经外科杂志,2007,23(11)：585-588
[5]HOIT DA, MALEK AM. Three-dimensional rotational angiographic detection of in-stent stenosis in wide-necked aneurysms treated with a self-expanding intracranial stent (J).Neurosurgery,2005,57(1):1228-1236
[6]杨建军,宋雪丹。颅内宽颈动脉瘤的血管内治疗33例分析(J)介入放射学杂志,2009,18(5)：645～648
[8]肖兵,赵卫,宋建琼,等。Neuroform支架联合Matrix Ⅱ弹簧圈治疗了颅内宽颈动脉瘤初步经验(J)中国介入影像与治疗学杂志.2007,4(1)：23～26
[7]BOSE A, HARTMANN M, HENKES H,et al.A novel,self-expanding,nitimol stent in medical refractory intracranial atherosclerotic stenoses:the Wingspan study (J),Stroke,2007,38(5):1531-1537
[8]张鑫,刘建民,周晓平,等。血管内支架结合弹簧圈栓塞犬宽颈动脉瘤的病理学研究(J)中华神经外科杂志,2007,23(9)：585～588
[9]FIORELLA D,LEVY El, TURK AS,et al,US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease:periprocedural results (J).Stroke,2007,38(3):881-887
[10]罗剑渊,赵卫,黄建强,等。颅内动脉瘤血管内介入治疗与术后随访研究(J)昆明医学院硕士学位论文
2. Molyneux A. International subarachnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured aneurysms:a randomized trial. Lancet, 2002.360:1267—1274.
3. Lubicz B,Lecerc X,Gauvrit J Y, et al.Giant vertebrobasilar aneurysms:endovascular treatmentand long-term follow-up.Neurosurgery,2004,55(2):316.
4. Yahia AM,Gordon V,Whapham J,et al.Complications of Neuroform Stent in Endovascular Treatment of Intracranial Aneurysms.Neurocrit Care.2008,8:19-22
5. Sato Mitsuo MD. Preoperative cerebral aneurysm assessment by three—dimensional magnetic resonance angiography:feasibility of surgery without conventional catheter angiography. Neurosurgery.2005,56:903—912.
6. Vindlacheruvu RR,Mendelow AD,Mitchell P.Risk-benefit analysis of the treatment of unruptured intracranial aneurysms.J Neurol Neurosurg Psychiatry,2005,76:234-239.
7. Weber W,Bendszus M,Kis B,et al.A new self-expanding nitinol stent(Enterprise) for the treatment of wide-necked intracranial aneurysms:initial clinical and angiographic results in 31 aneurysms.Neuroradiology.2007;49:555-61.
8. Hayakawa M,Murayama Y,Duckwilre GR,et al.Natural history of the neck remnant of a cerebral aneurysms treated with the Gugliemi detachable coil system[J].J Neurosurg,2000,93(4):561-568
9. Henkes H, bose A,Felber S,et al.Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (Neuroform). Interv Neuryoradiol,2002,8:107-119.
10. Pouratian N, Oskouian RJ, Jensen ME, etal. Endovascular management of unruptured intracranial aneurysms. J Neurol NeurosurgPsychiatry,2006,77:572-578.
11. Geremia G,Brack T,Brennecke L,Haklin M,Falter R Occlusion of experimentally created fusiform aneurysms with porous metallic stents.AJNR,2000,21:739-745
12. Geremia G.,M.Haklin,..Embolization of experimentally created aneurysms with intravascular stent devices.AJNR,1994,15(7):1223-31.
13. Higashida RT,Smith W,Gress D,et al.Intravascular stents and endovascular coil placement for ruptured fusiform aneurysms of the basilar artery:case report and review of the literature.Neurosurgery,1997;87(6):944-949.)
14. Krex D, Kotteek K, Konig IR, etal. Matrix metalloproteinase-9 coding sequence single-nucleotide polymorphisms in Caucasians with intracranial aneurysms[J]. Neurosurgery,2004,55(1):207
15. Ingebrigtsen T, Morgan MK, Faulder K, et al. Bifurcation geometry and the presence of cerebral artery aneurysms[J]. J Neurosurg,2004,101(1):108—113.
16. Feng Y, Wade S, Tsubota K, etal. The application of computer simulation in the genesis and development of intracranial aneurysms [J]. Technol Health Care,2005,13(4):281—291.
17. ShNima M, Oshima M, Takagi K, et al. Magnitude and role of wall shear stress on cerebral aneurysm; computational fluid dynamic study of 20 middle cerebral artery aneurysms[J]. Stroke,2004,35(11):2500—2505.
18.刘建民,张鑫,周晓平等.血管内支架结合电解可脱卸弹簧圈治疗犬颈动脉宽颈动脉瘤的实验研究.介入放射学杂志,2004；13(3)：258-263
19.赵瑞,刘建明,许奕,等.血管内支架治疗颅内动脉瘤的实验及临床研究.第二军医大学博士学位论文,2007,45—46
20. Abruzzo T,Shengelaia GG,Dawson RC 3rd,et al.Histologic and morphologic comparison of experimental aneurysms with human intracranial aneurysms.AJNR 1998,Aug;19(7):1309-1314
21. Barath KF, Cassot DA, Rufenacht, et al. Anatomically shaped internal carotid artery aneurysm in vitro model for flow analysis to evaluate stent effect[J]. AJNR,2004,25:1750 —1759.
22. Meng HZ, Wang M, Kim, et al. Saceular aneurysms on straight and curved vessels are subject to different hemodynamics:implications of intravascular stenting [J]. MNR,2006,27:1861 —1865.
23.赵庆平,李铁林.颅内动脉瘤血管内治疗临床应用研究.第一军医大学博士学位论文,2005
24. Mu SQ,Yang XJ,Li YX,et al.Endovascular treatment of wide-necked intracranial aneurysms using of"remodeling technique"with the HyperForm balloon[J].Chin Med J(Engl).2008;121(8):725—729.
25. HOIT DA, MALEK AM. Three-dimensional rotational angiographic detection of in-stent stenosis in wide-necked aneurysms treated with a self-expanding intracranial stent (J).Neurosurgery,2005,57(1):1228-1236
26. Lopes DK,Ringer AJ,Boulos AS,et al.Fate of branch arteries after intracranial stenting Neurosurgery,2006(52):1275-1279
27.杨建军,宋雪丹。颅内宽颈动脉瘤的血管内治疗33例分析(J)介入放射学杂志,2009,18(5)：645～648
28.罗剑渊,赵卫,黄建强,等。颅内动脉瘤血管内介入治疗与术后随访研究.昆明医学院硕十学位论文.2009
29. Molyneux AJ,Cekirge S,Saatci I,et al. cerebral Aneurysm Multicenter European Ony x(CAMEO) trial:results of a prospective observational study in 20 European center. AJNR AM J Neuroradiol,2004,25(1):39-51.
30. Fiorella D,Albuquerque FC,Han P,et al.Preliminary experience using the neuronform stent for the treatment of cerebral anurysms.Neurosurgery,2004,54:6-17.
31. Howington JU,Hanel RA,Harrigan MR,et al.The neuroform stent the first microcatheter delivered stent for use in the intracranial circulation. Neurosurgery,2004,54:2-5.
[1]田彦龙,宋冬雷,冷冰等。Neuroform支架辅助栓塞宽颈或夹层颅内动脉瘤临床疗效分析(J)中国脑血管病杂志。2008,5(7)：75～77
[2]程美雄,谢晓东,王朝华等。Neuroform支架结合弹簧圈治疗颅内复杂动脉瘤(J)WEST CHINA MEDICAL JOURNAL,2009,24(2):148-150
[3]BIONDI A, JANARDHAN V, KATZ JM, et al. Neuoform stent-assisted coil embolization of wide-neck intracranial aneurysms:strategies in stent deployment and midterm follow-up (J) Neurosurgery.2007,61(3):460-469
[4]张鑫,刘建民,周晓平,等。血管内支架结合弹簧圈栓塞犬宽颈动脉瘤的病理学研究(J)中华神经外科杂志,2007,23(11)：585-588
[5]HOIT DA, MALEK AM. Three-dimensional rotational angiographic detection of in-stent stenosis in wide-necked aneurysms treated with a self-expanding intracranial stent (J).Neurosurgery,2005,57(1):1228-1236
[6]杨建军,宋雪丹。颅内宽颈动脉瘤的血管内治疗33例分析(J)介入放射学杂志,2009,18(5)：645～648
[8]肖兵,赵卫,宋建琼,等。Neuroform支架联合Matrix Ⅱ弹簧圈治疗了颅内宽颈动脉瘤初步经验(J)中国介入影像与治疗学杂志.2007,4(1)：23～26
[7]BOSE A, HARTMANN M, HENKES H,et al.A novel,self-expanding,nitimol stent in medical refractory intracranial atherosclerotic stenoses:the Wingspan study (J),Stroke,2007,38(5):1531-1537
[8]张鑫,刘建民,周晓平,等。血管内支架结合弹簧圈栓塞犬宽颈动脉瘤的病理学研究(J)中华神经外科杂志,2007,23(9)：585～588
[9]FIORELLA D,LEVY El, TURK AS,et al,US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease:periprocedural results (J).Stroke,2007,38(3):881-887
[10]罗剑渊,赵卫,黄建强,等。颅内动脉瘤血管内介入治疗与术后随访研究(J)昆明医学院硕士学位论文