Darsaut Tim E, Bing Fabrice, Makoyeva Alina, Gevry Guylaine, Salazkin Igor, Raymond Jean
University of Alberta Hospital, Mackenzie Health Sciences Centre, Division of Neurosurgery, Department of Surgery, Edmonton, Alberta, Canada.
CHRU Strasbourg, Service de Neuroradiologie, Strasbourg, France.
World Neurosurg. 2014 Dec;82(6):1120-6. doi: 10.1016/j.wneu.2013.09.036. Epub 2013 Sep 23.
Flow diverters (FDs) are increasingly used to treat difficult intracranial aneurysms. The objective of this study was to test whether treatment challenges posed by giant curved sidewall (cSW) and endwall bifurcation (EwB) aneurysms can be overcome with the use of very-low-porosity devices.
Large and giant EwB (n = 12) and cSW aneurysms (n = 5) were constructed in 17 dogs. EwB aneurysms were treated with 48 (n = 4), 64 (n = 4), or two overlapping 64-wire low-porosity devices (n = 4), whereas all cSW aneurysms were treated with single 64-wire devices. Angiographic results were recorded immediately and at 12 weeks before euthanasia. Pathologic specimens were photographed and neointimal coverage of devices measured and scored.
By 12 weeks, 1 of 12 EwB and 1 of 5 cSW aneurysms were occluded. All other aneurysms were patent. Device-related arterial stenoses occurred in 13 of 17 animals, hemodynamically significant in two. All branches jailed by the FDs remained patent. There was a significant correlation between angiographic scores and the degree of neointima formation on the device (Rho = 0.527; P = 0.04). Failures of aneurysm occlusion could be explained by holes, sometimes barely visible, in the neointima that formed over FDs.
Low-porosity FDs fail to reliably occlude experimental giant EwB and cSW aneurysms.
血流导向装置（FDs）越来越多地用于治疗复杂的颅内动脉瘤。本研究的目的是测试使用极低孔隙率装置能否克服巨大弯曲侧壁（cSW）和端壁分叉（EwB）动脉瘤带来的治疗挑战。
在17只犬体内构建大型和巨大型EwB（n = 12）及cSW动脉瘤（n = 5）。EwB动脉瘤采用48（n = 4）、64（n = 4）或两个重叠的64线低孔隙率装置进行治疗（n = 4），而所有cSW动脉瘤均采用单个64线装置治疗。在安乐死时即刻及12周时记录血管造影结果。对病理标本进行拍照，并测量和评分装置的新生内膜覆盖情况。
至12周时，12个EwB动脉瘤中的1个和5个cSW动脉瘤中的1个被闭塞。所有其他动脉瘤均保持通畅。17只动物中有13只出现了与装置相关的动脉狭窄，其中2只具有血流动力学意义。被FDs封堵的所有分支均保持通畅。血管造影评分与装置上新生内膜形成程度之间存在显著相关性（Rho = 0.527；P = 0.04）。动脉瘤闭塞失败可归因于FDs上形成的新生内膜中的孔洞，有时这些孔洞几乎不可见。
低孔隙率FDs未能可靠地闭塞实验性巨大EwB和cSW动脉瘤。
