Barburoglu M, Arat A
From the Department of Radiology (M.B.), Istanbul University Medical School, Istanbul, Turkey.
Department of Radiology (A.A.), School of Medicine, Hacettepe University, Ankara, Turkey.
AJNR Am J Neuroradiol. 2017 Jan;38(1):113-118. doi: 10.3174/ajnr.A4959. Epub 2016 Oct 20.
There is very limited data concerning utilization of flow diverters in children. Our aim is to report results for the treatment of complex intracranial aneurysms and carotid cavernous fistulas by using flow diverters in children.
Retrospective review of children (17 years of age or younger) treated with flow diverters between May 2011 and July 2014 was performed. Clinical and laboratory data and angiographic findings were extracted. Seven patients (6 males, 1 female; mean age, 12.7 years; range, 3-16 years) were included. Two presented with posttraumatic fistulas. The remaining patients presented with traumatic aneurysms of the cavernous carotid artery or fusiform aneurysms of the distal vertebral artery, M1, or A2 segments. All patients were premedicated with clopidogrel (75 mg daily for patients with body weights of >45 kg, 37.5 mg daily for 1 small child with a body weight of <45 kg) and aspirin (300 mg daily for ≥45 kg, 100 mg daily for smaller children).
VerifyNow and Multiplate Analyzer values were higher than expected. No clinical complications were noted. Imaging performed at 7-52 months after the procedure (mean/median, 22.3/14 months) revealed occlusions of all aneurysms and fistulas. One patient had an asymptomatic occlusion of the parent artery; otherwise, no hemodynamically significant parent artery restenosis was observed. There were no clinically significant neurologic events during follow-up.
Although flow-diverter placement appears to be safe and effective on midterm follow-up in children, longer follow-up is critical. The current sizes of flow diverter devices and delivery systems cover the pediatric size range, obviating developing flow diverters specific to children.
关于儿童使用血流导向装置的数据非常有限。我们的目的是报告使用血流导向装置治疗儿童复杂颅内动脉瘤和颈动脉海绵窦瘘的结果。
对2011年5月至2014年7月间接受血流导向装置治疗的17岁及以下儿童进行回顾性研究。提取临床、实验室数据及血管造影结果。纳入7例患者（6例男性，1例女性；平均年龄12.7岁；范围3 - 16岁）。2例为创伤后瘘。其余患者表现为海绵窦段颈内动脉创伤性动脉瘤或椎动脉远端、M1或A2段梭形动脉瘤。所有患者均预先服用氯吡格雷（体重>45 kg的患者每日75 mg，1例体重<45 kg的小儿每日37.5 mg）和阿司匹林（体重≥45 kg的患者每日300 mg，较小儿童每日100 mg）。
VerifyNow和Multiplate分析仪的值高于预期。未观察到临床并发症。术后7 - 52个月（平均/中位数，22.3/14个月）进行的影像学检查显示所有动脉瘤和瘘均闭塞。1例患者出现无症状的供血动脉闭塞；除此之外，未观察到血流动力学上有意义的供血动脉再狭窄。随访期间未发生具有临床意义的神经事件。
尽管在儿童中期随访中，血流导向装置置入似乎安全有效，但更长时间的随访至关重要。目前血流导向装置及输送系统的尺寸涵盖了儿科尺寸范围，无需研发专门针对儿童的血流导向装置。
