Department of Cerebrovascular and Endovascular Neurosurgery, King's College Hospital, London, UK.
J Neurointerv Surg. 2011 Jun;3(2):167-71. doi: 10.1136/jnis.2010.002873. Epub 2011 Mar 1.
Flow-diverting stents have demonstrated great promise for the treatment of cerebral aneurysms; however, clinical experience with the devices remains very preliminary. We present two cases of spontaneous delayed complications-one fatal aneurysm rupture and one symptomatic increase in aneurysm volume-following the treatment of intradural aneurysms with the Pipeline Embolization Device (PED).
PRESENTATION/INTERVENTION: Two patients with unruptured, intradural aneurysms of the carotid artery underwent uneventful treatment with the PED (eV3, Irvine, California, USA). One patient, with a giant aneurysm of the carotid terminus, experienced worsening headache 5 days after the procedure and ultimately collapsed and became unresponsive. CT of the head demonstrated acute subarachnoid and intraventricular hemorrhage. The patient died the following day. A second patient with a large left posterior communicating artery aneurysm presented with progressive memory loss 3 months after PED reconstruction of the carotid artery. Although serial CT angiograms showed progressive thrombosis of the aneurysm to near-complete occlusion, MR of the brain demonstrated marked interval growth of the collective aneurysm-intra-aneurysmal thrombus mass with extensive edema throughout the adjacent left temporal lobe.
Flow-diverting devices have demonstrated tremendous promise for the treatment of complex, unruptured cerebral aneurysms. However, experience with this novel approach to aneurysm treatment is preliminary and the consequences of its application within the cerebrovasculature remain incompletely defined. Mural destabilization resulting in delayed, spontaneous, aneurysm growth and/or rupture may occur in the days to weeks following the application of flow-diverting devices to treat previously unruptured intracranial aneurysms. A better understanding of the incidence and etiology of these complications is essential for this technology to be optimally applied.
血流导向装置在治疗颅内动脉瘤方面显示出巨大的潜力；然而，对该设备的临床应用经验仍非常初步。我们报告了两例颅内动脉瘤采用 Pipeline 栓塞装置（PED）治疗后发生自发性迟发性并发症的病例，一例为致命性的动脉瘤破裂，另一例为动脉瘤体积增大伴症状。
病例介绍/干预：两名未破裂的颈内动脉颅内动脉瘤患者接受了 Pipeline 栓塞装置（PED）（美国加利福尼亚州欧文市 eV3）的顺利治疗。一名患者颈内动脉末端有巨大动脉瘤，在手术后 5 天出现头痛加重，最终晕倒且对刺激无反应。头颅 CT 显示急性蛛网膜下腔出血和脑室内出血。患者于次日死亡。另一名患者患有大型左侧后交通动脉瘤，在 PED 重建颈内动脉 3 个月后出现进行性记忆力减退。尽管连续 CT 血管造影显示动脉瘤进行性血栓形成接近完全闭塞，但脑部磁共振成像显示，动脉瘤内血栓的集体体积明显增大，伴有左颞叶广泛水肿。
血流导向装置在治疗复杂未破裂颅内动脉瘤方面显示出巨大的潜力。然而，这种治疗动脉瘤的新方法的经验是初步的，其在脑血管内的应用后果仍不完全明确。在使用血流导向装置治疗先前未破裂的颅内动脉瘤后的数天至数周内，可能会发生壁不稳定导致延迟、自发性的动脉瘤生长和/或破裂。为了使该技术得到最佳应用，必须更好地了解这些并发症的发生率和病因。
