Tubridge blood flow-guided device treats a case of traumatic cervical artery pseudo-aneurysm

Traumatic intracranial pseudo-aneurysms are rare, often caused by blunt or penetrating injuries to the head, and may also be caused by medically induced injuriesClinical manifestations vary depending on the location and size of the aneurysm and whether it rupturesPseudoanananomas are difficult to treat and have a high risk of rupture in surgery, although spontaneous remission has been reported, but there is a high rate of rupture before receiving definitive treatmentTherefore, surgical intervention is its standard treatment, the traditional treatment is to carry tumor
vascularaocstatotic or intracranial vascular bypass transplantationWith the advance of intravascular therapy, most patients can choose safe and effective minimally invasive treatmentThe author reported a case of vascular reconstruction using Tubridge stent to treat a traumatic cervical artery pseudo-aneurysmpatient male, 32, was admitted to the Cerebrovascular Disease Center of the First Affiliated Hospital of naval medical university on July 24, 2018 after being injured in a car accident that left his left eye for nearly a monthOn June 26, 2018, the patient accidentally fell on a motorcycle caused head trauma, immediately after the injury appeared mouth and nose bleeding, gradually stopped, in the local hospital line brain CT examination, indicating the left upper endofal epidural hematoma, emphysema, multiple skull fracture, left upper jaw sinus inner wall fracture, left optic nerve tube multiple fracture, no mesh subcavity bleedingAfter the trauma 10h through the mouth again spit out the old and new mixed blood dozens of milliliters, considering the skull fracture and upper jaw sinus fracture and other bleeding causedto be treated conservatively (specific drugs and doses are unknown) after 2 weeks the condition is stableDue to multiple fractures at the base of the skull, the left optic nerve tube has multiple fractures near the inner artery in the neck, and the patient received a DSA examination at a local hospital on July 9, 2018, showing a pseudo-aneurysm in the left cervical artery spongiform sinus segment, located near the end of the eye artery, with irregular tumor forms, and its tip vesicles pointing to the frontOn July 24, 2018, the patient was admitted to the First Affiliated Hospital of naval medical universityafter admission to the physical examination: into the ward, conscious, left eye tube vision, vision index 2m, the rest did not see abnormalAdmissiondiagnosis: pseudo-aneurysm in the sinus section of the left cervical artery spongy sectionAfter admission to the hospital on July 26, 2018, general anesthesia of the undergoing cerebrovascular angiography and left cervical atomial pseudoanoma stent placement, aneurysm form compared to July 9, 2018 no significant changethe measurement of the upper section of the intra-neck artery bed burst 3.92mm diameter and the diameter of the sponge sinus section 4.97mm, decided to use 2 Tubridge stents (Minimally Invasive Shentong Medical Technology (Shanghai) Co., Ltd.) overlapping technology treatmentThe first Tubridge 5.5mm x 20.0mm, the 2nd Tubridge 5.0mm x 15.0mm was first released using the 6F Chaperon Guide Tube (Microvention, United States) in the left cervical artery rock section, using the T-track microcatheter (SymcanolyTic Medical Technology (Shanghai) Co., Ltd., and the first Tubridge 5.5mm x 20.0mmAfter the release of the stent, the contrast agent visible in the pseudo-aneurysm was obviously stuck, the tumor tumor development was reduced, and the stent opened wellThe second day after surgery was reviewed for MRI and no new cerebral infarction was seenthe 4th day after surgery to review the head MR vascular imaging still see aneurysm developmentOn the 10th day after surgery, the DSA was reviewed, and it was visible that the aneurysm development was significantly reduced, the tumor wall morphology rules, smooth, and the vesicles pointing to the upper part of the front did not developAnti-platelet aggregation treatment plan: preoperative no anti-platelet aggregation preparation, take postoperative for the luofiban and double anti-drug (clopidogrel and aspirin) alternate program, that is, the stent into the start of micro-pumping into the diffiban, according to the instructions, 6 ml intravenous injection (half load 5 sg/kg, body mass 60 kg), continue to 6 ml / h .075 g / kg micropump ingestion, anesthesia after sobering to give double anti-load (aspirin 300mg, clopidogre300mg), 6h after the discontinuation of the tifiel; After 4 months of follow-up, left eye symptoms before surgery, no brain haemorrhage, cerebral infarction and other new symptoms, generally in good conditionDSA showed that aneurysms were completely non-dominant, that the stent endometriosis was mildly hyperplifying but no significant stenosis, and that the carrier artery and eye artery were smoothdiscussionpseudo-aneurysms are often caused by trauma, moldinfection, vascular mezzanine or congenital collagen deficiency, traumatic intracranial pseudo-aneurysms are less common, less than 1% of all intracranial aneurysms, mainly in the neck artery neck section, sponge sinus and rock bone sectionA literature review of patients with 193 exceptionally invasive pseudoherosms reported that road traffic accidents accounted for 51%, device injuries 12%, high falls 8%, and other causes of trauma accounted for 29%; The total fatality rate associated with neck vascular injury associated with pseudo-aneurysm was 20% to 30% intracranial pseudo-aneurysms lack a real vascular wall due to permeable damage, with only fragile connective tissue layer scarcity Pathological studies have shown that the aheromoma wall is thrombosis component, and there is no real aneurysm wall Although there are reports of spontaneous remission of pseudo-aneurysms, the rate of rupture is as high as 60% before receiving definitive treatment, and the fatality rate after rupture is as high as 31% to 54% The imaging characteristics of pseudo-aneurysm include irregular aneurysm walls, contrast agent delay edgy, contrast agent retention, tumor neck ambiguity and other characteristics This case of patients for multiple fractures of the cranial base, the same side optic nerve tube visible multiple fracture fragments, DSA to check the aneurysm morphology irregularities, so we think this is an exceptional false aneurysm, and given treatment the most commonly used means of amengiocine, at present, with the progress of intravascular treatment technology, amenation aneurysm at the same time to retain the carrier tumor vascular is possible, and gradually become the first choice for the treatment of pseudo-aneurysm, especially the false aneurysm of the rock bone section, because its anatomical position limits open surgery, angiovascular therapy may be the only treatment The most commonly used in the research report is the mulch stent, which can reconstruct the tumor-bearing artery well, seal the tumor neck, less complications, and the treatment effect is good The biggest consideration of intracranial vascular application mulch stent is its internal leakage caused by pass-through and poor wall At present, the intracranial-specific coating stent is a domestic Willis stent, although better than the previous coronary artery mulch stent passability, but its maximum diameter is only 4.5mm the patient's aneurysm is located in the front knee section of the spongy sinuses, the bent intravascular release coating stent, the stent may not be fully opened, and the near end of the neck artery diameter 4.97mm, the far end 3.92mm, the tube diameter difference is large, the stent wall is prone to internal leakage; Blood flow-oriented devices can treat large intracranial, shuttle or recurrence of complex aneurysms, while the treatment of pseudo-aneurysms is increasingly reported, the stent placed on the carrier tumor artery reconstruction, changeits its hemodynamics, promote intratumor thrombosis, and provide support for endothelial Amenta and others reported 1 case of Pipeline stent treatment of patients with a coronary artery damaged by butterfly sinus surgery, two stents placed in the post-tumor apparently stranded, 4 months after the review of aneurysm completely disappeared; Zelenak and others reported the successful use of two Silk stents to treat the cervical artery segment of the pseudo-aneurysm Blood flow-oriented device technology success rate is high, although some patients after the stent still have the development of aneurysm, but most follow-up time aneurysms can be completely closed the patient's follow-up for 4 months after surgery confirmed that the aneurysm was completely unreflected and that the carrier aneurysm was smooth Tubridge blood flow guide device is a high metal coverage (20% to 40%), low-hole rate of self-expanding intravascular stent system, in the transport process can be pushed stent and retract micro-catheter combination to control the coverage of the tumor neck stent hole rate, in the aneurystic neck, metal coverage can reach 30% to 50% patients in this case did not consider the use of spring ring in treatment, the main reasons are: (1 ) patients have been trauma for 1 month, short-term risk of re-bleeding is low; The blood flow guide must use double resistance, so to consider the risk of post-traumatic bleeding, most trauma patients face contradictions, such as severe intracranial injury, multiple injuries or puncture wounds, there is a contraindication of anti-thrombotic treatment Therefore, in addition to life-threatening emergency surgery, blood flow-oriented devices should be used at least 1 month after trauma patients repeatedly review EDCt did not see cobweb subcavity bleeding, so consider the false aneurysm did not break, in the stable condition 1 month after the blood flow-oriented device placement, it is taking into account the patient's trauma after intracranial hemorrhage factors, before surgery also did not carry out antiplatelet aggregation drug preparation, after surgery using the leptabean and double anti-anti- alternating Stent placed immediately after the pseudo-aneurysm internal contrast agent stuck, after surgery 10d review DSA show tumor shrinkage, suggesting that the pseudo-aneurysm continued to repair, 4 months after surgery to review dSA show aneurysm completely cured