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使用血流导向支架进行神经血管重建治疗87例颅内动脉瘤:临床结果

Neurovascular reconstruction with flow diverter stents for the treatment of 87 intracranial aneurysms: Clinical results.

作者信息

Giacomini Leonardo, Piske Ronie L, Baccin Carlos E, Barroso Marcelo, Joaquim Andrei F, Tedeschi Helder

机构信息

Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil

Centro de NeuroAngiografia (CNA), Hospital Beneficencia Portuguesa de São Paulo, São Paulo, Brazil.

出版信息

Interv Neuroradiol. 2015 Jun;21(3):292-9. doi: 10.1177/1591019915582153. Epub 2015 May 11.

Abstract

BACKGROUND

Flow diverter stents represent a new endovascular tool to treat complex aneurysms, such as giant, large, wide-necked and fusiform. The highly dense mash of these stents reduces inflow and outflow inside the aneurysm, resulting in intra aneurysmal thrombosis and stent endothelialization.

OBJECTIVES

To present the results of treatment of intracranial aneurysms with flow diverter stents in a single center.

METHODS

Retrospective review of 77 patients with 87 aneurysms treated using two different types of flow diverter stent, the Pipeline Embolization Device and SILK stent, between October 2010 and September 2013 in an interventional neuroradiology center.

RESULTS

Flow diverter stent placement was successful in 98% of the lesions and resulted in an immediate major stasis within most of the treated aneurysms. The overall aneurysm occlusion rate at six months and 18 months was 80% and 84% respectively. Symptomatic complications occurred in 11 patients (14.3%) with morbidity in eight (10.4%) and mortality in three patients (3.9%).

CONCLUSION

Flow diversion is a promising technique for treatment of challenging intracranial aneurysms with acceptable morbidity. A high rate of complete occlusion for small large necked aneurysms, a low morbidity and mortality rate and no recanalization encourage their use in these aneurysms. Further studies accessing long-term aneurysm occlusion and recanalization are required.

摘要

背景

血流导向支架是一种治疗复杂动脉瘤的新型血管内治疗工具,如巨大型、大型、宽颈和梭形动脉瘤。这些支架的高密度网眼可减少动脉瘤内的流入和流出,导致动脉瘤内血栓形成和支架内皮化。

目的

介绍在单一中心使用血流导向支架治疗颅内动脉瘤的结果。

方法

回顾性分析2010年10月至2013年9月间在一个介入神经放射中心使用两种不同类型的血流导向支架(Pipeline栓塞装置和SILK支架)治疗的77例患者的87个动脉瘤。

结果

98%的病变成功置入血流导向支架,且在大多数治疗的动脉瘤内立即实现了主要血流停滞。6个月和18个月时的总体动脉瘤闭塞率分别为80%和84%。11例患者(14.3%)出现症状性并发症,其中8例(10.4%)出现致残,3例患者(3.9%)死亡。

结论

血流导向是一种治疗具有挑战性的颅内动脉瘤的有前景的技术,其致残率可接受。小型宽颈动脉瘤的完全闭塞率高、致残率和死亡率低且无再通现象,这促使其在这些动脉瘤治疗中的应用。需要进一步研究以评估动脉瘤的长期闭塞和再通情况。

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