Tanweer O, Raz E, Brunswick A, Zumofen D, Shapiro M, Riina H A, Fouladvand M, Becske T, Nelson P K
From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.).
Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.).
AJNR Am J Neuroradiol. 2014 Dec;35(12):2334-40. doi: 10.3174/ajnr.A4081. Epub 2014 Aug 21.
Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This study examines the authors' institutional experience and a systematic review of the literature for outcomes and complications using the Pipeline Embolization Device in unruptured cavernous carotid aneurysms.
A retrospective search for cavernous carotid aneurysms from a prospectively collected data base of aneurysms treated with the Pipeline Embolization Device at our institution was performed. Baseline demographic, clinical, and laboratory values; intrainterventional data; and data at all follow-up visits were collected. A systematic review of the literature for complication data was performed with inquiries sent when clarification of data was needed.
Forty-three cavernous carotid aneurysms were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion. Aneurysm complete or near-complete occlusion rates at 6 months, 12 months, and 36 months were 81.4%, 89.7%, and 100%, respectively. Of patients with neuro-ophthalmologic deficits on presentation, 84.2% had improvement in their visual symptoms. Overall, we had a 0% mortality rate and a 2.3% major neurologic complication rate. Our systematic review of the literature yielded 227 cavernous carotid aneurysms treated with the Pipeline Embolization Device with mortality and morbidity rates of 0.4% and 3.1%, respectively.
Endoluminal reconstruction with flow diversion for large unruptured cavernous carotid aneurysms can yield high efficacy with low complications. Further long-term data will be helpful in assessing the durability of the cure; however, we advocate a revisiting of current management paradigms for cavernous carotid aneurysms.
采用血流导向支架进行腔内重建的最新技术尚未纳入海绵窦段颈内动脉瘤的治疗方案。本研究探讨了作者所在机构使用Pipeline栓塞装置治疗未破裂海绵窦段颈内动脉瘤的经验，并对相关文献进行系统综述，以了解其疗效和并发症情况。
对我院前瞻性收集的使用Pipeline栓塞装置治疗的动脉瘤数据库进行回顾性检索，以查找海绵窦段颈内动脉瘤。收集基线人口统计学、临床和实验室数据；介入治疗期间的数据；以及所有随访时的数据。对文献中的并发症数据进行系统综述，必要时进行询问以澄清数据。
本研究纳入了43例海绵窦段颈内动脉瘤。影像学随访的平均时间为2.05年。在最后一次随访时，88.4%接受治疗的动脉瘤实现了完全或近乎完全闭塞。6个月、12个月和36个月时动脉瘤的完全或近乎完全闭塞率分别为81.4%、89.7%和100%。出现神经眼科缺损的患者中，84.2%的视觉症状有所改善。总体而言，死亡率为0%，严重神经并发症发生率为2.3%。我们对文献的系统综述共纳入了227例使用Pipeline栓塞装置治疗的海绵窦段颈内动脉瘤，死亡率和发病率分别为0.4%和3.1%。
采用血流导向进行腔内重建治疗大型未破裂海绵窦段颈内动脉瘤可获得高疗效、低并发症。进一步的长期数据将有助于评估治疗效果的持久性；然而，我们主张重新审视当前海绵窦段颈内动脉瘤的管理模式。
