Herweh C, Nagel S, Pfaff J, Ulfert C, Wolf M, Bendszus M, Möhlenbruch M
Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Department of Neurology, University of Heidelberg Medical Center, Heidelberg, Germany.
Clin Neuroradiol. 2018 Jun;28(2):201-207. doi: 10.1007/s00062-016-0545-9. Epub 2016 Sep 27.
Stent-assisted coiling of wide-necked intracranial aneurysms has become an established treatment and has significantly benefited from the introduction of compliant, self-expanding devices, such as the Enterprise VRD (EP-VRD). We report our experiences with the successor model, the Enterprise2 (EP2) stent in stent-assisted coiling as well as in the treatment of atherosclerotic stenosis.
In 11 consecutive patients 12 EP2 were used to treat 9 intracranial aneurysms and 2 stenoses.
All stents could easily be delivered including partial or complete recapturing when necessary. In two cases with sharp angled curves in the carotid siphon there was kinking and flattening of the stent resulting in incomplete wall apposition of the stent. Moreover, when vascular anatomy showed curves with angles >50° it was regularly observed that the proximal stent markers were asymmetrically arranged along the vessel circumference without influence on the stent apposition. Both findings could be reproduced in a silicone flow model.
The EP2 performed well in our small patient cohort; however, above a critical acute angle there may be incomplete wall apposition of the stent.
支架辅助弹簧圈栓塞宽颈颅内动脉瘤已成为一种成熟的治疗方法,并且从顺应性自膨式装置(如Enterprise VRD,简称EP-VRD)的引入中显著获益。我们报告了我们使用后续型号Enterprise2(简称EP2)支架进行支架辅助弹簧圈栓塞以及治疗动脉粥样硬化狭窄的经验。
连续11例患者使用12枚EP2支架治疗9例颅内动脉瘤和2例狭窄。
所有支架均能轻松输送,必要时可部分或完全回收。在2例颈内动脉虹吸部存在锐角弯曲的病例中,支架出现扭结和扁平化,导致支架与血管壁贴合不完全。此外,当血管解剖显示角度>50°的弯曲时,经常观察到近端支架标记物沿血管圆周不对称排列,但不影响支架贴壁。这两种情况均可在硅胶血流模型中重现。
EP2在我们的小样本患者队列中表现良好;然而,在超过临界锐角时,可能会出现支架与血管壁贴合不完全的情况。