Yoon Jang W, Siddiqui Adnan H, Dumont Travis M, Levy Elad I, Hopkins L Nelson, Lanzino Giuseppe, Lopes Demetrius K, Moftakhar Roham, Billingsley Joshua T, Welch Babu G, Boulos Alan S, Yamamoto Junichi, Tawk Rabih G, Ringer Andrew J, Hanel Ricardo A
*Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida; ‡Department of Neurosurgery, University of Buffalo Medical Center, Buffalo, New York; §Department of Surgery, Division of Neurosurgery, University of Arizona, Tucson, Arizona (work was conducted while at the University of Buffalo Medical Center, Buffalo, New York); ¶Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; ‖Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois; #Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas; **Department of Neurosurgery, Albany Medical Center, Albany, New York; ‡‡Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio; §§Lyerly Neurosurgery, Baptist Health, Jacksonville, Florida.
Neurosurgery. 2014 Oct;75(4):419-29; discussion 429. doi: 10.1227/NEU.0000000000000487.
Treatment of internal carotid ruptured blister aneurysms (IC-RBA) presents many challenges to neurosurgeons because of the high propensity for rebleeding during intervention. The role of a Pipeline Embolization Device (PED) in the treatment of this challenging aneurysm subtype remains undefined despite theoretical advantages.
To present a series of 11 patients treated with a PED and to discuss the management and results of this novel application of flow diverters.
Medical records of patients who presented with IC-RBA from May 2011 to March 2013 were retrospectively reviewed at 6 institutions in the United States. All relevant data were independently compiled.
A total of 12 IC-RBAs in 11 patients were treated during the study period. Nine (75%) were treated with a single PED; 1 was treated with 2 PEDs; 1 was treated with coils and 1 PED; and 1 was treated with coils and 2 PEDs. Three (27%) had major perioperative complications: middle cerebral artery territory infarction, vision loss, and death. Seven patients demonstrated complete obliteration of the aneurysm in postoperative imaging. Early clinical outcomes were favorable (modified Rankin Scale score, 0-2) in all 10 survivors.
This study demonstrates the feasibility and safety of using the PED to treat IC-RBA with fair initial results. The proper introduction and management of antiplatelet regimen are key for successful results. Bleeding complications related to dual antiplatelet therapy were similar to those in previous studies of stent-assisted coiling for the same population. Larger cohort analysis is needed to define the precise role of flow diverters in the treatment of IC-RBA.
由于在干预过程中再出血倾向高，颈内动脉破裂性水泡状动脉瘤（IC-RBA）的治疗给神经外科医生带来了诸多挑战。尽管具有理论优势，但血流导向装置（PED）在治疗这种具有挑战性的动脉瘤亚型中的作用仍不明确。
介绍11例接受PED治疗的患者，并讨论这种新型血流导向装置应用的管理和结果。
对2011年5月至2013年3月在美国6家机构就诊的IC-RBA患者的病历进行回顾性研究。所有相关数据均独立汇总。
在研究期间，共治疗了11例患者的12个IC-RBA。9个（75%）使用单个PED治疗；1个使用2个PED治疗；1个使用弹簧圈和1个PED治疗；1个使用弹簧圈和2个PED治疗。3个（27%）发生了严重的围手术期并发症：大脑中动脉区域梗死、视力丧失和死亡。7例患者在术后影像学检查中显示动脉瘤完全闭塞。所有10名幸存者的早期临床结果良好（改良Rankin量表评分，0-2）。
本研究证明了使用PED治疗IC-RBA的可行性和安全性，初步结果尚可。正确引入和管理抗血小板方案是取得成功结果的关键。与双重抗血小板治疗相关的出血并发症与先前针对同一人群的支架辅助弹簧圈栓塞研究中的并发症相似。需要进行更大规模的队列分析来确定血流导向装置在IC-RBA治疗中的精确作用。
