Service de Neuroradiologie Interventionnelle, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, 25-29 rue Manin, 75940 Paris Cedex 19, France.
Stroke. 2012 Apr;43(4):1032-8. doi: 10.1161/STROKEAHA.111.636019. Epub 2012 Jan 26.
Flow Diverters (FD) are a new emerging therapy for intracranial aneurysms. Initial reports focused on the treatment of proximally located aneurysms. We report our experience with FDs in the treatment of aneurysms at and beyond the circle of Willis.
We treated 30 aneurysms at and beyond the circle of Willis with FDs (silk and pipeline). Aneurysms were treated with FDs alone in 73.3% (22/30) and with FDs and coils in 23.3% (7/30). One procedure was converted in parent vessel occlusion.
Thirty aneurysms (21/30, 70.0% saccular; 7/30, 23.3% fusiform; 2/30, 6.7% blister-like; sizes 1.2-19.6, mean 6.8 mm) were treated in 26 patients (17 women, 9 men; mean age, 49 years) during 27 procedures. Access site complication was noted in 3.7% (1/27). Reversible neurological complications were noted in 7.4% (2/27), permanent neurological complication in 3.7% (1/27). There was no mortality. No aneurysms bled or rebled after treatment. Aneurysms treated with FDs alone were significantly smaller than those treated with FDs and coils (5.7 and 10.0 mm, respectively; P=0.0174). Immediate angiographic occlusion was achieved in 18.2% (4/22) with FDs alone, in 0.0% (0/7) with FDs and coils. Twenty-four aneurysms (80.0%) had been followed (mean, 13 months). Fifteen of 19 aneurysms (78.9%) treated with FDs against 4 of 4 of aneurysms (100%) treated with FDs and coils were occluded. There was no angiographic recurrence of initially totally occluded aneurysms.
Aneurysms at and beyond the circle of Willis are amenable to selective treatment with FDs.
血流导向装置（FD）是一种新兴的颅内动脉瘤治疗方法。最初的报告主要集中在治疗近端位置的动脉瘤。我们报告了我们在 Willis 环内外使用 FD 治疗动脉瘤的经验。
我们使用 FD（ silk 和 pipeline）治疗了 30 个 Willis 环内外的动脉瘤。73.3%（22/30）的动脉瘤单独使用 FD 治疗，23.3%（7/30）的动脉瘤 FD 联合线圈治疗。1 例在载瘤动脉闭塞中转手术。
30 个动脉瘤（21/30，70.0%囊状；7/30，23.3%梭形；2/30，6.7%疱状；大小 1.2-19.6，平均 6.8mm）在 26 例患者（17 例女性，9 例男性；平均年龄 49 岁）的 27 次手术中进行了治疗。3.7%（1/27）出现入路并发症。7.4%（2/27）出现可逆性神经并发症，3.7%（1/27）出现永久性神经并发症。无死亡。治疗后无动脉瘤出血或再出血。单独使用 FD 治疗的动脉瘤明显小于 FD 联合线圈治疗的动脉瘤（分别为 5.7 和 10.0mm，P=0.0174）。单独使用 FD 即刻完全闭塞率为 18.2%（4/22），FD 联合线圈为 0.0%（0/7）。24 个动脉瘤（80.0%）进行了随访（平均 13 个月）。19 个单独使用 FD 治疗的动脉瘤中有 15 个（78.9%）闭塞，4 个 FD 联合线圈治疗的动脉瘤中有 4 个（100%）闭塞。最初完全闭塞的动脉瘤无影像学复发。
Willis 环内外的动脉瘤可通过选择性 FD 治疗。
