Department of Neurological Surgery, Massachusetts General Hospital and Harvard Medical School, White Building, Room 502, 55 Fruit Street, Boston, MA 02114, USA.
J Clin Neurosci. 2011 Jul;18(7):891-4. doi: 10.1016/j.jocn.2011.01.002. Epub 2011 May 14.
We aimed to identify the initial preliminary experience with flow diverting stents (FDS) for the treatment of intracranial aneurysms (IA). A PubMed search was performed to identify studies reporting patients treated with FDS. Selection was made for studies that provided either immediate or short term follow-up data. For each study, the number of patients and IA were identified. Details regarding the aneurysm itself were recorded; such as aneurysm morphology (saccular or fusiform), location, and rupture status. The primary treatment modality and the number of stents used to treat each aneurysm was recorded along with the antiplatelet regimen used. Outcomes such as aneurysm occlusion and complications, including stroke, in-stent thrombosis and stenosis, and death were identified. The average length of follow-up was calculated in weeks. A total of 10 manuscripts reporting 206 IA in 190 patients were identified in the literature. Occlusion rates were variably reported, ranging from 58% to 94% in the larger series. Major complications of treatment included stroke (6.0%), in-stent thrombosis and stenosis (4.9%), and death (3.3%). A phenomenon of delayed aneurysm rupture was also identified. We concluded that flow diverting stents have proven effective in a variety of scenarios. The major complications with FDS have related to perforator artery stroke, aneurysm re-rupture, and in-stent stenosis and thrombosis. Long-term efficacy, optimal antithrombotic agent regimen, and perforator stroke risk are yet to be determined.
我们旨在确定血流导向装置（FDS）治疗颅内动脉瘤（IA）的初步经验。对 PubMed 进行了检索，以确定报道 FDS 治疗患者的研究。选择提供即时或短期随访数据的研究。对于每项研究，确定患者和 IA 的数量。记录与动脉瘤本身相关的详细信息；例如动脉瘤形态（囊状或梭形）、位置和破裂状态。记录主要治疗方式和用于治疗每个动脉瘤的支架数量，以及使用的抗血小板方案。确定诸如动脉瘤闭塞和并发症（包括中风、支架内血栓形成和狭窄以及死亡）等结果。平均随访时间以周计算。在文献中总共确定了 10 篇报告了 190 名患者的 206 个 IA 的文章。闭塞率报道不一，较大系列的范围为 58%至 94%。治疗的主要并发症包括中风（6.0%）、支架内血栓形成和狭窄（4.9%）和死亡（3.3%）。还确定了动脉瘤迟发性破裂的现象。我们得出结论，血流导向装置在各种情况下已被证明有效。FDS 的主要并发症与穿支动脉中风、动脉瘤再破裂以及支架内狭窄和血栓形成有关。长期疗效、最佳抗血栓药物方案和穿支动脉中风风险仍有待确定。
