Department of Diagnostic Radiology, Tampere University Hospital, Tampere, Finland.
Neurosurgery. 2012 Mar;70(3):617-23; discussion 623-4. doi: 10.1227/NEU.0b013e31823387d4.
The flow-diverting stent is a new option in endovascular therapy specifically designed for the endovascular reconstruction of a segmentally diseased artery. The safety of flow-diverting stents is still equivocal.
To evaluate the technical aspects, thromboembolic events, adjunctive therapies, and midterm results in patients with complex intracranial aneurysms treated with a flow-diverting stent (Silk; Balt Extrusion, Montmorency, France).
We retrospectively examined angiographic images and clinical reports of 24 consecutive patients (29 stents) treated (n = 23) or attempted to treat (n = 1) with a flow-diverting device in 2 Finnish centers between March 2009 and October 2010.
The primary technical success rate was 67% (16/24). Adjunctive therapies were required in 6 (25%) patients, including 4 cases where intra-arterial abciximab was administered for the treatment of intraprocedural thromboembolic events. Technique-related complication rate and the 30-day mortality rate were each 4% (1/24). Follow-up imaging revealed 1 case of delayed in-stent thrombosis resulting in permanent disability of the patient, 1 asymptomatic occlusion, and 1 asymptomatic stenosis of the stented artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 16 of the 23 aneurysms (70%) where follow-up images were available.
Many previously untreatable cerebral aneurysms may be successfully treated with the Silk flow-diverting stent, but the associated risk of thromboembolic events is justifiable only if conventional endovascular or surgical treatment options are not applicable. Perioperative thromboembolic events should be prepared for and treated without unnecessary delays because they frequently respond to adjunctive medical therapy.
血流导向装置是一种新型的血管内治疗选择，专门设计用于血管内重建节段性病变的动脉。血流导向装置的安全性仍存在争议。
评估 24 例（29 枚支架）复杂颅内动脉瘤患者使用血流导向装置（Silk；Balt Extrusion，Montmorency，法国）的技术方面、血栓栓塞事件、辅助治疗和中期结果。
我们回顾性分析了 2009 年 3 月至 2010 年 10 月在芬兰的 2 个中心接受（n=23）或试图接受（n=1）血流导向装置治疗的 24 例连续患者（29 枚支架）的血管造影图像和临床报告。
主要技术成功率为 67%（16/24）。6 例（25%）患者需要辅助治疗，包括 4 例术中给予阿昔单抗治疗术中血栓栓塞事件。技术相关并发症发生率和 30 天死亡率均为 4%（1/24）。随访影像学显示 1 例支架内迟发性血栓形成导致患者永久性残疾，1 例无症状闭塞，1 例支架内动脉狭窄。23 例可获得随访图像的动脉瘤中，16 例（70%）观察到动脉瘤完全闭塞，载瘤动脉完全通畅。
许多以前无法治疗的脑动脉瘤可以用 Silk 血流导向支架成功治疗，但只有在传统的血管内或手术治疗方法不可用时，血栓栓塞事件的相关风险才是合理的。应准备并及时治疗围手术期血栓栓塞事件，避免不必要的延误，因为它们通常对辅助药物治疗有反应。
