特殊類型動脈瘤的

介入治療特殊類型動脈瘤的

介入治療特殊類型動脈瘤特殊部位頸動脈前壁動脈瘤脈絡膜前動脈動脈瘤大腦后動脈動脈瘤遠端動脈瘤穿支血管動脈瘤特殊類型合并假性成分的動脈瘤夾層動脈瘤外傷性動脈瘤蛇形動脈瘤特殊類型動脈瘤特殊部位脈絡膜前動脈動脈瘤脈絡膜前動脈動脈瘤（AnteriorChoroidalArteryAneurysm,AChAN）占所有顱內動脈瘤的2-5%AChA頸內動脈的終末分支，其穿支供應了視束、大腦腳、外側膝狀體、蒼白球、內囊后肢等重要的結構。AChA發自瘤頸，術后缺血并發癥發生率23.8%（5/21）AchA與動脈瘤無關，無缺血并發癥（0/17）KimBMetal.Neuroradiology(2008)50:251脈絡膜前動脈動脈瘤脈絡膜前動脈動脈瘤（AnteriorCh脈絡膜前動脈動脈瘤Case151-Y-O-F脈絡膜前動脈動脈瘤Case110minlater10minlater術后即刻言語含糊，對側上肢肌力1級，下肢3級，對側Babinski征陽性1個月后對側肢體輕偏癱術后即刻言語含糊，對側上肢肌力1級，下肢3級，對側BabinSubtotalEmbo.Case247-Y-O-FSAHSubtotalEmbo.Case2特殊類型動脈瘤的介入治療課件FinalFinalStent+coilCase356-Y-O-FSAHStent+coilCase3MESHtechniqueMESHtechnique特殊類型動脈瘤的介入治療課件15mFU15mFU建議術前3-D重建仔細分析AchA與An的關系術中注意AchA通暢性累及AchA的An，寧愿次全栓塞或瘤頸殘留支架有利于AchA的保護和動脈瘤愈合建議術前3-D重建仔細分析AchA與An的關系大腦后動脈動脈瘤占全部顱內動脈瘤的0.7-2.3%多發于P1、P2段發病平均年齡38歲大或巨大動脈瘤常見Drake,42%ofgiantaneurysmsYasargil,50%ofgiantaneurysmsCiceri,24%ofgiantaneurysms分類囊性動脈瘤夾層動脈瘤大腦后動脈動脈瘤占全部顱內動脈瘤的0.7-2.3%大腦后動脈分段ZealAA,RhotonALJr.JNeurosurg,1978,48(4):534CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27大腦后動脈分段ZealAA,RhotonALJr.JThePCAcanbesubdividedintofouranatomicsegments(6–8),asshowninFigure1.TheP1segmentextendsfromthetipofthebasilararterytotheoriginoftheposteriorcommunicatingartery.TheP2segmentextendsfromtheposteriorcommunicatingarterytothedorsalaspectofthemidbrain;thisP2segmentcanbefurthersubdividedintoanterior(P2A)andposterior(P2P)segments.TheP3segmentextendsfromthelateralaspectofthequadrigeminalcisternattheoriginoftheposteriortemporalartery,totheanteriorlimitofthecalcarinefissure.TheP4segmentconsistsoftheterminalcorticalbranchesofthePCA,afterthetakeoffoftheparietooccipitalandcalcarinearteries.Eachofthesesegmentsgivesoffgroupsofbranchesthatsupplydistinctanatomicterritories:brainstemandthalamicbranches,ventricularbranches,andcorticalbranches.ThefoursegmentsofthePCAandtheirrespectivebranchesaredetailedinFigure1.CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27ThePCAcanbesubdividedinto治療方法手術technicaldifficultiesandhighrisks介入囊性動脈瘤：動脈瘤彈簧圈栓塞夾層動脈瘤：載瘤動脈閉塞（parentvesselocclusion，PVO）riskofinfarctionfromperforatorsand/ordistalbranchocclusion支架輔助栓塞治療方法手術technicaldifficu囊性動脈瘤Case9男，47歲突發頭痛SAH囊性動脈瘤Case9特殊類型動脈瘤的介入治療課件無再出血，無神經功能缺損無再出血，無神經功能缺損囊性動脈瘤囊性動脈瘤2mFU2mFU囊性動脈瘤PCA-An血流動力學相關的多為囊性動脈瘤AJNRAmJNeuroradiol22:27–34,January2001囊性動脈瘤PCA-An血流動力學相關的多為囊性動脈瘤AJNR夾層動脈瘤P2P段Case1045-Y-O-FSAH&IVH夾層動脈瘤P2P段Case10特殊類型動脈瘤的介入治療課件Case11男，26歲頭痛，神經系統（-）夾層動脈瘤P2P段Case11夾層動脈瘤P2P段特殊類型動脈瘤的介入治療課件術前R-ICA術后R-ICA術后左側視野缺損術后3月改善術前R-ICA術后R-ICA術后左側視野缺損術后3月術后3月特殊類型動脈瘤的介入治療課件Itisimpossibletobecertainwhetherornotaparentarteryocclusionwillbetolerated.Ingeneral,however,weavoidparentarteryocclusionattheP1orP2segmentsgiventherichvascularsupplytothebrainstemthatoriginatesfromtheseanatomiclocationsandthepossibleneurologicdeficitsthatmayoccurasaresultofsuchtreatment.CiceriEFetal.

AJNRAmJNeuroradiol2001,22:27–34Itisimpossibletobecertain夾層動脈瘤P2A段Case1258-year-oldmaleincidentalfound夾層動脈瘤P2A段Case12Enterprise4.5/22Enterprise4.5/22特殊類型動脈瘤的介入治療課件11MFU11MFU11MFU11MFU特殊類型動脈瘤的介入治療課件After2EnterprisestentsABDCAfter2EnterprisestentsABDCPVOTheincidenceofsymptomaticinfarctionafterPAocclusionwas16.3%intheliteraturereview.BOT無效，不常用StentassistedcoilingInliteraturereview,themorbidityandmortalityofstentforPCAaneurysmswas7.9%intotal.Noinfarctionwasreported.Therewerethree(13%)recurrences,butonlyone(4.3%)causedrebleeding.HuangQ,etal.ClinNeuroradiol.2013PVOHuangQ,etal.ClinNeuror建議囊性動脈瘤應單純栓塞動脈瘤夾層動脈瘤可能需要閉塞載瘤動脈P1、P2段動脈瘤閉塞載瘤動脈可能導致穿支閉塞，盡可能保留載瘤動脈定期隨訪建議囊性動脈瘤應單純栓塞動脈瘤幕下遠端動脈瘤Distalaneurysmsofcerebellararteriesarerarelesionsaccountingfor0.6%ofalltreatedaneurysms夾層、假性動脈瘤常見一般需要閉塞載瘤動脈PelusoJPP,etal.AJNRAmJNeuroradiol.2007,28:1573TokimuraH,etal.NeurosurgRev.2012,35:497幕下遠端動脈瘤DistalaneurysmsofcerDistalPICAAnCase1358-Y-O-FSAH&IVHin4thventricleDistalPICAAnCase13特殊類型動脈瘤的介入治療課件特殊類型動脈瘤的介入治療課件Case14DistalAICAAnCase14DistalAICAAnMarathonsuperselectiveangio.Marathonsuperselectiveangio.Onyx-34Onyx-34ControlangiographyafterembolizationControlangiographyafteremboMRI4daysafterembolizationMRI4daysafterembolization特殊類型動脈瘤的介入治療課件注意事項注意事項Onyx-34intraprocedualleakageOnyx-34intraprocedualleakage特殊類型動脈瘤的介入治療課件術前術后術前術后評價閉塞動脈瘤及載瘤動脈原位閉塞注意術中破裂風險評價閉塞動脈瘤及載瘤動脈F,52Yrs,Suddenonsetofheadache&nauseaRebleeding20dayslater,HHgradeII2010-10-292010-11-182010-11-22合并假性成分的AnCase15F,52Yrs,SuddenonsetofheadOnyx0.2ml

Endovascular

coiling&Onyxinjection.Hydrosoft2/6SuccessfulsealtestHyperform4/7Onyx0.2mlEndovascular

coiliFinalcontrol6MFollow-upFinalcontrol6MFollow-upCase16Case16特殊類型動脈瘤的介入治療課件IntralumenonyxIntralumenonyx評價利：栓塞率高、栓塞效果好不利：操作復雜、占位效應、經驗較少建議：特殊病例應用，注意并發癥評價利：栓塞率高、栓塞效果好椎動脈夾層動脈瘤椎動脈夾層動脈瘤出血性夾層再出血24%~71.4%70%發生在首次出血后24小時內，80%發生在一周內缺血性夾層無癥狀椎動脈夾層動脈瘤椎動脈夾層動脈瘤治療手術近端夾閉動脈瘤孤立顱神經麻痹介入夾層動脈瘤孤立夾層近端閉塞血管重建治療手術Case21SAHVA-V4出血性夾層Case21SAHVA-V4出血性夾層Case2058yFemale,acuteSAH,bilateralVAdissectioninganeurysm.VA-V4出血性夾層Case2058yFemale,acuteSAH,R-VAdissectionworkingprojection,doublemicrocatheterinpositionR-VAdissectionworkingprojecSemi-deploythestentandintroducecoilsSemi-deploythestentandintrFourcoilsintroducedandfullydeploythefirstEnterpriseFourcoilsintroducedandfullAfterdeploying3stents,decreasedcontrastinthedissectioninganeurysmwasoberserved.Afterdeploying3stents,decrL-VAocclusionL-VAocclusion50minafterdeployingthe3rdstent,R-VAreconstructed,R-PICApatent50minafterdeployingthe3rdCase22非出血性夾層Case22非出血性夾層4Enterprisestents4Enterprisestents特殊類型動脈瘤的介入治療課件8mFU8mFU三維模擬速度場壁面切應力壓力場三維模擬速度場壁面切應力壓力場支架孔率對血流動力學的效應關系匯聚變發散完全抑制強度變弱金屬覆蓋率30%-40%支架孔率對血流動力學的效應關系匯聚變發散完全抑制強度變弱金屬支架和彈簧圈對于分支血流的影響收縮末期經過分支截面的血流速度。A為治療前；B-D為植入1-3枚支架，隨著支架數量的增加，血流速度無明顯變化；E-H為植入1枚支架和不同栓塞密度的彈簧圈，彈簧圈密度分別為2.5%，4.7%，8.5%和14.9%，隨著彈簧圈的增加，血流速度進行性下降，當栓塞密度達到14.9%時，血流方向發生改變。I-L為0-3枚支架結合4.7%栓塞密度的彈簧圈,在彈簧圈數量固定的情況下增加支架數量，分支血流速度無明顯變化。支架和彈簧圈對于分支血流的影響收縮末期經過分支Tubridge46根鎳鈦絲（40u）2根Pt顯影芯（80u）金屬覆蓋率35%脈瘤頸處30%～50%其它位置12%～20%Tubridge46根鎳鈦絲（40u）特殊類型動脈瘤的介入治療課件6mFU6mFU外傷性假性動脈瘤外傷性假性動脈瘤特殊類型動脈瘤的介入治療課件特殊類型動脈瘤的介入治療課件87M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA87M38,4weeksafterheadtrau88M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA88M38,4weeksafterheadtrau89Enterprisestentinposition,firsthydrocoil4/10,followbythree3/10barecoils,twoAxium1.5/2coils89Enterprisestentinposition90Last3/4coil,partialloopsatruptureholeandpartialintheparentvessel,wishingtocovertheruptureholeafterstentdeployment90Last3/4coil,partialloops91Finalresult91Finalresult92ImmediatelyafterOp1weekFU92ImmediatelyafterOp93ImmediatelyafterOp4mFU93ImmediatelyafterOp94ImmediatelyafterOp4mFU94ImmediatelyafterOpNon-intracranialcoveredstents:Jostent(AbbottVascular)Symbiot(BostonScientific)CarotidWallstent(BostonScientific)Autologousvein-coveredstentIntracranialcoveredstentWillis(MicroPort,Shanghai,China)Non-intracranialcoveredstentJostentJostent6mfollowup6mfollowupThanksThanksSAHCalcificationinPcomAarea蛇形動脈瘤SAH蛇形動脈瘤DSADSA3D-DSAMCAICAAchAP2PcomAP13D-DSAMCAICAAchAP2PcomAP1DynaCTP2PcomAP1P2ICAAchAPcomADynaCTP2PcomAP1P2ICAAchAPcomADSAL-CCASlimICA,distalICAfilledbycollateralbranchesofMMAviaretrogradeflowthroughOA,MCAthusfilledICADSAL-CCASlimICA,distalICADSAR-ICAA1DSAR-ICAA1DynaCTCarotidCanalCarotidCanalDynaCTCarotidCanalCarotidCanPreoperativeCTPPreoperativeCTPStrategyStep1STA-MCABypssStep2BOTinBAStep3OcclusionofPcomA&AnStrategyStep1PosterativeCTPrCBV↑rCBF↑TTP-MTT-ComparedwithpreoperativeCTPPosterativeCTPrCBV↑10dayslaterAngio.&BOTviaL-CCA10dayslaterAngio.&BOT3DDSA3DDSACBVbasedon8sDSAPre-BOTCBVbasedon8sDSAPre-BOTBOTinBAPCABOTinBAPCABOTinBAICABOTinBAICACBVwhenBOTinBANosignificantdifferencewithpreviousCTPCBVwhenBOTinBANosignificaEmbolizationofPcomA&AnEmbolizationofPcomA&AnPost-embolizationPost-embolizationPost-embolizationPost-embolizationPost-embolizationPost-embolizationPost-embolizationCoilsContrastinPcomAPost-embolizationCoilsContrast特殊類型動脈瘤的介入治療課件特殊類型動脈瘤的

介入治療特殊類型動脈瘤的

介入治療特殊類型動脈瘤特殊部位頸動脈前壁動脈瘤脈絡膜前動脈動脈瘤大腦后動脈動脈瘤遠端動脈瘤穿支血管動脈瘤特殊類型合并假性成分的動脈瘤夾層動脈瘤外傷性動脈瘤蛇形動脈瘤特殊類型動脈瘤特殊部位脈絡膜前動脈動脈瘤脈絡膜前動脈動脈瘤（AnteriorChoroidalArteryAneurysm,AChAN）占所有顱內動脈瘤的2-5%AChA頸內動脈的終末分支，其穿支供應了視束、大腦腳、外側膝狀體、蒼白球、內囊后肢等重要的結構。AChA發自瘤頸，術后缺血并發癥發生率23.8%（5/21）AchA與動脈瘤無關，無缺血并發癥（0/17）KimBMetal.Neuroradiology(2008)50:251脈絡膜前動脈動脈瘤脈絡膜前動脈動脈瘤（AnteriorCh脈絡膜前動脈動脈瘤Case151-Y-O-F脈絡膜前動脈動脈瘤Case110minlater10minlater術后即刻言語含糊，對側上肢肌力1級，下肢3級，對側Babinski征陽性1個月后對側肢體輕偏癱術后即刻言語含糊，對側上肢肌力1級，下肢3級，對側BabinSubtotalEmbo.Case247-Y-O-FSAHSubtotalEmbo.Case2特殊類型動脈瘤的介入治療課件FinalFinalStent+coilCase356-Y-O-FSAHStent+coilCase3MESHtechniqueMESHtechnique特殊類型動脈瘤的介入治療課件15mFU15mFU建議術前3-D重建仔細分析AchA與An的關系術中注意AchA通暢性累及AchA的An，寧愿次全栓塞或瘤頸殘留支架有利于AchA的保護和動脈瘤愈合建議術前3-D重建仔細分析AchA與An的關系大腦后動脈動脈瘤占全部顱內動脈瘤的0.7-2.3%多發于P1、P2段發病平均年齡38歲大或巨大動脈瘤常見Drake,42%ofgiantaneurysmsYasargil,50%ofgiantaneurysmsCiceri,24%ofgiantaneurysms分類囊性動脈瘤夾層動脈瘤大腦后動脈動脈瘤占全部顱內動脈瘤的0.7-2.3%大腦后動脈分段ZealAA,RhotonALJr.JNeurosurg,1978,48(4):534CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27大腦后動脈分段ZealAA,RhotonALJr.JThePCAcanbesubdividedintofouranatomicsegments(6–8),asshowninFigure1.TheP1segmentextendsfromthetipofthebasilararterytotheoriginoftheposteriorcommunicatingartery.TheP2segmentextendsfromtheposteriorcommunicatingarterytothedorsalaspectofthemidbrain;thisP2segmentcanbefurthersubdividedintoanterior(P2A)andposterior(P2P)segments.TheP3segmentextendsfromthelateralaspectofthequadrigeminalcisternattheoriginoftheposteriortemporalartery,totheanteriorlimitofthecalcarinefissure.TheP4segmentconsistsoftheterminalcorticalbranchesofthePCA,afterthetakeoffoftheparietooccipitalandcalcarinearteries.Eachofthesesegmentsgivesoffgroupsofbranchesthatsupplydistinctanatomicterritories:brainstemandthalamicbranches,ventricularbranches,andcorticalbranches.ThefoursegmentsofthePCAandtheirrespectivebranchesaredetailedinFigure1.CiceriEF,etal.AJNRAmJNeuroradiol,2001,22:27ThePCAcanbesubdividedinto治療方法手術technicaldifficultiesandhighrisks介入囊性動脈瘤：動脈瘤彈簧圈栓塞夾層動脈瘤：載瘤動脈閉塞（parentvesselocclusion，PVO）riskofinfarctionfromperforatorsand/ordistalbranchocclusion支架輔助栓塞治療方法手術technicaldifficu囊性動脈瘤Case9男，47歲突發頭痛SAH囊性動脈瘤Case9特殊類型動脈瘤的介入治療課件無再出血，無神經功能缺損無再出血，無神經功能缺損囊性動脈瘤囊性動脈瘤2mFU2mFU囊性動脈瘤PCA-An血流動力學相關的多為囊性動脈瘤AJNRAmJNeuroradiol22:27–34,January2001囊性動脈瘤PCA-An血流動力學相關的多為囊性動脈瘤AJNR夾層動脈瘤P2P段Case1045-Y-O-FSAH&IVH夾層動脈瘤P2P段Case10特殊類型動脈瘤的介入治療課件Case11男，26歲頭痛，神經系統（-）夾層動脈瘤P2P段Case11夾層動脈瘤P2P段特殊類型動脈瘤的介入治療課件術前R-ICA術后R-ICA術后左側視野缺損術后3月改善術前R-ICA術后R-ICA術后左側視野缺損術后3月術后3月特殊類型動脈瘤的介入治療課件Itisimpossibletobecertainwhetherornotaparentarteryocclusionwillbetolerated.Ingeneral,however,weavoidparentarteryocclusionattheP1orP2segmentsgiventherichvascularsupplytothebrainstemthatoriginatesfromtheseanatomiclocationsandthepossibleneurologicdeficitsthatmayoccurasaresultofsuchtreatment.CiceriEFetal.

AJNRAmJNeuroradiol2001,22:27–34Itisimpossibletobecertain夾層動脈瘤P2A段Case1258-year-oldmaleincidentalfound夾層動脈瘤P2A段Case12Enterprise4.5/22Enterprise4.5/22特殊類型動脈瘤的介入治療課件11MFU11MFU11MFU11MFU特殊類型動脈瘤的介入治療課件After2EnterprisestentsABDCAfter2EnterprisestentsABDCPVOTheincidenceofsymptomaticinfarctionafterPAocclusionwas16.3%intheliteraturereview.BOT無效，不常用StentassistedcoilingInliteraturereview,themorbidityandmortalityofstentforPCAaneurysmswas7.9%intotal.Noinfarctionwasreported.Therewerethree(13%)recurrences,butonlyone(4.3%)causedrebleeding.HuangQ,etal.ClinNeuroradiol.2013PVOHuangQ,etal.ClinNeuror建議囊性動脈瘤應單純栓塞動脈瘤夾層動脈瘤可能需要閉塞載瘤動脈P1、P2段動脈瘤閉塞載瘤動脈可能導致穿支閉塞，盡可能保留載瘤動脈定期隨訪建議囊性動脈瘤應單純栓塞動脈瘤幕下遠端動脈瘤Distalaneurysmsofcerebellararteriesarerarelesionsaccountingfor0.6%ofalltreatedaneurysms夾層、假性動脈瘤常見一般需要閉塞載瘤動脈PelusoJPP,etal.AJNRAmJNeuroradiol.2007,28:1573TokimuraH,etal.NeurosurgRev.2012,35:497幕下遠端動脈瘤DistalaneurysmsofcerDistalPICAAnCase1358-Y-O-FSAH&IVHin4thventricleDistalPICAAnCase13特殊類型動脈瘤的介入治療課件特殊類型動脈瘤的介入治療課件Case14DistalAICAAnCase14DistalAICAAnMarathonsuperselectiveangio.Marathonsuperselectiveangio.Onyx-34Onyx-34ControlangiographyafterembolizationControlangiographyafteremboMRI4daysafterembolizationMRI4daysafterembolization特殊類型動脈瘤的介入治療課件注意事項注意事項Onyx-34intraprocedualleakageOnyx-34intraprocedualleakage特殊類型動脈瘤的介入治療課件術前術后術前術后評價閉塞動脈瘤及載瘤動脈原位閉塞注意術中破裂風險評價閉塞動脈瘤及載瘤動脈F,52Yrs,Suddenonsetofheadache&nauseaRebleeding20dayslater,HHgradeII2010-10-292010-11-182010-11-22合并假性成分的AnCase15F,52Yrs,SuddenonsetofheadOnyx0.2ml

Endovascular

coiling&Onyxinjection.Hydrosoft2/6SuccessfulsealtestHyperform4/7Onyx0.2mlEndovascular

coiliFinalcontrol6MFollow-upFinalcontrol6MFollow-upCase16Case16特殊類型動脈瘤的介入治療課件IntralumenonyxIntralumenonyx評價利：栓塞率高、栓塞效果好不利：操作復雜、占位效應、經驗較少建議：特殊病例應用，注意并發癥評價利：栓塞率高、栓塞效果好椎動脈夾層動脈瘤椎動脈夾層動脈瘤出血性夾層再出血24%~71.4%70%發生在首次出血后24小時內，80%發生在一周內缺血性夾層無癥狀椎動脈夾層動脈瘤椎動脈夾層動脈瘤治療手術近端夾閉動脈瘤孤立顱神經麻痹介入夾層動脈瘤孤立夾層近端閉塞血管重建治療手術Case21SAHVA-V4出血性夾層Case21SAHVA-V4出血性夾層Case2058yFemale,acuteSAH,bilateralVAdissectioninganeurysm.VA-V4出血性夾層Case2058yFemale,acuteSAH,R-VAdissectionworkingprojection,doublemicrocatheterinpositionR-VAdissectionworkingprojecSemi-deploythestentandintroducecoilsSemi-deploythestentandintrFourcoilsintroducedandfullydeploythefirstEnterpriseFourcoilsintroducedandfullAfterdeploying3stents,decreasedcontrastinthedissectioninganeurysmwasoberserved.Afterdeploying3stents,decrL-VAocclusionL-VAocclusion50minafterdeployingthe3rdstent,R-VAreconstructed,R-PICApatent50minafterdeployingthe3rdCase22非出血性夾層Case22非出血性夾層4Enterprisestents4Enterprisestents特殊類型動脈瘤的介入治療課件8mFU8mFU三維模擬速度場壁面切應力壓力場三維模擬速度場壁面切應力壓力場支架孔率對血流動力學的效應關系匯聚變發散完全抑制強度變弱金屬覆蓋率30%-40%支架孔率對血流動力學的效應關系匯聚變發散完全抑制強度變弱金屬支架和彈簧圈對于分支血流的影響收縮末期經過分支截面的血流速度。A為治療前；B-D為植入1-3枚支架，隨著支架數量的增加，血流速度無明顯變化；E-H為植入1枚支架和不同栓塞密度的彈簧圈，彈簧圈密度分別為2.5%，4.7%，8.5%和14.9%，隨著彈簧圈的增加，血流速度進行性下降，當栓塞密度達到14.9%時，血流方向發生改變。I-L為0-3枚支架結合4.7%栓塞密度的彈簧圈,在彈簧圈數量固定的情況下增加支架數量，分支血流速度無明顯變化。支架和彈簧圈對于分支血流的影響收縮末期經過分支Tubridge46根鎳鈦絲（40u）2根Pt顯影芯（80u）金屬覆蓋率35%脈瘤頸處30%～50%其它位置12%～20%Tubridge46根鎳鈦絲（40u）特殊類型動脈瘤的介入治療課件6mFU6mFU外傷性假性動脈瘤外傷性假性動脈瘤特殊類型動脈瘤的介入治療課件特殊類型動脈瘤的介入治療課件207M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA87M38,4weeksafterheadtrau208M38,4weeksafterheadtraumawithskullbasefracture,lefteyeblindness,pseudo-aneurysmofophthalmicsegmentofleftICA88M38,4weeksafterheadtrau209Enterprisestentinposition,firsthydrocoil4/10,followbythree3/10barecoils,twoAxium1.5/2coils89Enterprisestentinposition210Last3/4coil,partialloopsatruptureholeandpartialintheparentvessel,wishingtocovertheruptureholeafterstentdeployment90Last3/4coil,partialloops211Finalre