Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium.
World Neurosurg. 2011 Jul-Aug;76(1-2):114-9. doi: 10.1016/j.wneu.2011.02.015.
To report our preliminary experience with the Pipeline flow-diverter stent for the endovascular treatment (EVT) of intracranial aneurysms.
Between September 2009 and October 2010, 20 patients with 27 fusiform or wide-necked unruptured aneurysms were included and treated by Pipeline stent placement alone. Technical issues, immediate findings, delayed complications, and clinical and imaging follow-up at three and six months were assessed.
EVT was successfully performed in all patients. Clinical outcome was excellent in all but one patient who died. This latter patient developed a massive infarct due to a delayed stent thrombosis. Other complications without permanent deficit included one perimesencephalic subarachnoid hemorrhage and one retroperitoneal hematoma. Minor technical issues without clinical consequence were encountered in nine patients and included stent migration, stent misplacement, unanticipated stent shortening, and the impossibility to recapture the distal coil tip of the supporting device. Angiographic follow-up in 19 patients with 25 aneurysms showed 21 complete occlusions, one neck remnant, and three incomplete occlusions. No significant parent artery stenosis was seen.
This study shows that the Pipeline stent is useful for EVT of fusiform and wide-necked intracranial aneurysms. Moreover, the stent is well tolerated with a low rate of intra-stent stenosis at short-term follow-up. However, technical improvements are needed to ensure safe and precise use of the device.
报告我们在颅内未破裂的梭形或宽颈动脉瘤的血管内治疗（EVT）中使用 Pipeline 血流导向装置的初步经验。
在 2009 年 9 月至 2010 年 10 月期间，20 例 27 个梭形或宽颈未破裂的动脉瘤患者，单独使用 Pipeline 支架置入进行治疗。评估了技术问题、即刻发现、迟发性并发症以及 3 个月和 6 个月时的临床和影像学随访。
所有患者均成功进行了 EVT。除了 1 例因支架内血栓形成导致大面积梗死而死亡的患者外，所有患者的临床预后均良好。其他无永久性缺损的并发症包括 1 例中脑周围蛛网膜下腔出血和 1 例腹膜后血肿。9 例患者出现轻微的技术问题但无临床后果，包括支架移位、支架放置不当、支架意外缩短以及无法重新捕获支撑装置的远端线圈尖端。19 例患者中的 25 个动脉瘤进行了血管造影随访，结果显示 21 个完全闭塞，1 个瘤颈残留，3 个不完全闭塞。未见明显的母动脉狭窄。
这项研究表明，Pipeline 支架可用于 EVT 治疗梭形和宽颈颅内动脉瘤。此外，支架在短期随访中耐受性良好，支架内狭窄率低。然而，需要技术改进以确保该装置的安全和精确使用。
