University of Virginia, Department of Neurological Surgery, P.O. Box 800212, Charlottesville, VA 22908, USA.
University of Virginia, Department of Radiology, Charlottesville, VA, USA.
J Clin Neurosci. 2014 Jul;21(7):1241-4. doi: 10.1016/j.jocn.2013.12.008. Epub 2014 Jan 3.
The treatment of intracranial aneurysms with microsurgical clipping is associated with a very low rate of recurrence. However, in cases of aneurysm recurrence after previous clipping, microsurgical dissection due to adhesions and fibrosis may be challenging, and it may be difficult to safely occlude the recurrent lesion without the risk of significant morbidity. Flow-diverting stents have drastically changed the landscape of endovascular neurosurgery. We present two patients with large, recurrent supraclinoid internal carotid artery (ICA) aneurysms which were previously clipped 17 and 23 years ago at outside institutions. Both recurrent lesions were treated with the Pipeline Embolization Device (PED; ev3 Endovascular, Irvine, CA, USA) without radiographic or clinical complications. In the first patient, the 15 mm aneurysm significantly decreased in size at 6 month angiographic follow-up. The 21 mm aneurysm in the second patient was completely occluded 7 months following PED treatment. The moderate degree of in-stent stenosis present on initial follow-up imaging resolved on angiography 11 months post-treatment. The management of recurrent aneurysms after clipping is sparsely reported in the literature due to its infrequent occurrence. In carefully selected cases, flow-diverting stents may be used for complex aneurysms of the distal ICA, even for those which have recurred following microsurgical clipping.
显微夹闭治疗颅内动脉瘤的复发率非常低。然而，对于先前夹闭后出现的动脉瘤复发，由于粘连和纤维化，显微解剖可能具有挑战性，并且可能难以在不引起明显发病率的情况下安全地闭塞复发性病变。血流导向装置极大地改变了血管神经外科学的格局。我们介绍了 2 例在其他机构分别于 17 年前和 23 年前接受过显微夹闭的大型、复发性颈内动脉（ICA）虹吸段动脉瘤患者。这两个复发性病变均使用 Pipeline 栓塞装置（PED；ev3 血管内，欧文，CA，美国）治疗，没有出现影像学或临床并发症。在第一个患者中，15mm 的动脉瘤在 6 个月的血管造影随访时明显缩小。第二个患者的 21mm 动脉瘤在 PED 治疗后 7 个月完全闭塞。在治疗后 11 个月，初始随访成像上存在的中度支架内狭窄在血管造影上得到解决。由于其罕见发生，夹闭后复发动脉瘤的处理在文献中报道较少。在精心选择的病例中，即使是那些在显微夹闭后复发的复杂 ICA 远端动脉瘤，也可以使用血流导向装置。
