Медицинская литература. Новинки

 

 

 

 

 

 

Эндоваскулярное лечение интракраниальных аневризм с применением трехмерного наведения

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Цель работы: оценка возможностей эндоваскулярной эмболизации интракраниальных аневризм (ИА) с использованием трехмерного (3D) наведения. Материал и методы. За период с 2010 по 2011 г. в отделении ангиографии МОНИКИ им. М.Ф. Владимирского было произведено 30 лечебных вмешательств у 26 пациентов с ИА. Эмболизация аневризм осуществлялась отделяемыми металлическими спиралями. Во время вмешательств для проведения эндоваскулярного инструментария по церебральным сосудам и катетеризации полости ИА применялась технология 3D-наведения. Техника 3D-наведения основывалась на создании композитных изображений, на которых рентгеноскопическое 2D-изображение в реальном времени накладывалось на виртуальную 3Dмодель сосуда, полученную по данным ротационной 3Dангиографии или КТангиографии (КТА). Результаты. Эндоваскулярные вмешательства с применением методики 3Dнаведения были выполнены у 13 (43%) пациентов. Среди них у 9 (70%) в основе создания 3Dмодели использовались данные ротационной ангиографии, у 4 (30%) – данные КТА. Технический успех эндоваскулярной эмболизации достигнут у всех пациентов. Был разработан комплексный алгоритм диагностики и рентгеноэндоваскулярного лечения ИА с применением технологии 3Dнаведения. Заключение. Первый отечественный опыт применения 3D-наведения в лечении аневризм церебральных артерий в нашей клинике убедительно показал, что использование этой методики возможно и эффективно. Успех процедуры составил 100%. Накопление опыта свидетельствует об отчетливой тенденции к сокращению продолжительности процедуры и уменьшению количества вводимого рентгеноконтрастного средства.

Ключевые слова:
3D-наведение, внутричерепная аневризма, эмболизация.

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H/S.+Heye.

Endovascular treatment of intracranial aneurisms using three+dimensional navigation

The purpose of this study is to evaluate the opportunities of Endovascular treatment of intracranial aneurisms (IA) using threedimensional navigation (3D-roadmapping). Materials and methods. During 2010–2011 years 30 embolizations of IA in 26 patients were performed in our angiography department. Embolizations were managed by metallic detachable coils. 3Droadmapping technique was applied for guidance of endovascular tools in cerebral arteries and catheterization of the cavity of IA during the procedure. 3Droadmapping technique is based on creation of composite images that superimpose twodimensional fluoroscopic views and virtual threedimensional model of the vessel. Results. Endovascular interventions with 3D-roadmapping were performed in 13 (43%) cases. 3D-model was created using 3D rotational angiography (3DRA) in 9 (70%) cases, and CTangiography (3DCTA) data – in 4 (30%) cases. Technical success was achieved in all patients. Complex algorithm of diagnosis and endovascular treatment of IA using 3Droadmapping was obtained. Conclusion. The first national experience of the endovascular embolization of IA with 3Droadmapping convincingly showed that usage of this technique is possible and effective. The success of the procedure was 100%. Gaining experience indicates a distinct tendency of decreasing the duration of the procedure and the amount of required contrast agent

Keywords:
3D-roadmapping, intracranial aneurism, embolization