Department of Radiology, Tuen Mun Hospital, Tuen Mun, China.
J Neurosurg. 2012 Apr;116(4):882-7. doi: 10.3171/2011.12.JNS111514. Epub 2012 Jan 20.
Use of a flow-diverting device has shown promising short-term results in the management of vertebral artery (VA) dissecting aneurysms, but there is still uncertainty regarding its long-term efficacy and safety. The authors report their initial experience with respect to the potential utility and long-term clinical outcomes of using a flow-diverting device in the treatment of unruptured dissecting VA aneurysms.
The authors conducted a retrospective review of all cases of unruptured intracranial VA dissecting aneurysms treated at their institution (Tuen Mun Hospital) with a flow-diverting device. They describe the clinical presentations and angiographic features of the cases and report the clinical outcome (with modified Rankin Scale [mRS] scores) at most recent follow-up, as well as results of the latest angiographic assessment, with particular focus on in-stent patency and side-branch occlusion.
A total of 4 aneurysms were successfully obliterated by using flow-diverting devices alone. Two devices were deployed in a telescoping fashion in each of 2 aneurysms, whereas only 1 device was inserted in each of the other 2 aneurysms. No periprocedural complication was encountered. No patient showed any angiographic evidence of recurrence, in-stent thrombosis, or side-branch occlusion in angiographic reassessment at a mean of 22 months after treatment (range 18-24 months). As of the most recent clinical follow-up (mean 30 months after treatment, range 24-37 months), all patients had favorable outcomes (mRS Score 0).
Reconstruction using a flow-diverting device is an attractive alternative in definitive treatment of dissecting VA aneurysms, demonstrating favorable long-term clinical and angiographic outcomes and the ability to maintain parent artery and side-branch patency. It is particularly useful in cases with eloquent side-branch or dominant VA involvement.
在椎动脉（VA）夹层动脉瘤的治疗中，使用血流导向装置已显示出有前景的短期结果，但长期疗效和安全性仍存在不确定性。作者报告了他们在使用血流导向装置治疗未破裂的夹层 VA 动脉瘤方面的初步经验，包括其潜在用途和长期临床结果。
作者对在其机构（屯门医院）接受血流导向装置治疗的所有未破裂颅内 VA 夹层动脉瘤病例进行了回顾性研究。他们描述了病例的临床表现和血管造影特征，并报告了最近随访时的临床结果（采用改良 Rankin 量表[mRS]评分），以及最新血管造影评估的结果，特别关注支架内通畅性和侧支闭塞。
共有 4 个动脉瘤通过单独使用血流导向装置成功闭塞。2 个动脉瘤中每个动脉瘤采用 2 个支架套叠放置，另外 2 个动脉瘤中每个动脉瘤只放置 1 个支架。在围手术期未发生任何并发症。在治疗后平均 22 个月（范围 18-24 个月）的血管造影复查中，没有患者出现血管造影再发、支架内血栓形成或侧支闭塞的证据。截至最近的临床随访（治疗后平均 30 个月，范围 24-37 个月），所有患者的结局均良好（mRS 评分 0）。
使用血流导向装置进行重建是治疗夹层 VA 动脉瘤的一种有吸引力的替代方法，可获得良好的长期临床和血管造影结果，并能维持载瘤动脉和侧支通畅。对于有重要侧支或优势 VA 受累的病例，尤其有用。
