Lylyk Pedro, Ferrario Angel, Pasbón Boris, Miranda Carlos, Doroszuk Gustavo
Department of Neurosurgery and Interventional Neuroradiology, Clínica Médica Belgrano, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina.
J Neurosurg. 2005 Feb;102(2):235-41. doi: 10.3171/jns.2005.102.2.0235.
The authors report their experience with the use of the Neuroform Microdelivery System for intravascular reconstruction. They assess the technical feasibility of the system, the efficacy of the combined application of stent and detachable coils, and the follow-up findings.
Fifty patients found to harbor a complex wide-necked intracranial aneurysm were selected for the study. Different strategies were chosen and the performance and technical success of the device were evaluated. Stent placement was recorded as optimal or suboptimal with respect to the stent position. Clinical and angiographic follow-up examinations were obtained. Forty-six patients with 48 intracranial aneurysms were treated, leading to a technical success rate of 92%. Forty-two lesions were located in the anterior circulation. In every case the dome/neck ratio was less than 2 and the mean aneurysm size in these patients was 8.8 mm. The most frequent clinical presentation was subarachnoid hemorrhage in 48% of cases. Stent placement was optimal in 81.2% of cases and suboptimal in 18.8%. In 31% of cases, the investigators encountered difficulties in placing the Neuroform stent. Clinical follow up was recorded in all patients and angiographic follow up was obtained in 63%. There were no cases of repeated hemorrhage. In a single case in which only the stent was implanted progressive thrombosis was identified during the follow-up period. The procedure-related morbidity and mortality rates were 8.6 and 2.1%, respectively.
On the basis of the results, the authors conclude that the Neuroform self-expanding stent is a flexible and useful device that can be readily and safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. Early in the authors' experience, stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although the early results are promising, the long-term benefit of this technique has to be proved by angiographic and clinical follow-up examinations.
作者报告使用Neuroform微输送系统进行血管内重建的经验。他们评估该系统的技术可行性、支架与可脱卸弹簧圈联合应用的疗效以及随访结果。
选择50例患有复杂宽颈颅内动脉瘤的患者进行研究。选择不同策略并评估该装置的性能和技术成功率。根据支架位置将支架置入记录为最佳或次优。进行临床和血管造影随访检查。46例患者的48个颅内动脉瘤得到治疗，技术成功率为92%。42个病变位于前循环。在每种情况下，瘤顶/瘤颈比均小于2，这些患者的动脉瘤平均大小为8.8毫米。最常见的临床表现是48%的病例出现蛛网膜下腔出血。81.2%的病例支架置入最佳，18.8%为次优。在31%的病例中，研究人员在置入Neuroform支架时遇到困难。所有患者均记录了临床随访情况，63%的患者进行了血管造影随访。无再次出血病例。在仅植入支架的1例患者中，随访期间发现有进行性血栓形成。与手术相关的发病率和死亡率分别为8.6%和2.1%。
基于这些结果，作者得出结论，Neuroform自膨式支架是一种灵活且有用的装置，可轻松、安全地通过迂曲的颅内血管进行操作，能够对复杂宽颈动脉瘤进行血管内治疗。在作者的经验早期，支架输送存在困难；然而，第二代装置已解决了这一局限性。尽管早期结果令人鼓舞，但该技术的长期益处仍需通过血管造影和临床随访检查来证实。
