Gory Benjamin, Spiotta Alejandro M, Di Paola Franscesco, Mangiafico Salvatore, Renieri Leonardo, Consoli Arturo, Biondi Alessandra, Riva Roberto, Labeyrie Paul-Emile, Turjman Francis
FHU IRIS, Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
World Neurosurg. 2017 Mar;99:605-609. doi: 10.1016/j.wneu.2016.12.065. Epub 2016 Dec 23.
BACKGROUND/OBJECTIVE: PulseRider is a new endovascular stent dedicated to treat bifurcation intracranial aneurysms with a wide neck. Our purpose was to evaluate 6-month clinical and anatomic results of the device when used to facilitate endovascular coiling of wide-neck bifurcation aneurysms.
Unruptured intracranial aneurysms coiled with PulseRider, in 6 European centers and 1 U.S. center, were retrospectively reviewed from June 2014 to October 2015. Immediate and 6-month results were evaluated independently by using the Raymond classification scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement on the Raymond scale.
Nineteen patients (10 women, 9 men; mean age, 63 years) harboring 19 bifurcation aneurysms (mean dome size, 8.8 mm; mean neck size, 5.8 mm) were included. Immediate angiographic outcome showed 11 complete aneurysm occlusions, 6 neck remnants, and 2 residual aneurysms. Follow-up at 6 months, obtained in all patients, included 12 complete aneurysm occlusions (63.1%), 6 neck remnants (31.6%), and 1 residual aneurysm (5.3%). Adequate occlusion (defined as complete occlusion and neck remnant combined) was observed in 94.7%. Progressive thrombosis was observed in 2 cases (10.6%) and recanalization in 1 case (5.3%). There was no in-stent stenosis or jailed branch occlusion. No bleeding was observed during the follow-up period. Permanent morbidity rate was 5.3% (1/19), and the mortality rate was 0% at 6 months.
The PulseRider allows endovascular treatment of wide-neck bifurcation intracranial aneurysms. Larger series are needed to confirm our preliminary results.
背景/目的：PulseRider是一种新型血管内支架，专门用于治疗宽颈颅内分叉动脉瘤。我们的目的是评估该装置用于促进宽颈分叉动脉瘤血管内栓塞时的6个月临床和解剖学结果。
回顾性分析2014年6月至2015年10月期间在6个欧洲中心和1个美国中心使用PulseRider进行栓塞治疗的未破裂颅内动脉瘤。使用Raymond分级量表独立评估即刻和6个月的结果。再通定义为病情恶化，进展性血栓形成定义为Raymond分级改善。
纳入19例患者（10例女性，9例男性；平均年龄63岁），共19个分叉动脉瘤（平均瘤顶大小8.8 mm；平均瘤颈大小5.8 mm）。即刻血管造影结果显示11个动脉瘤完全闭塞，6个瘤颈残留，2个残留动脉瘤。所有患者均进行了6个月的随访，结果包括12个动脉瘤完全闭塞（63.1%），6个瘤颈残留（31.6%），1个残留动脉瘤（5.3%）。充分闭塞（定义为完全闭塞和瘤颈残留合计）率为94.7%。观察到2例（10.6%）进展性血栓形成，1例（5.3%）再通。未观察到支架内狭窄或分支血管闭塞。随访期间未观察到出血。永久性致残率为5.3%（1/19），6个月时死亡率为0%。
PulseRider可用于宽颈颅内分叉动脉瘤的血管内治疗。需要更大规模的系列研究来证实我们的初步结果。
