Pipeline 栓塞装置延迟回缩和 corking 失败：破裂动脉瘤中 Pipeline 栓塞装置放置的陷阱。
Delayed retraction of the pipeline embolization device and corking failure: pitfalls of pipeline embolization device placement in the setting of a ruptured aneurysm.
机构信息
Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5105, USA.
出版信息
Neurosurgery. 2013 Jun;72(2 Suppl Operative):onsE245-50; discussion onsE250-1. doi: 10.1227/NEU.0b013e31827fc9be.
BACKGROUND AND IMPORTANCE
The safety of flow-diverting stents for the treatment of ruptured intracranial aneurysms is unknown.
CLINICAL PRESENTATION
A 35-year-old woman with a ruptured dissecting aneurysm of the intradural right vertebral artery and incorporating the right posterior inferior cerebellar artery was treated with a Pipeline Embolization Device (PED). Five days after reconstruction of the diseased right vertebral segment, she was treated for vasospasm, and retraction of the PED was observed, leaving her dissecting aneurysm unprotected. A second PED was placed with coverage of the aneurysm, but vasospasm complicated optimal positioning of the device.
CONCLUSION
In addition to the potential risks of dual antiplatelet therapy in these patients, this case illustrates 2 pitfalls of flow-diverting devices in vessels in vasospasm: delayed retraction of the device and difficulty positioning the device for deployment in the setting of vasospasm.
背景与重要性
对于破裂颅内动脉瘤的治疗，血流导向装置的安全性尚不清楚。
临床表现
一名 35 岁女性，患有硬脊膜内右侧椎动脉破裂性夹层动脉瘤，并包含右侧小脑后下动脉。该患者使用 Pipeline 栓塞装置（PED）进行治疗。在重建病变的右侧椎动脉段后 5 天，她因血管痉挛接受治疗，观察到 PED 回缩，使她的夹层动脉瘤未得到保护。放置了第二个 PED 以覆盖动脉瘤，但血管痉挛使设备的最佳定位变得复杂。
结论
除了这些患者接受双联抗血小板治疗的潜在风险外，该病例还说明了血管痉挛时血流导向装置的 2 个陷阱：装置延迟回缩和在血管痉挛情况下难以定位装置以进行部署。
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