Chalouhi Nohra, Chitale Rohan, Starke Robert M, Jabbour Pascal, Tjoumakaris Stavropoula, Dumont Aaron S, Rosenwasser Robert H, Gonzalez L Fernando
Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
J Neurointerv Surg. 2014 Jan;6(1):19-23. doi: 10.1136/neurintsurg-2012-010612. Epub 2013 Jan 23.
The treatment of recurrent aneurysms after previous surgery or embolization is challenging. Little is known regarding the use of the Pipeline Embolization Device (PED) for recurrent aneurysms.
To analyze the safety and results of PED therapy for recurrent aneurysms.
Fifteen patients with recurrent intracranial aneurysms after previous embolization or surgical clipping were treated with the PED at our institution between 2011 and 2012. Procedural complications and clinical and angiographic outcomes were analyzed.
Median aneurysm size was 12 mm. Previous aneurysm treatment consisted of coiling in eight patients, stent coiling in four, a telescoping stent technique in two and surgical clipping in one. Major procedural complications (leaving significant morbidity) occurred in one patient (6.7%) and minor procedural or technical complications (no or minor morbidity) occurred in four patients (26.7%). Fourteen of the 15 patients (93.3%) had a favorable outcome (modified Rankin Scale score 0-2). Of 14 patients with angiographic follow-up, nine (64.3%) had complete aneurysm occlusion (100%), four (28.6%) had near-complete occlusion (≥90%) and only one (7.1%) had incomplete occlusion (<90%). Four of the five patients with less than 100% occlusion at follow-up had a previous stent in situ.
Treatment of recurrent aneurysms with the PED appears to be effective, but patients with a previous stent in situ may achieve lower obliteration rates. The morbidity rate associated with PED therapy may be higher than with more standard endovascular techniques using historical data. Larger studies are needed to assess this question better.
既往手术或栓塞治疗后复发动脉瘤的治疗具有挑战性。关于使用密网支架（PED）治疗复发动脉瘤的情况知之甚少。
分析PED治疗复发动脉瘤的安全性和疗效。
2011年至2012年期间，我们机构对15例既往栓塞或手术夹闭后复发的颅内动脉瘤患者采用PED进行治疗。分析手术并发症以及临床和血管造影结果。
动脉瘤中位大小为12毫米。既往动脉瘤治疗包括8例患者采用弹簧圈栓塞，4例采用支架辅助弹簧圈栓塞，2例采用套叠式支架技术，1例采用手术夹闭。1例患者（6.7%）发生严重手术并发症（导致严重致残），4例患者（26.7%）发生轻微手术或技术并发症（无或轻微致残）。15例患者中有14例（93.3%）预后良好（改良Rankin量表评分0 - 2分）。在14例接受血管造影随访的患者中，9例（64.3%）动脉瘤完全闭塞（100%），4例（28.6%）接近完全闭塞（≥90%），仅1例（7.1%）闭塞不完全（<90%）。随访时闭塞率低于100%的5例患者中有4例既往有原位支架。
使用PED治疗复发动脉瘤似乎有效，但既往有原位支架的患者闭塞率可能较低。与使用历史数据的更标准血管内技术相比，PED治疗相关的致残率可能更高。需要开展更大规模的研究以更好地评估这一问题。
