Chalouhi Nohra, Zanaty Mario, Whiting Alex, Yang Steven, Tjoumakaris Stavropoula, Hasan David, Starke Robert M, Hann Shannon, Hammer Christine, Kung David, Rosenwasser Robert, Jabbour Pascal
1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania;
2Department of Neurosurgery, University of Iowa, Iowa City, Iowa; and.
J Neurosurg. 2015 Jun;122(6):1498-502. doi: 10.3171/2014.12.JNS14411. Epub 2015 Jan 30.
OBJECT Flow diverters are increasingly used for treatment of intracranial aneurysms. In most series, the Pipeline Embolization Device (PED) was used for the treatment of large, giant, complex, and fusiform aneurysms. Little is known about the use of the PED in small aneurysms. The purpose of this study was to assess the safety and efficacy of the PED in small aneurysms (≤ 7 mm). METHODS A total of 100 consecutive patients were treated with the PED at the authors' institution between May 2011 and September 2013. Data on procedural safety and efficacy were retrospectively collected. RESULTS The mean aneurysm size was 5.2 ± 1.5 mm. Seven patients (7%) had sustained a subarachnoid hemorrhage. All except 5 aneurysms (95%) arose from the anterior circulation. The number of PEDs used was 1.2 per aneurysm. Symptomatic procedure-related complications occurred in 3 patients (3%): 1 distal parenchymal hemorrhage that was managed conservatively and 2 ischemic events. At the latest follow-up (mean 6.3 months), 54 (72%) aneurysms were completely occluded (100%), 10 (13%) were nearly completely occluded (≥ 90%), and 11 (15%) were incompletely occluded (< 90%). Six aneurysms (8%) required further treatment. Increasing aneurysm size (OR 3.8, 95% CI 0.99-14; p = 0.05) predicted retreatment. All patients achieved a favorable outcome (modified Rankin Scale Score 0-2) at follow-up. CONCLUSIONS In this study, treatment of small aneurysms with the PED was associated with low complication rates and high aneurysm occlusion rates. These findings suggest that the PED is a safe and effective alternative to conventional endovascular techniques for small aneurysms. Randomized trials with long-term follow-up are necessary to determine the optimal treatment that leads to the highest rate of obliteration and the best clinical outcomes.
目的 血流导向装置越来越多地用于治疗颅内动脉瘤。在大多数系列研究中，Pipeline栓塞装置（PED）用于治疗大型、巨大型、复杂型和梭形动脉瘤。关于PED在小型动脉瘤中的应用知之甚少。本研究的目的是评估PED治疗小型动脉瘤（≤7mm）的安全性和有效性。方法 2011年5月至2013年9月期间，作者所在机构共有100例连续患者接受了PED治疗。回顾性收集手术安全性和有效性的数据。结果 动脉瘤平均大小为5.2±1.5mm。7例患者（7%）发生过蛛网膜下腔出血。除5个动脉瘤（95%）外，所有动脉瘤均起源于前循环。每个动脉瘤使用的PED数量为1.2个。3例患者（3%）发生了与手术相关的有症状并发症：1例远端实质内出血经保守治疗，2例缺血性事件。在最近一次随访时（平均6.3个月），54个（72%）动脉瘤完全闭塞（100%），10个（13%）几乎完全闭塞（≥90%），11个（15%）未完全闭塞（<90%）。6个动脉瘤（8%）需要进一步治疗。动脉瘤大小增加（比值比3.8，95%可信区间0.99-14；p=0.05）预示着需要再次治疗。所有患者在随访时均获得了良好的预后（改良Rankin量表评分0-2）。结论 在本研究中，用PED治疗小型动脉瘤的并发症发生率低，动脉瘤闭塞率高。这些发现表明，对于小型动脉瘤，PED是传统血管内技术的一种安全有效的替代方法。有必要进行长期随访的随机试验，以确定能实现最高闭塞率和最佳临床结果的最佳治疗方法。
