Darsaut T E, Rayner-Hartley E, Makoyeva A, Salazkin I, Berthelet F, Raymond J
Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
Interv Neuroradiol. 2013 Jun;19(2):180-5. doi: 10.1177/159101991301900206. Epub 2013 May 21.
Haemorrhagic complications can occur following aneurysm treatment with flow diverters (FD), but the underlying mechanism remains unknown. We describe a case where deformation of the device may have contributed to the complication. A patient with a giant, previously unruptured cavernous aneurysm that extended intracranially to cause oedema of the internal capsule was treated with flow diversion. Treatment was followed by multiple episodes of peri-aneurysmal haemorrhages within eight days. A deformation of the device which occurred where it curved to cross the aneurysm neck created residual flows which, in the presence of a stent stenosis immediately beyond the neck, may have contributed to the observed ruptures. Following multiple haemorrhages the patient subsequently died. Autopsy demonstrated early red thrombus partially bridging the struts of the flow diverter, and intra-aneurysmal thrombus of various ages. Microscopic pathology showed an aneurysm wall consisting of collagen infiltrated with neutrophils, but the wall was absent near the cerebral peduncle, adjacent to the brain haemorrhage. Radiographs of the extracted specimen confirmed deformation of the FD construct, located at the transition zone of the stent, leading to increased pore size and porosity. The site of the deformation correlated with the angiographic presence of a continued blood inflow jet into the aneurysm. Stent deformation at the transition zone may promote persistent blood entry into the aneurysm, and in turn potentially contribute to haemorrhagic complications.
使用血流导向装置（FD）治疗动脉瘤后可能会发生出血性并发症，但其潜在机制尚不清楚。我们描述了一例装置变形可能导致该并发症的病例。一名患有巨大的、此前未破裂的海绵窦动脉瘤的患者，动脉瘤向颅内扩展导致内囊水肿，接受了血流导向治疗。治疗后八天内动脉瘤周围多次发生出血。装置在弯曲穿过动脉瘤颈部处发生变形，产生了残余血流，在颈部紧邻处存在支架狭窄的情况下，这可能导致了观察到的破裂。多次出血后患者最终死亡。尸检显示早期红色血栓部分连接血流导向装置的支柱，以及不同时期的动脉瘤内血栓。显微镜下病理显示动脉瘤壁由浸润中性粒细胞的胶原组成，但在脑桥附近、与脑出血相邻处无动脉瘤壁。取出标本的X线片证实FD结构在支架过渡区发生变形，导致孔径和孔隙率增加。变形部位与血管造影显示的持续血流进入动脉瘤的情况相关。支架在过渡区的变形可能促进血液持续进入动脉瘤，进而可能导致出血性并发症。
