Kev Kho Mob Aneurysm
Cov txheej txheem ntxov tshaj plaws ntawm endovascular embolization tau tsim los ntawm neurosurgeons thiab neuroradiologists nyob rau xyoo 1960 thiab 1970s los kho cov kab mob "inoperable" cerebrovascular lesions. Txij li thaum muaj hnub nyoog ntxov ntawm kev tshawb fawb neurointerventional, feem ntau ntawm cov txheej txheem aneurysm embolization tau ua los ntawm kev cuam tshuam neuroradiologists thiab endovascular neurosurgeons. Cov yav dhau los kos rau ntawm lawv cov kev paub txog angiography thiab cov duab qhia kev phais cov txheej txheem raws li kev tsim nyog, thiab tom kawg kos rau lawv cov kev txawj ntse anatomical thiab kev nkag siab tob ntawm aneurysms. Tau ntau xyoo lawm, cov kev tshwj xeeb no tau ua haujlwm ua ke los ua kom muaj peev xwm ua tau zoo ntawm txoj hlab ntsha intracranial navigation thiab aneurysm embolization.
Thaum ntxov keeb kwm ntawm neurointerventional
Intravascular cannulation tau dav siv hauv kev kuaj mob thiab kho cov tswv yim hauv kev kho mob. Tus pioneer ntawm intravascular cannulation yog tus txiv plig Stephen Hales nyob rau hauv lub xyoo pua 18th, uas tau ua kev sim ntawm nees qauv. Qhov cuam tshuam loj ntawm cov kab mob hauv cov hlab ntsha tau lees paub thaum Andre Frederic Cournand, Werner Forssmann thiab Dickinson Richards tau txais Nobel nqi zog hauv Physiology lossis Tshuaj hauv xyoo 1956 rau lawv qhov kev tshawb pom txog kev mob plawv. Diagnostic cerebral angiography yog thawj zaug piav nyob rau hauv 1927 los ntawm Antonio Caetano de Abreu Freire rau lub intracranial ncig, nrog rau lub hom phiaj ntawm imaging txawv vascular qauv nyob ib ncig ntawm lub hlwb hlav. Tom qab ntawd nws yeej 1949 Nobel nqi zog hauv Physiology lossis Tshuaj rau nws txoj haujlwm ntawm lobotomy rau kev kho mob hlwb. Ua raws li cov lus cog tseg no hais txog kev siv tshuaj intravascular cannulation thiab angiography, thawj qhov kev kho mob intravascular cannulation ntawm tib neeg lub ncauj tsev menyuam tau tshaj tawm los ntawm Alfred Lussenhop thiab Alfredo Velasquez hauv xyoo 1964, thaum lawv tau piav qhia txog ib rooj plaub ntawm intracervical Ib rooj plaub ntawm ruptured arterial saccular anemery 5. mm spherical silicone embolization ntaus ntawv. Txawm hais tias tau tshaj tawm cov txiaj ntsig tsis zoo zaum kawg rau cov neeg mob, qhov kev paub ntxov no yog qhov tseem ceeb rau kev txhim kho neurointerventional kho mob thiab tau ua raws los ntawm ntau qhov kev sim los txhim kho endovascular navigation thiab txo qis vascular trauma. Xyoo 1960s kuj tau pom kev siv cov thawj microcatheters, cov tswv yim qhia kev sib nqus, thiab qhov tshwm sim ntawm ib txoj kev ntawm aneurysm embolization siv lub detachable magnetic tip thiab txuas hlau embolic hais. Balloon occlusion thev naus laus zis tau los ua qhov tseem ceeb hauv xyoo 1970 thaum Serbinenko qhia txog kev kho ntau dua 300 lub hlwb aneurysms siv cov txheej txheem no. Txawm hais tias qee lub chaw thiab cov tswv lag luam tawm tswv yim siv lub zais pa embolization los kho intracranial aneurysms, lub tswv yim no thaum kawg suav tias tsis muaj kev nyab xeeb, nrog rau qhov tsis zoo ntawm qhov siab aneurysm rupture tus nqi thiab kev kho mob tsis zoo. Nws tsis yog txog thaum lub tswv yim ntawm coil thev naus laus zis uas niaj hnub kev kho mob endovascular ntawm intracranial aneurysms tau dhau los ua cov txheej txheem ua tau. Ua ntej qhov kev tshwm sim ntawm endovascular coiling technology, endovascular kev kho mob ntawm intracranial aneurysms feem ntau koom nrog occlusion ntawm niam txiv hlab ntsha tom qab kev sim ntawm balloon occlusion ntawm aneurysm uas ua tsis tau tejyam phais clipping.
Intravascular coil embolization
Kev hloov pauv ntawm cov cuab yeej kho mob endovascular tau dhau los ntawm ntau cov tswv yim kho mob. txhua txoj kev kho mob muaj ntau yam kev xav ntawm kev ua haujlwm. Qhov tshwm sim ntawm endovascular coiling thev naus laus zis tau cim lub ntsiab lus tseem ceeb hauv kev kho mob neurointerventional raws li nws tau ua kom ruaj khov aneurysm occlusion yam tsis muaj kev pheej hmoo loj rau tus neeg mob. Txawm hais tias cov coils twb muaj los kho ntau yam kab mob intracranial thiab niam txiv cov hlab ntsha occlusions, Guglielmi, Vinuela, Sepetka, thiab Macellari siv cov txheej txheem xa khoom uas me dua li 5F thiab 4F qhov ntau thiab tsawg los pab intracranial nkoj navigation. Cov cuab yeej siv no tau ua ke nrog cov mos platinum tso tawm cov coils, uas tau hloov mus rau hauv cov coils stretch-resistant los ntawm kev tso cov sutures los yog guidewires nyob rau hauv ib qho kev txiav txim thawj zaug helix. Intra-aneurysmal coils tau tsim nyob rau xyoo 1990. Cov txheej txheem embolization. Lawv lub tswv yim yog ua raws li kev tso lub microcatheter taub rau lub caj dab ntawm lub saccular aneurysm ua ntej coil microcatheter xa los ntawm Sadek Hilal thiab nce qib platinum coils siv stainless hlau xa ntawv guidewire. Tom qab ntawd ib qho ncaj qha tam sim no yog siv rau qhov sib thooj ntawm cov ntawv qhia xa khoom kom pib electrocoagulation thiab tso tawm ntawm platinum coil hauv qhov aneurysm. Lub electrocoagulation nam ntawm lawv lub tswv yim yog raws li nyob rau hauv thaum ntxov ua hauj lwm los ntawm Sean Mullan ntawm lub University of Chicago, uas tau siv ib tug qhib kev phais txoj kev los kho cavernous sinus aneurysms thiab siv tooj liab xov hlau rau puncture lub aneurysms. Hauv lawv thawj qhov kev kho mob uas siv cov tswv yim no, Guglielmi thiab al tau ua tiav ib nrab lossis ua tiav cov kab mob aneurysm occlusion hauv txhua tus neeg mob, tsuas yog ib kis ntawm kev tsis txaus ntawm cov paj hlwb. Thaum lub sij hawm, qhov kev xav zoo tshaj plaws yog tias intraaneurysmal occlusion tau ua tiav los ntawm electrocoagulation ua rau cov qe ntshav dawb tsis zoo, cov qe ntshav liab, thiab cov khoom siv ntshav los ntawm kev txhawb nqa ntshav los ntawm kev siv cov coil zoo. Cov kev tshawb fawb tom qab tau lees paub tias cov txiaj ntsig kho mob ntawm cov coils tau ua tiav los ntawm kev sau qhov chaw nrog platinum coils, thiab cov platinum coils uas tsis yog electrodecompression muaj cov txiaj ntsig zoo sib xws thiab rov ua dua. Cov txheej txheem muaj peev xwm los tiv thaiv kev sib tsoo aneurysm suav nrog qeeb cov ntshav ntws hauv thiab tawm ntawm qhov aneurysm los txhawb kev tsim cov thrombus thiab kev loj hlob tom ntej, nrog rau lwm yam kev cuam tshuam xws li kev khiav dej num lossis kev sib cuam tshuam ntawm cov coils nrog cov phab ntsa aneurysm.
Lub International Subarachnoid Aneurysm Trial (ISAT), ib qho kev sim ntawm kev kho mob ntawm ruptured intracranial aneurysms, tau luam tawm nyob rau hauv 2002 thiab qhia tias kev kho mob aneurysms nrog endovascular coiling ua rau muaj kev tsis taus ciaj sia zoo dua li kev phais clipping. . Qhov txiaj ntsig no tau ua rau muaj kev hloov pauv hauv kev kho mob ntawm feem ntau intracranial aneurysms los ntawm "clipping thawj" rau kev kho mob endovascular thiab ua rau muaj kev nce siab ntawm cov hlwb aneurysms kho nrog endovascular coiling. Qhov tseeb, txij xyoo 2004 txog 2014, tag nrho ntawm 79,627 intracranial aneurysms hauv Tebchaws Meskas tau kho nrog endovascular coiling, thaum 42,256 tau kho nrog kev phais clipping, kev hloov pauv loj hauv kev faib cov hom kev kho mob ua ntej tso tawm ISAT.
Tom qab siv dav dav ntawm endovascular coils los kho lub hlwb aneurysms hauv kev kho mob neurointerventional xyaum, cov neeg tsim khoom pib tsim cov txheej txheem bioactive. Tom qab ntawd, kom zoo dua embolize qhov chaw nyob rau hauv lub aneurysm sac, bioinert hydrogel-coated coils tau tsim. Coated thiab hloov kho coils txuas ntxiv yog qhov muaj txiaj ntsig zoo ntawm cov neurointerventionalists. Txawm hais tias thawj cov txiaj ntsig tau los ntawm kev sim randomized sib piv cov nqi rov qab nrog hydrogel coils piv rau liab qab platinum coils hauv kev kho mob ntawm cov hlab ntsha tau sib xyaw, cov pov thawj qib 1 tsis ntev los no qhia tau hais tias kev siv hydrogel coils hauv ruptured aneurysms yuav zoo dua li siv Bare platinum coils ntau dua. muaj txiaj ntsig. Hmoov tsis zoo, cov txiaj ntsig zoo sib xws tsis tau pom nrog bioactive coils. Tom qab ntawd cov tuam txhab tau rov mus xyuas cov platinum liab qab nrog cov txheej txheem sib txawv los yog qhov chaw ntim khoom.
Intravascular coil embolization muaj ntau yam kev txwv. Cov no muaj xws li aneurysm recurrence, coil herniation thiab tsiv teb tsaws, txwv tsis pub siv nyob rau hauv dav-caj dab saccular aneurysms, teeb meem nrog aneurysms uas muaj arterial ceg, thiab nyuaj rau catheter positioning rau distal aneurysms. Cov kev txwv no yuav raug hais los ntawm cov khoom siv rov qab thiab cov qauv xa tawm tshiab. Txawm hais tias cov kev txwv no, endovascular coils tseem niaj hnub siv rau cov neeg mob uas muaj mob ruptured aneurysms thiab hauv cov neeg mob uas tsis tuaj yeem tiv thaiv kev kho mob antiplatelet.