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使用p64血流导向支架对颅内动脉瘤进行血管内治疗:35例患者41个颅内动脉瘤的中期结果

Endovascular treatment of intracranial aneurysms with the p64 flow diverter stent: mid-term results in 35 patients with 41 intracranial aneurysms.

作者信息

Morais Ricardo, Mine Benjamin, Bruyère Pierre Julien, Naeije Gilles, Lubicz Boris

机构信息

Cliniques Universitaires de Bruxelles, Erasme University Hospital, Imagerie médicale - Clinique de Neuroradiologie, Route de Lennik 808 - B, Bruxelles, Belgium.

Medical Imaging Department, Coimbra University and Hospital Centre, Coimbra, Portugal.

出版信息

Neuroradiology. 2017 Mar;59(3):263-269. doi: 10.1007/s00234-017-1786-2. Epub 2017 Feb 24.


DOI:10.1007/s00234-017-1786-2
PMID:28236050
Abstract

INTRODUCTION: The p64 flow diverter (FD) device is a fully resheathable and detachable stent dedicated for endovascular treatment (EVT) of intracranial aneurysms (IAs). We report our mid-term experience with this device. METHODS: Between January 2015 and February 2016, we retrospectively identified, in our prospectively maintained database, all patients treated with p64 FDs in two institutions. Independent clinical follow-up was performed by a vascular neurologist. Imaging follow-up included a digitalized subtraction angiography (DSA) at 3, 6, and 12 months and a magnetic resonance angiography (MRA) at 12 months. RESULTS: Thirty-nine patients (22 women/17 men; median age 54 years) with 48 IAs (median aneurysm size 6.2 mm; mean neck size 3.4 mm) were identified. All IAs were saccular and unruptured. Failure of safe stent delivery occurred in 15% of cases (7/48 IAs) which were excluded. Transient neurological morbidity occurred in 2/35 patients (5.7%) including one delayed thromboembolic complication. No permanent morbidity or mortality was encountered. Complete aneurysmal occlusion at 3, 6, and 12 months was 20/30 (66.6%), 18/27 (66.6%), and 24/28 (85.7%), respectively. Intra-stent stenosis was observed in 9/29 patients (31%) and classified as moderate in 4/29 (13.7%) and mild in 5/29 patients (17.2%). These stenoses gradually improved over time, with only mild stenoses being identified at 6 months and at 12 months. CONCLUSION: In our small case series, the p64 FD stent appears safe and effective for EVT of IAs. A high occlusion rate and a low morbidity rate were observed.

摘要

引言:p64血流导向装置是一种完全可重新鞘内操作且可分离的支架,专门用于颅内动脉瘤(IA)的血管内治疗(EVT)。我们报告了使用该装置的中期经验。 方法:在2015年1月至2016年2月期间,我们在两个机构中,从前瞻性维护的数据库中回顾性识别了所有接受p64血流导向装置治疗的患者。由血管神经科医生进行独立的临床随访。影像学随访包括在3、6和12个月时进行数字化减影血管造影(DSA),以及在12个月时进行磁共振血管造影(MRA)。 结果:共识别出39例患者(22例女性/17例男性;中位年龄54岁),有48个颅内动脉瘤(中位动脉瘤大小6.2mm;平均瘤颈大小3.4mm)。所有颅内动脉瘤均为囊状且未破裂。15%的病例(7/48个颅内动脉瘤)出现安全支架置入失败,这些病例被排除。2/35例患者(5.7%)出现短暂性神经功能障碍,包括1例延迟性血栓栓塞并发症。未出现永久性神经功能障碍或死亡。在3、6和12个月时,动脉瘤完全闭塞的比例分别为20/30(66.6%)、18/27(66.6%)和24/28(85.7%)。在29例患者中观察到支架内狭窄,其中4/29例(13.7%)为中度狭窄,5/29例(17.2%)为轻度狭窄。这些狭窄随时间逐渐改善,在6个月和12个月时仅发现轻度狭窄。 结论:在我们的小病例系列中,p64血流导向装置对颅内动脉瘤血管内治疗似乎是安全有效的。观察到较高的闭塞率和较低的发病率。

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[4]
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[5]
Endovascular Treatment of Intracranial Aneurysms.

Life (Basel). 2021-4-10

[6]
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[7]
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[8]
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[9]
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[10]
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本文引用的文献

[1]
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J Neurointerv Surg. 2017-7

[2]
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JAMA Neurol. 2016-8-1

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Neuroradiol J. 2015-8

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Initial Experience with p64: A Novel Mechanically Detachable Flow Diverter for the Treatment of Intracranial Saccular Sidewall Aneurysms.

AJNR Am J Neuroradiol. 2015-11

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J Neurosurg. 2015-12

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J Neurointerv Surg. 2016-3

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p64 Flow Modulation Device in the treatment of intracranial aneurysms: initial experience and technical aspects.

J Neurointerv Surg. 2016-2

[10]
Silk flow-diverter stent for the treatment of intracranial aneurysms: a series of 58 patients with emphasis on long-term results.

AJNR Am J Neuroradiol. 2015-3

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