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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.

DOI:10.1177/1591019915582153
PMID:25964435
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4757260/
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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AJNR Am J Neuroradiol. 2013 May;34(5):935-9. doi: 10.3174/ajnr.A3547. Epub 2013 Mar 14.
2
SILK flow diverter for treatment of intracranial aneurysms: initial experience and cost analysis.颅内动脉瘤治疗用丝流导向装置:初步经验和成本分析。
J Neurointerv Surg. 2013 Nov;5 Suppl 3:iii11-5. doi: 10.1136/neurintsurg-2012-010590. Epub 2013 Feb 19.
3
Treatment of posterior circulation aneurysms with the pipeline embolization device.采用Pipeline 栓塞装置治疗后循环动脉瘤。
Neurosurgery. 2013 Jun;72(6):883-9. doi: 10.1227/NEU.0b013e31828ba984.
4
Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms.加拿大在使用Pipeline 栓塞装置修复未破裂颅内动脉瘤方面的经验。
AJNR Am J Neuroradiol. 2013 Feb;34(2):381-7. doi: 10.3174/ajnr.A3224. Epub 2012 Aug 2.
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Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results.采用 Pipeline 血流导向装置治疗颅内动脉瘤:单中心经验及长期随访结果。
AJNR Am J Neuroradiol. 2012 Sep;33(8):1436-46. doi: 10.3174/ajnr.A3246. Epub 2012 Jul 19.
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Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms.灵丹妙药还是问题所在:血流导向装置治疗症状性大型或巨大梭形椎基底动脉动脉瘤。
J Neurosurg. 2012 Jun;116(6):1258-66. doi: 10.3171/2012.2.JNS111942. Epub 2012 Mar 9.
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Delayed ipsilateral parenchymal hemorrhage following flow diversion for the treatment of anterior circulation aneurysms.血流导向装置治疗前循环动脉瘤后迟发性对侧实质内出血。
AJNR Am J Neuroradiol. 2012 Apr;33(4):603-8. doi: 10.3174/ajnr.A3065. Epub 2012 Mar 8.
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AJNR Am J Neuroradiol. 2012 Jun;33(6):1150-5. doi: 10.3174/ajnr.A2907. Epub 2012 Feb 2.
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