Briganti Francesco, Leone Giuseppe, Marseglia Mariano, Mariniello Giuseppe, Caranci Ferdinando, Brunetti Arturo, Maiuri Francesco
Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
Neuroradiol J. 2015 Aug;28(4):365-75. doi: 10.1177/1971400915602803. Epub 2015 Aug 27.
Flow-diverter devices (FDDs) are new-generation stents placed in the parent artery at the level of the aneurysm neck to disrupt the intra-aneurysmal flow thus favoring intra-aneurysmal thrombosis.
The objective of this review article is to define the indication and results of the treatment of intracranial aneurysms by FDD, reviewing 18 studies of endovascular treatment by FDDs for a total of 1704 aneurysms in 1483 patients.
The medical literature on FDDs for intracranial aneurysms was reviewed from 2009 to December 2014. The keywords used were: "intracranial aneurysms," "brain aneurysms," "flow diverter," "pipeline embolization device," "silk flow diverter," "surpass flow diverter" and "FRED flow diverter."
The use of these stents is advisable mainly for unruptured aneurysms, particularly those located at the internal carotid artery or vertebral and basilar arteries, for fusiform and dissecting aneurysms and for saccular aneurysms with large necks and low dome-to-neck ratio. The rate of aneurysm occlusion progressively increases during follow-up (81.5% overall rate in this review). The non-negligible rate of ischemic (mean 4.1%) and hemorrhagic (mean 2.9%) complications, the neurological morbidity (mean 3.5%) and the reported mortality (mean 3.4%) are the main limits of this technique.
Treatment with FDDs is a feasible and effective technique for unruptured aneurysms with complex anatomy (fusiform, dissecting, large neck, bifurcation with side branches) where coiling and clipping are difficult or impossible. Patient selection is very important to avoid complications and reduce the risk of morbidity and mortality. Further studies with longer follow-up are necessary to define the rate of complete occlusion.
血流导向装置（FDDs）是新一代支架，放置在动脉瘤颈部水平的载瘤动脉中，以扰乱瘤内血流，从而促进瘤内血栓形成。
这篇综述文章的目的是明确血流导向装置治疗颅内动脉瘤的适应证和治疗结果，回顾18项关于血流导向装置血管内治疗的研究，共涉及1483例患者的1704个动脉瘤。
检索2009年至2014年12月关于血流导向装置治疗颅内动脉瘤的医学文献。使用的关键词为：“颅内动脉瘤”、“脑动脉瘤”、“血流导向”、“管道栓塞装置”、“丝绸血流导向装置”、“超越血流导向装置”和“FRED血流导向装置”。
这些支架主要适用于未破裂动脉瘤，特别是位于颈内动脉或椎基底动脉的动脉瘤、梭形和夹层动脉瘤以及瘤颈大、瘤顶与瘤颈比例低的囊状动脉瘤。随访期间动脉瘤闭塞率逐渐增加（本综述总体闭塞率为81.5%）。缺血性（平均4.1%）和出血性（平均2.9%）并发症发生率、神经功能障碍发生率（平均3.5%）以及报告的死亡率（平均3.4%）不可忽视，是该技术的主要局限性。
对于解剖结构复杂（梭形、夹层、瘤颈大、有分支的分叉处）、难以或无法进行弹簧圈栓塞和夹闭的未破裂动脉瘤，血流导向装置治疗是一种可行且有效的技术。患者选择对于避免并发症以及降低发病和死亡风险非常重要。需要进一步进行更长时间随访的研究来确定完全闭塞率。
