Analysis and treatment of electrolysis coil embolization of cerebral aneurysm

With the extensive development of GDC technology in China, we believe it is necessary to combine the latest literature for a special review. The incidence of TEC The lowest rate of TEC reported by MLIray-ama at the University of California Los Angeles Medical Center (UCLA). Diffusion-weighted magnetic resonance imaging (DWx) and transcranial Doppler (TCD) examinations may reveal more asymptomatic individuals, suggesting that neurological deficits are only part of those with structural brain damage, and the actual incidence of TEC should be higher than Statistical results of the literature. Among the 720 patients treated during UCLA for 10 years, the incidence of TEC was only 2.5%, but the hospital was the first unit in the world to carry out GDc technology, and there were more unruptured or non-acute ruptured cerebral aneurysms.

Operational factors The operational factors of TEC include: inadequate anticoagulation, thrombosis or plaque detachment in the parent artery, existing or fresh blood clots in the aneurysm, iatrogenic dissection of the arteries leading to thrombosis, 6DC, catheter, Guidewire and balloon induced thrombus, metal debris and breakage of GDC, bubbles and contrast agents. After embolization, the thrombus in the GDc extends to the tumor-bearing artery, and the residual blood flow in the aneurysm causes the thrombus to inject into the tumor-bearing artery or GDc into the tumor-bearing artery, which is a common factor leading to thrombosis. Superselective cannulation of the catheter guidewire may result in endothelial damage, exposure to subendothelial collagen fibers, and a site of platelet aggregation that initiates the coagulation system. The micro-welding between the coils of the early GDc and the propelling wire may produce metal fragments after electrolysis, and even the debris may be found in the magnetic resonance. A new generation of products has solved this problem.

Risk factors for TEC Risk factors include large or wide neck A, reshaping techniques, stents, dual microcatheters, hypercoagulation, and prolonged operation. Derdeyn et al. 71 found that large aneurysms and Indian esophageal arteries are closely related to TEC. Due to the large amount of residual blood flow and thrombus in the large aneurysm coil, the neck is large, and there are many opportunities for complex operations such as reshaping techniques, stents and double microcatheters, resulting in an increased chance of thrombosis.

Diagnostic angiography provides the most direct evidence, but if a small thrombus blocks a small blood vessel, even intraoperative angiography is difficult to find. In addition, the operation of multiple anesthesia, the symptoms appearing during surgery are not easy to find. TCD can detect microemboli that is not seen in the angiography in real time. Dwi is an objective and sensitive imaging tool for early detection of post-embolization TEc, especially small and asymptomatic TEC, but intracranial hematoma and subarachnoid hemorrhage (SAH) may interfere with the identification of ischemic lesions.

Treatment of TEC includes local thrombolysis, administration of antiplatelet agents, enhancement of anticoagulation, expansion and boosting to promote collateral blood flow. Most of the TECs that occur during thrombolysis and embolization can be relieved by thrombolytic therapy. Combined mechanical and fibrinolytic drugs are more effective than thrombolysis alone. Mechanically agitate the thrombus with a guide wire or a snare, or introduce a microcatheter into a thrombus with a guide wire and inject saline, followed by injection of urokinase or rtPA at the distal end of the thrombus, for which superselective intubation or mechanical agitation is not possible. The thrombolytic drug can be injected directly at the proximal end of the thrombus. Mechanical agitation can establish a blood flow channel in the thrombus, allowing thrombolytic drugs, heparin, and endogenous thrombolytic factors to enter, while increasing the contact area between the thrombolytic drug and the thrombus. Therefore, for ruptured aneurysms, thrombolysis should be performed after occlusion of the aneurysm. If thrombolysis is first, re-rupture may be induced, and those who have not ruptured may be thrombolyzed first. Thrombolysis is potentially dangerous. If the embolization is a small blood vessel in the non-functional area or there is sufficient collateral circulation, the drug can be treated without thrombolysis. The content of fibrinogen in the blood should be determined after thrombolysis. According to strother, the poor improvement in symptoms after reperfusion or complete recanalization is related to the nature of the thrombus and the degree of collateral opening. Thrombolysis may be ineffective for fully mechanized thrombi (such as hardened plaques that have been in the aneurysm or carotid artery before treatment).

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