Griessenauer C J, Gupta R, Shi S, Alturki A, Motiei-Langroudi R, Adeeb N, Ogilvy C S, Thomas A J
From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
AJNR Am J Neuroradiol. 2017 Feb;38(2):323-326. doi: 10.3174/ajnr.A5010. Epub 2016 Nov 10.
Flow diversion with the Pipeline Embolization Device has emerged as an attractive treatment for cerebral aneurysms. Processes involved in aneurysm occlusion include changes in intra-aneurysmal hemodynamics and endothelialization of the device. Here, we call attention to a radiographic sign not previously reported that is detected in incompletely occluded aneurysms after treatment with the Pipeline Embolization Device at angiographic follow-up and referred to as the "collar sign."
A retrospective review of all patients who underwent placement of a Pipeline Embolization Device for cerebral aneurysms between January 2014 and May 2016 was performed. All aneurysms found to show the collar sign at follow-up were included. Optical coherence tomography was performed in 1 case.
One hundred thirty-five aneurysms were treated in 115 patients. At angiographic follow-up, 17 (10.7%) aneurysms were found to be incompletely occluded. Ten (58.8%) of these aneurysms (average diameter, 7.9 ± 5.0 mm) were found to have the collar sign at angiographic follow-up (average, 5.5 ± 1.0 months). Four (40.0%) of the aneurysms underwent a second angiographic follow-up (average, 11.0 ± 0.9 months) after treatment, and again were incompletely occluded and showing the collar sign. Two patients underwent retreatment with a second Pipeline Embolization Device. Optical coherence tomography showed great variability of endothelialization at the proximal end of the Pipeline Embolization Device.
The collar sign appears to be indicative of endothelialization, but continued blood flow into the aneurysm. This is unusual given the processes involved in aneurysm occlusion after placement of the Pipeline Embolization Device and has not been previously reported.
使用Pipeline栓塞装置进行血流导向已成为一种治疗脑动脉瘤的有吸引力的方法。动脉瘤闭塞所涉及的过程包括瘤内血流动力学的改变以及装置的内皮化。在此，我们提请注意一种先前未报道的影像学征象，该征象在使用Pipeline栓塞装置治疗后血管造影随访时在未完全闭塞的动脉瘤中被检测到，我们将其称为“项圈征”。
对2014年1月至2016年5月期间接受Pipeline栓塞装置治疗脑动脉瘤的所有患者进行回顾性研究。纳入所有在随访时发现有项圈征的动脉瘤。对1例患者进行了光学相干断层扫描。
115例患者共治疗了135个动脉瘤。在血管造影随访时，发现17个（10.7%）动脉瘤未完全闭塞。其中10个（58.8%）动脉瘤（平均直径7.9±5.0mm）在血管造影随访时（平均5.5±1.0个月）发现有项圈征。4个（40.0%）动脉瘤在治疗后进行了第二次血管造影随访（平均11.0±0.9个月），再次显示未完全闭塞且有项圈征。2例患者接受了第二次Pipeline栓塞装置再治疗。光学相干断层扫描显示Pipeline栓塞装置近端的内皮化存在很大差异。
项圈征似乎表明存在内皮化，但仍有血流进入动脉瘤。考虑到放置Pipeline栓塞装置后动脉瘤闭塞所涉及的过程，这一情况并不常见，且此前未见报道。
