Department of Surgery, Division of Neurosurgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada.
J Neurointerv Surg. 2013 Sep 1;5(5):452-7. doi: 10.1136/neurintsurg-2012-010451. Epub 2012 Jul 10.
Flow diverters (FDs) have led to spectacular results in otherwise untreatable aneurysm cases, but complications can occur. There is a pressing need to study factors that might predict their safety and efficacy.
The anatomical constraints that may impact on the ability of FDs to redirect blood flow and provide a scaffold for neointima formation across the aneurysm or branch ostia are explored and classified. A nomenclature is needed to identify the key factors that should be taken into account before contemplating the use of FDs in clinical aneurysms, and that should be reproduced in experimental models, if they are to guide safe clinical use.
The free stent segment (FSS), the portion of the device that covers an aneurysm or branch origin, dictates whether aneurysms or branches will remain patent. Three levels of increasing complexity must be taken into account to anticipate what will occur at the FSS level. (1) Virtual models can provide basic principles; (2) in vitro studies allow testing FSS deformations that may occur in various anatomical circumstances and impact on efficacy and safety; (3) but only in vivo studies can provide key information on neointimal closure following implantation that will differentiate success from failure.
A nomenclature is necessary to determine the optimal or suboptimal conditions for FDs and to design the virtual, in vitro and in vivo studies that will allow a better understanding of the factors involved in the success or failure of this novel treatment.
血流导向装置（FDs）在原本无法治疗的动脉瘤病例中取得了显著效果，但也可能出现并发症。因此迫切需要研究可能预测其安全性和有效性的因素。
探讨并分类了可能影响 FDs 重新引导血流并在动脉瘤或分支口形成新生内膜的能力的解剖学限制因素。需要一个命名法来确定在考虑将 FDs 用于临床动脉瘤之前应考虑的关键因素，并且如果要指导安全的临床使用，则应在实验模型中再现这些因素。
自由支架段（FSS）是覆盖动脉瘤或分支起源的装置部分，决定了动脉瘤或分支是否保持通畅。为了预测 FSS 水平可能发生的情况，必须考虑三个级别的复杂性（1）虚拟模型可以提供基本原理；（2）体外研究允许测试可能在各种解剖情况下发生的 FSS 变形，从而影响疗效和安全性；（3）但只有体内研究才能提供关于植入后新生内膜闭合的关键信息，从而区分成功和失败。
需要一个命名法来确定 FDs 的最佳或次优条件，并设计虚拟、体外和体内研究，以更好地了解这种新型治疗成功或失败的相关因素。
