Mpotsaris Anastasios, Henkes Hans, Weber Werner
Department of Radiology and Neuroradiology, Klinikum Vest, Recklinghausen, Germany.
BMJ Case Rep. 2013 Dec 17;2013:bcr2013010921. doi: 10.1136/bcr-2013-010921.
Broad based bifurcation aneurysms are challenging. Various endovascular techniques aim at stabilizing the coil package in the aneurysm. Among these, the waffle cone technique provides a viable alternative to Y stenting in selected cases, incorporating a less complex delivery, and the reduced inherent risk of a single stenting procedure compared with the use of two stents in Y configuration. Unlike conventional stents, the distal end of the new pCONus device opens like a blossoming flower inside of the aneurysm to facilitate the waffle cone technique. In a case with tandem unruptured broad based middle cerebral artery bifurcation aneurysms, the complex anatomical challenge was resolved by a unique combination of both techniques: two pCONus deployed in Y configuration, offering stable neck coverage for coiling both aneurysms. The angiographic results with complete occlusion of both aneurysms and the uneventful clinical course at 90 days with continued daily administration of dual antiplatelet therapy are encouraging.
宽颈分叉动脉瘤具有挑战性。各种血管内技术旨在使动脉瘤内的线圈组件稳定。其中，华夫饼锥技术在某些情况下为Y形支架置入提供了一种可行的替代方案，其输送过程不太复杂，与使用两个呈Y形配置的支架相比，单个支架置入程序的固有风险降低。与传统支架不同，新型pCONus装置的远端在动脉瘤内像花朵一样展开，以促进华夫饼锥技术。在一例串联未破裂的大脑中动脉宽颈分叉动脉瘤病例中，通过两种技术的独特组合解决了复杂的解剖学挑战：两个pCONus呈Y形配置，为两个动脉瘤的栓塞提供稳定的瘤颈覆盖。两个动脉瘤均完全闭塞的血管造影结果以及在持续每日给予双重抗血小板治疗的情况下90天的平稳临床过程令人鼓舞。
