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动脉瘤栓塞过程中的临时支架支撑

Temporary stent scaffolding during aneurysm coiling.

作者信息

Zumofen Daniel W, Sahasrabudhe Nikhil, Riina Howard A, Raz Eytan, Shapiro Maksim, Becske Tibor, Nelson Peter K

机构信息

Bernard and Irene Schwartz Interventional Neuroradiology Section, Department of Radiology, NYU Langone Medical Center, New York University School of Medicine, 660 First Avenue, 7th Floor, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA.

Department of Neurosurgery, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA.

出版信息

J Clin Neurosci. 2014 May;21(5):852-4. doi: 10.1016/j.jocn.2013.10.009. Epub 2013 Oct 30.

Abstract

We report a case of temporary Solitaire FR stent (Covidien, Mansfield, MA, USA) scaffolding to reduce coil herniation during embolization of a large neck anterior communicating artery aneurysm. In contrast to classic stent-assisted coiling, the fully retrievable stent is recaptured prior to detachment of the last coil. The presented technical nuance hence does not require institution of prolonged antiplatelet coverage. But the door is left open for coil-repositioning in case of coil basket instability. Permanent stent redeployment remains a fall-back option if critical hardware conflict occurs. In comparison to classic balloon remodeling, the presented method may offer easier distal access, particularly in tortuous arterial anatomy. Temporary occlusion of the parent artery, side branches, and perforators is also avoided. Given its specific potential advantages, temporary stent scaffolding using the fully retrievable Solitaire FR device may find its niche as a bailout option, primarily in a very specific subset of distally located wide neck aneurysms.

摘要

我们报告了一例使用Solitaire FR临时支架(美国马萨诸塞州曼斯菲尔德市科维迪恩公司生产)进行支架辅助,以减少大型颈内前交通动脉瘤栓塞过程中弹簧圈疝出的病例。与传统的支架辅助弹簧圈栓塞术不同,在最后一个弹簧圈脱离之前,可完全回收的支架会被重新捕获。因此,本文介绍的技术细节不需要长期使用抗血小板药物。但如果弹簧圈篮不稳定,仍可进行弹簧圈重新定位。如果发生关键的硬件冲突,永久性支架重新部署仍是备用选择。与传统的球囊重塑相比,本文介绍的方法可能提供更便捷的远端通路,尤其是在动脉解剖结构迂曲的情况下。同时也避免了对载瘤动脉、分支和穿支动脉的临时阻断。鉴于其特定的潜在优势,使用可完全回收的Solitaire FR装置进行临时支架辅助可能会成为一种补救选择,主要适用于非常特定的远端宽颈动脉瘤亚组。

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