Gascou G, Lobotesis K, Brunel H, Machi P, Riquelme C, Eker O, Bonafé A, Costalat V
From the Department of Neuroradiology (G.G., P.M., C.R., O.E., A.B., V.C.), CHU Gui de Chauliac, Montpellier, France
Department of Imaging (K.L.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, United Kingdom.
AJNR Am J Neuroradiol. 2015 Apr;36(4):725-31. doi: 10.3174/ajnr.A4191. Epub 2014 Dec 18.
Flow-diverter technology has proved to be a safe and effective treatment for intracranial aneurysm based on the concept of flow diversion allowing parent artery and collateral preservation and aneurysm healing. We investigated the patency of covered side branches and flow modification within the parent artery following placement of the Pipeline Embolization Device in the treatment of intracranial aneurysms.
Sixty-six aneurysms in 59 patients were treated with 96 Pipeline Embolization Devices. We retrospectively reviewed imaging and clinical results during the postoperative period at 6 and 12 months to assess flow modification through the parent artery and side branches. Reperfusion syndrome was assessed by MR imaging and clinical evaluation.
Slow flow was observed in 13 of 68 (19.1%) side branches covered by the Pipeline Embolization Device. It was reported in all cases of anterior cerebral artery coverage, in 3/5 cases of M2-MCA coverage, and in 5/34 (14.7%) cases of ophthalmic artery coverage. One territorial infarction was observed in a case of M2-MCA coverage, without arterial occlusion. One case of deep Sylvian infarct was reported in a case of coverage of MCA perforators. Two ophthalmic arteries (5.9%) were occluded, and 11 side branches (16.2%) were narrowed at 12 months' follow-up; patients remained asymptomatic. Parent vessel flow modification was responsible for 2 cases (3.4%) of reperfusion syndrome. Overall permanent morbidity and mortality rates were 5.2% and 6.9%, respectively. We did not report any permanent deficit or death in case of slow flow observed within side branches.
After Pipeline Embolization Device placement, reperfusion syndrome was observed in 3.4%, and territorial infarction, in 3.4%. Delayed occlusion of ophthalmic arteries and delayed narrowing of arteries covered by the Pipeline Embolization Device were observed in 5.9% and 16.2%, respectively. No permanent morbidity or death was related to side branch coverage at midterm follow-up.
基于血流转向的概念，血流导向技术已被证明是一种安全有效的颅内动脉瘤治疗方法，可保留载瘤动脉和侧支循环并促使动脉瘤愈合。我们研究了在使用Pipeline栓塞装置治疗颅内动脉瘤后，被覆盖侧支的通畅情况以及载瘤动脉内的血流改变。
59例患者的66个动脉瘤接受了96枚Pipeline栓塞装置治疗。我们回顾性分析了术后6个月和12个月时的影像学及临床结果，以评估通过载瘤动脉和侧支的血流改变。通过磁共振成像和临床评估来评估再灌注综合征。
在68个被Pipeline栓塞装置覆盖的侧支中，有13个（19.1%）出现血流缓慢。在前交通动脉覆盖的所有病例、大脑中动脉M2段覆盖的3/5病例以及眼动脉覆盖的5/34（14.7%）病例中均有报道。在大脑中动脉M2段覆盖的1例病例中观察到1次区域梗死，无动脉闭塞。在大脑中动脉穿支覆盖的1例病例中报道了1次深部大脑外侧裂梗死。在12个月的随访中，2条眼动脉（5.9%）闭塞，11个侧支（16.2%）狭窄；患者仍无症状。载瘤血管血流改变导致2例（3.4%）再灌注综合征。总体永久性致残率和死亡率分别为5.2%和6.9%。在侧支出现血流缓慢的病例中，我们未报告任何永久性神经功能缺损或死亡。
放置Pipeline栓塞装置后，观察到3.4%的患者出现再灌注综合征，3.4%的患者出现区域梗死。分别有5.9%和16.2%的患者观察到眼动脉延迟闭塞和被Pipeline栓塞装置覆盖的动脉延迟狭窄。在中期随访中，未发现与侧支覆盖相关的永久性致残或死亡。
