*Department of Radiology, Federal University of Rio de Janeiro, Brazil; ‡Department of Neurosurgery, Federal University of Rio de Janeiro, Brazil; §Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois; ‖Departments of Neurosurgery and Radiology, Rush Center for Neuroendovascular Surgery, Rush University Medical Center, Chicago, Illinois.
Neurosurgery. 2014 Mar;10 Suppl 1:E161-6; discussion E166. doi: 10.1227/NEU.0000000000000029.
A variety of deconstructive and reconstructive therapies have been used to treat intracranial aneurysms. The Pipeline embolization device (PED) has become a quite successful option to treat aneurysms, while reconstructing and remodeling the parent vessel. We report a case of off-label PED use, where a flow diverter was placed across the parent vessel of a giant intracranial aneurysm in a novel deconstructive strategy.
A 40-year-old man with a giant, slow-flow aneurysm of the distal middle cerebral artery (MCA) was treated with the placement of a PED across the vessel containing the aneurysm after superselective test balloon occlusion of that vessel failed. PED was successfully deployed in a competing MCA branch across the origin of the MCA branch supplying the giant aneurysm. The patient continued dual-antiplatelet therapy for 5 months and aspirin monotherapy thereafter. Follow-up angiography, performed 6 months after treatment, demonstrated complete and asymptomatic thrombosis of the aneurysm and its parent MCA branch. A collateral pial and leptomeningeal network developed, reconstructing the distal branches of the occluded MCA branch. After 18 months, the patient remains neurologically intact.
This appears to be the first description of progressive deconstruction for aneurysm treatment by using PED. Despite not tolerating acute vessel occlusion with superselective test balloon occlusion, the patient was asymptomatic following long-term occlusion with PED secondary to the growth of pial and leptomeningeal collateral networks.
已经有多种解构和重建疗法被用于治疗颅内动脉瘤。Pipeline 栓塞装置（PED）已成为一种治疗动脉瘤的非常成功的选择，同时重建和重塑母血管。我们报告了一例超适应证的 PED 使用病例，其中在一种新的解构策略中，将血流转向器放置在颅内巨大动脉瘤的母血管中。
一名 40 岁男性患有巨大的、慢血流型大脑中动脉（MCA）远端动脉瘤，在对该血管进行超选择性测试球囊闭塞失败后，在该血管中放置了 PED。PED 成功地部署在竞争 MCA 分支中，横跨供应巨大动脉瘤的 MCA 分支的起源处。患者继续接受 5 个月的双联抗血小板治疗，然后改为阿司匹林单药治疗。治疗后 6 个月进行的随访血管造影显示，动脉瘤及其母 MCA 分支完全无症状性血栓形成。皮髓质和软脑膜侧支网络发展，重建了闭塞 MCA 分支的远端分支。18 个月后，患者仍然神经功能完整。
这似乎是首例通过使用 PED 进行动脉瘤治疗的渐进式解构描述。尽管不能耐受超选择性测试球囊闭塞的急性血管闭塞，但由于皮髓质和软脑膜侧支网络的生长，患者在 PED 长期闭塞后无症状。
