Lin Li-Mei, Colby Geoffrey P, Kim Jennifer E, Huang Judy, Tamargo Rafael J, Coon Alexander L
Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA.
Surg Neurol Int. 2013 Sep 6;4:114. doi: 10.4103/2152-7806.117711. eCollection 2013.
The pipeline embolization device (PED) provides effective, durable and safe endovascular reconstruction of large and giant intracranial aneurysms. However, 80% of all cerebral aneurysms found in the general population are less than 10 mm in size. Treatment of small aneurysms (<10 mm) with flow diverters may be advantageous over endosaccular modalities that carry risks of procedural rupture during aneurysm access or coil placement.
We retrospectively reviewed a prospective, single-center aneurysm database to identify all patients with small (<10 mm) internal carotid artery (ICA) aneurysms who underwent endovascular treatment using the PED. Patient demographics, aneurysm characteristics, procedural details, complications, and technical and clinical outcomes were analyzed.
Forty-four cases were performed in 41 patients (age range 31-78 years). PED was successfully implanted in 42 cases. A single PED was used in 37/42 (88%) cases. Mean postprocedure hospital stay was 1.7 ± 0.3 days and 98% of patients were discharged home. Major complication occurred in one patient (2.3%), who died of early subarachnoid hemorrhage. Transient neurological deficit, delayed intracerebral hemorrhage (asymptomatic), and delayed groin infection occurred in one patient each. Follow-up rate was 91.8% (45 aneurysms in 35 patients) with a mean follow-up of 4.0 ± 1.9 months. By 6 months post-PED implantation, angiographic success (complete or near complete aneurysm occlusion) was observed in 80%. Mild (<50%), asymptomatic, nonflow limiting in-stent stenosis was observed in 5.4% (2/37 cases). All the 35 patients with follow-up remained at preprocedure neurological baseline.
Small (<10 mm) ICA aneurysm treatment with PED implantation is safe and carries a high rate of early angiographic success.
管道栓塞装置（PED）为大型和巨大型颅内动脉瘤提供了有效、持久且安全的血管内重建。然而，在普通人群中发现的所有脑动脉瘤中，80%的大小小于10毫米。使用血流导向装置治疗小型动脉瘤（<10毫米）可能比囊内治疗方式更具优势，因为后者在动脉瘤穿刺或弹簧圈置入过程中存在手术破裂风险。
我们回顾性分析了一个前瞻性单中心动脉瘤数据库，以确定所有接受PED血管内治疗的小型（<10毫米）颈内动脉（ICA）动脉瘤患者。分析了患者的人口统计学特征、动脉瘤特征、手术细节、并发症以及技术和临床结果。
41例患者（年龄范围31 - 78岁）共进行了44例手术。42例成功植入PED。37/42（88%）例使用了单个PED。术后平均住院时间为1.7±0.3天，98%的患者出院回家。1例患者（2.3%）发生严重并发症，死于早期蛛网膜下腔出血。1例患者发生短暂性神经功能缺损，1例发生迟发性脑出血（无症状），1例发生迟发性腹股沟感染。随访率为91.8%（35例患者中的45个动脉瘤），平均随访时间为4.0±1.9个月。在PED植入后6个月时，80%观察到血管造影成功（完全或接近完全动脉瘤闭塞）。5.4%（2/37例）观察到轻度（<50%）、无症状、不影响血流的支架内狭窄。所有35例接受随访的患者神经功能仍保持在术前基线水平。
植入PED治疗小型（<10毫米）ICA动脉瘤是安全的，且早期血管造影成功率高。
