Department of Neuroradiology, National Institute of Neurosurgery, Amerikai ut 57, Budapest, Hungary.
AJNR Am J Neuroradiol. 2010 Jun;31(6):1139-47. doi: 10.3174/ajnr.A2023. Epub 2010 Feb 11.
Aneurysm treatment by intrasaccular packing has been associated with a relatively high rate of recurrence. The use of mesh tubes has recently gained traction as an alternative therapy. This article summarizes the midterm results of using an endoluminal sleeve, the PED, in the treatment of aneurysms.
A total of 19 wide-neck aneurysms were treated in 18 patients: 10 by implantation of PEDs alone and 9 by a combination of PED and coils. Angiographic and clinical results were recorded immediately and at 6 months following treatment.
Immediate angiographic occlusion was achieved in 4 and flow reduction, in another 15 aneurysms. Angiography at 6 months demonstrated complete occlusion in 17 and partial filling in 1 of 18 patients. There was no difference between coil-packed and unpacked aneurysms. Of 28 side branches covered by > or =1 device, the ophthalmic artery was absent immediately in 1 and at 6 months in another 2 cases. One patient experienced abrupt in-stent thrombosis resulting in a transient neurologic deficit, and 1 patient died due to rupture of a coexisting aneurysm. All giant aneurysms treated with PED alone were demonstrated by follow-up cross-sectional imaging to have involuted by 6 months.
Treatment of large, wide-neck, or otherwise untreatable aneurysms with functional reconstruction of the parent artery may be achieved with relative safety using dedicated flow-modifying devices with or without adjunctive use of intrasaccular coil packing.
腔内包裹治疗动脉瘤与相对较高的复发率相关。最近,使用网筒作为替代治疗方法受到关注。本文总结了使用腔内套管(PED)治疗动脉瘤的中期结果。
18 例患者的 19 个宽颈动脉瘤接受了治疗:10 例单独植入 PED,9 例 PED 联合线圈。记录即刻和治疗后 6 个月的血管造影和临床结果。
即刻血管造影显示 4 个动脉瘤完全闭塞,15 个动脉瘤显影减少。6 个月时血管造影显示 17 个动脉瘤完全闭塞,18 例患者中有 1 例部分填充。单纯线圈填塞和未填塞的动脉瘤之间无差异。28 个分支被>或=1 个装置覆盖,其中 1 个分支即刻无眼动脉,另 1 个分支在 6 个月时消失。1 例患者发生支架内血栓形成导致短暂性神经功能缺损,1 例患者因合并动脉瘤破裂而死亡。所有用 PED 治疗的大型宽颈或其他难以治疗的动脉瘤,在 6 个月时的随访横断面成像显示已经退缩。
使用专用的血流调节装置,或联合使用腔内线圈填塞,对大的、宽颈或其他难以治疗的动脉瘤进行治疗,实现母动脉的功能重建,可能相对安全。