Ganesh Kumar Nishant, Ladner Travis R, Kahn Imad S, Zuckerman Scott L, Baker Christopher B, Skaletsky Marybess, Cushing Deborah, Sanborn Matthew R, Mocco J, Ecker Robert D
Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA.
Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA.
J Neurol Sci. 2017 Jan 15;372:250-255. doi: 10.1016/j.jns.2016.11.057. Epub 2016 Nov 23.
INTRODUCTION/PURPOSE: Flow diversion has allowed cerebrovascular neurosurgeons and neurointerventionalists to treat complex, large aneurysms, previously treated with trapping, bypass, and/or parent vessel sacrifice. However, a minority of aneurysms remain that cannot be treated endovascularly, and microsurgical treatment is too dangerous. However, balloon test occlusion (macro and micro), micro WADA testing, ICG, intra-angiography and intra-operative monitoring are all available to clinically test the hypothesis that vessel sacrifice is safe. We describe a dual-institution series of aneurysms successfully treated with parent vessel occlusion (PVO).
MATERIALS/METHODS: Prospectively collected databases of all endovascular and open cerebrovascular cases performed at Maine Medical Center and Vanderbilt University Medical Center from 2011 to 2013 were screened for patients treated with primary vessel sacrifice. A total of 817 patients were screened and 17 patients were identified who underwent parent vessel sacrifice as primary treatment.
All 17 patients primarily treated with PVO are described below. Nine patients presented with SAH, and 3/17 involved anterior circulation. Complete occlusion was achieved in 15/17 patients. In the remaining 2 patients, significant reduction in the aneurysm occurred. Modified Rankin Score (mRS) of 0, signifying complete independence, was achieved for 16/17 patients. One patient died due to an extracranial process.
Parent vessel sacrifice remains a viable and durable solution in select ruptured and unruptured intracranial aneurysms. Many adjuncts are available to aid in the decision making. In this small series, patients naturally divided into vertebral dissecting aneurysms, giant aneurysms and small distal aneurysms. Outcomes were favorable in this highly selected group.
引言/目的：血流导向技术使脑血管神经外科医生和神经介入专家能够治疗复杂的大型动脉瘤，这类动脉瘤以往需采用夹闭、搭桥和/或牺牲载瘤血管的方法进行治疗。然而，仍有少数动脉瘤无法通过血管内治疗，而显微手术治疗又过于危险。不过，球囊试验闭塞（宏观和微观）、微WADA试验、吲哚菁绿（ICG）、血管内造影和术中监测均可用于临床验证牺牲血管是否安全这一假设。我们描述了一个双机构系列采用载瘤血管闭塞（PVO）成功治疗的动脉瘤病例。
材料/方法：对2011年至2013年在缅因医疗中心和范德比尔特大学医学中心进行的所有血管内和开放性脑血管病例的前瞻性收集数据库进行筛查，以寻找接受原发性血管牺牲治疗的患者。共筛查了817例患者，确定有17例患者接受了原发性载瘤血管牺牲治疗。
以下描述了所有17例主要接受PVO治疗的患者。9例患者表现为蛛网膜下腔出血（SAH），17例中有3例累及前循环。17例患者中有15例实现了完全闭塞。其余2例患者的动脉瘤有显著缩小。17例患者中有16例改良Rankin量表（mRS）评分为0，表明完全独立。1例患者因颅外病变死亡。
在某些破裂和未破裂的颅内动脉瘤中，牺牲载瘤血管仍然是一种可行且持久的解决方案。有许多辅助手段可帮助进行决策。在这个小系列中，患者自然分为椎动脉夹层动脉瘤、巨大动脉瘤和小的远端动脉瘤。在这个经过高度选择的组中，结果是良好的。
