Causin F, Pascarella R, Pavesi G, Marasco R, Zambon G, Battaglia R, Munari M
Neurosurgery Department, Padua University Hospital, Padua, Italy.
Interv Neuroradiol. 2011 Sep;17(3):357-64. doi: 10.1177/159101991101700313. Epub 2011 Oct 17.
A blood blister-like (BBL) or dissecting aneurysm should be carefully considered if located at a non-branching site of the supra-clinoid internal carotid artery (ICA). Several surgical and endovascular treatment methods have been proposed but they all carry a relatively high risk of morbidity and mortality. This study evaluated the effectiveness of a novel Silk flow-diverting device (SFD) placed in the early acute stage. Three patients presenting with acute subarachnoid haemorrhage caused by small blister-like aneurysms of the carotid siphon were treated within 48 hours after admission by placement of SFDs. More than one device was placed to cover the lesion. None of the patients were premedicated and started anti-platelet therapy during the procedure. All aneurysms were successfully occluded. A good outcome was observed in two out of three treated patients. No thromboembolic or haemorrhagic event occurred during or after the procedures, or during follow-up (6-14 months). SFD prevented rebleeding and the use of these devices could be proposed as an option to treat fragile uncoilable BBL aneurysms, even in the early acute phase without anti-platelet premedication. Larger studies and long-terms results are necessary.
如果血泡样（BBL）或夹层动脉瘤位于床突上段颈内动脉（ICA）的非分支部位，则应仔细考虑。已经提出了几种手术和血管内治疗方法，但它们都具有相对较高的发病率和死亡率风险。本研究评估了在急性早期置入新型丝型血流导向装置（SFD）的有效性。3例因颈内动脉虹吸部小血泡样动脉瘤导致急性蛛网膜下腔出血的患者在入院后48小时内接受了SFD置入治疗。放置了不止一个装置以覆盖病变。所有患者均未进行术前用药，且在手术过程中开始抗血小板治疗。所有动脉瘤均成功闭塞。3例接受治疗的患者中有2例预后良好。在手术期间或术后以及随访期间（6 - 14个月）均未发生血栓栓塞或出血事件。SFD可预防再出血，即使在没有抗血小板术前用药的急性早期，使用这些装置也可作为治疗脆弱且无法进行弹簧圈栓塞的BBL动脉瘤的一种选择。需要进行更大规模的研究和长期随访。
