Gawlitza Matthias, Januel Anne-Christine, Tall Philippe, Bonneville Fabrice, Cognard Christophe
Department of Neuroradiology, CHU Toulouse, Toulouse, France Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany.
Department of Neuroradiology, CHU Toulouse, Toulouse, France.
J Neurointerv Surg. 2016 May;8(5):481-7. doi: 10.1136/neurintsurg-2015-011682. Epub 2015 Apr 15.
Data regarding anatomic and clinical results of flow diversion treatment in complex bifurcation aneurysms of the anterior circulation are scarce.
To present our results of treatment of these lesions with special emphasis on the fate of 'jailed' cortical branches and perforating arteries.
Seventeen patients were treated with flow diverters (FDs) for 18 aneurysms of the middle cerebral artery bifurcation (n=13) and the anterior communicating artery complex (n=5). Nineteen cortical branches were covered. A single FD was used in all patients.
At latest follow-up (mean 7.9 months; range 3-36; median 4.0) 2/19 (10.5%) of the covered branches were occluded, 9/19 (47.4%) showed a decreased caliber and the remaining branches were unchanged. All branch modifications were clinically asymptomatic. Mortality and permanent morbidity were 0%. Symptomatic ischemic events in perforator territories occurred in three patients (17.6%), which were reversible in all of them within 24 h. Follow-up MRI disclosed asymptomatic lacunar defects corresponding to covered perforating artery territories in five patients (29.4%). Altogether, perforator lesions-symptomatic and asymptomatic-occurred in 7/17 patients (41.2%). 33.3% of the aneurysms were occluded at latest follow-up; decreased diameters were seen in the other 66.7%.
Flow diversion of bifurcation aneurysms is feasible with low rates of permanent morbidity and mortality. Caliber reduction and asymptomatic occlusion of covered cortical branches seems to be common, yet ischemic complications are rather linked to perforator occlusions. Our results on aneurysm occlusion rates are preliminary and longer follow-up periods are warranted.
关于前循环复杂分叉动脉瘤血流导向治疗的解剖学和临床结果的数据很少。
介绍我们对这些病变的治疗结果，特别强调“被困”皮质分支和穿支动脉的转归。
17例患者接受血流导向装置（FD）治疗18个大脑中动脉分叉处（n = 13）和前交通动脉复合体（n = 5）的动脉瘤。19个皮质分支被覆盖。所有患者均使用单个FD。
在最近一次随访时（平均7.9个月；范围3 - 36个月；中位数4.0个月），19个被覆盖分支中有2个（10.5%）闭塞，9个（47.4%）管径减小，其余分支未改变。所有分支改变在临床上均无症状。死亡率和永久性致残率为0%。3例患者（17.6%）在穿支区域发生有症状的缺血事件，所有这些事件在24小时内均可逆转。随访MRI显示5例患者（29.4%）在与被覆盖穿支动脉区域相对应的部位出现无症状的腔隙性缺损。总共，7/17例患者（41.2%）出现穿支病变，包括有症状和无症状的。在最近一次随访时，33.3%的动脉瘤闭塞；其他66.7%的动脉瘤直径减小。
分叉动脉瘤的血流导向治疗是可行的，永久性致残率和死亡率较低。被覆盖皮质分支的管径减小和无症状闭塞似乎很常见，但缺血性并发症与穿支闭塞关系更为密切。我们关于动脉瘤闭塞率的结果是初步的，需要更长的随访期。
