Department of Neurological Surgery, University of California, San Francisco.
Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston.
JAMA Neurol. 2016 Aug 1;73(8):1002-8. doi: 10.1001/jamaneurol.2016.0609.
Brain aneurysms have traditionally been treated with surgical clipping or endovascular coiling techniques. With these modalities, many large or complex aneurysms remain difficult to treat. A new option, flow diversion, is now available to treat aneurysms.
To summarize the clinical progression of flow diversion technology, from an experimental treatment to a commonly used method to treat large or complex aneurysms.
References for this topical review were identified by searches of PubMed and GoogleScholar between January 2000 and January 2016. The search terms aneurysm, flow diverter, stent, pipeline, FRED, SURPASS, SILK, flow diversion, and endovascular were used. Ongoing clinical trials were identified using the same search terms in the clinicaltrial.gov registry. Attention was focused on current indications, rates of complications, and areas of ongoing study in randomized clinical trials.
Flow diversion is a treatment approved by the US Food and Drug Administration for brain aneurysms that redirects blood flow away from the aneurysm, thereby promoting growth of a new endothelial lining across the aneurysm opening. Cure rates with this technology are high and complication rates are low.
Flow diversion is a disruptive technology that has changed the way many brain aneurysms are treated. It is currently a preferred treatment option for large or giant wide-necked proximal internal carotid artery aneurysms. Ongoing randomized studies will help to more rigorously determine the efficacy of flow diversion.
脑动脉瘤传统上采用手术夹闭或血管内线圈技术治疗。对于这些方法，许多大或复杂的动脉瘤仍然难以治疗。一种新的选择，即血流转向，现在可用于治疗动脉瘤。
总结血流转向技术的临床进展，从实验治疗到治疗大或复杂动脉瘤的常用方法。
本专题综述的参考文献通过 2000 年 1 月至 2016 年 1 月在 PubMed 和 GoogleScholar 上进行的搜索确定。搜索术语包括动脉瘤、血流转向、支架、管道、FRED、SURPASS、SILK、血流转向和血管内。使用相同的搜索词在 clinicaltrial.gov 注册处确定正在进行的临床试验。关注的重点是当前的适应症、并发症发生率和正在进行的随机临床试验研究领域。
血流转向是一种经美国食品和药物管理局批准用于治疗脑动脉瘤的治疗方法，它将血流从动脉瘤转移开，从而促进新的内皮衬里在动脉瘤开口处生长。该技术的治愈率高，并发症发生率低。
血流转向是一种颠覆性技术，改变了许多脑动脉瘤的治疗方式。它目前是治疗大型或巨大宽颈近端颈内动脉动脉瘤的首选治疗方法。正在进行的随机研究将有助于更严格地确定血流转向的疗效。
