Department of Neurological Surgery, Division of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Neurointerv Surg. 2014 Apr 1;6(3):184-94. doi: 10.1136/neurintsurg-2013-010648. Epub 2013 Mar 30.
The 'blister-type' aneurysm is one of the most devastating cerebrovascular lesions. Flow diversion with stent reconstruction is an emerging treatment and has shown promising initial results.
To evaluate the experience of one institution using stent reconstruction for pseudoaneurysms of the supraclinoid internal carotid artery and to compare with a review of the literature.
A retrospective review from one institution identified eight patients with 'blister' aneurysms over a 47-month period. The Raymond scale was used to classify the aneurysms. Clinical data were obtained using the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale. A literature review was performed and compared with our results. Clinical and angiographic data were obtained.
After treatment, two aneurysms were Raymond class 1 (25%) and six were class 3 (75%). Of the class 3 aneurysms, two required retreatment, three (50%) progressed to complete occlusion and three (50%) had persistent aneurysm filling. Clinical data revealed two patients with mRS score of 0 (25%), five with mRS score of 1 (62.5%) and one with mRS score of 2 (12.5%). From the literature review, residual filling was evident in nine patients (64.3%) and complete occlusion in four (28.6%). On follow-up angiography, nine (64.3%) were occluded, two (14.3%) had residual neck filling and one (7.1%) had persistent aneurysm filling. Thirteen patients (92.9%) had an mRS score of 2 or better. Combining the available experience, patients demonstrated either improvement (n=9, 41%) or stability (n=11, 50%). Only two (9%) had progression requiring retreatment.
Endovascular stent remodeling of 'blister-type' aneurysms is a safe and effective strategy.
“疱状”动脉瘤是最具破坏性的脑血管病变之一。支架重建的血流分流是一种新兴的治疗方法，已显示出良好的初步效果。
评估一家机构使用支架重建治疗颈内动脉虹吸段“疱状”动脉瘤的经验，并与文献复习进行比较。
对一家机构的 8 例“疱状”动脉瘤患者进行回顾性研究，研究时间为 47 个月。采用 Raymond 分级对动脉瘤进行分类。使用改良 Rankin 量表（mRS）和美国国立卫生研究院卒中量表（NIHSS）获取临床数据。进行文献复习，并与我们的结果进行比较。获取临床和血管造影数据。
治疗后，2 个动脉瘤为 Raymond 分级 1 级（25%），6 个为 3 级（75%）。3 级动脉瘤中，2 个需要再次治疗，3 个（50%）完全闭塞，3 个（50%）动脉瘤仍有残留。临床数据显示，2 例 mRS 评分 0 分（25%），5 例 mRS 评分 1 分（62.5%），1 例 mRS 评分 2 分（12.5%）。文献复习中，9 例（64.3%）有残留充盈，4 例（28.6%）完全闭塞。随访血管造影显示，9 例（64.3%）闭塞，2 例（14.3%）瘤颈残留充盈，1 例（7.1%）动脉瘤仍有残留充盈。13 例（92.9%）mRS 评分≤2 分。综合现有经验，患者的改善率为 9 例（41%），稳定率为 11 例（50%），仅 2 例（9%）进展需要再次治疗。
血管内支架重建治疗“疱状”动脉瘤是一种安全有效的策略。
