Pumar José Manuel, Banguero Alexandra, Cuellar Hugo, Guimaraens Leopoldo, Masso Javier, Miralbes Salvador, Blanco-Ulla Miguel, Vazquez-Herrero Fernando, Souto Miguel, Gelabert-Gonzalez Miguel
Department of Neuroradiology, Hospital Clinico Universitario, Universidad de Santiago de Compostela, Travesia de la Choupana s/n, Santiago de Compostela, Spain.
Department of Neurosurgery and Radiology at LSU Health Sciences Center, Shreveport, Louisiana.
Neurosurgery. 2017 Oct 1;81(4):595-601. doi: 10.1093/neuros/nyw123.
Flow-diverter technology has become an important stent-based embolization tool in the treatment of complex cerebrovascular pathology. We report here the experience of 4 Spanish centers with using the SILK flow-diverter (SFD) device.
To evaluate the safety and efficacy of using the SFD in the endovascular treatment of intracranial aneurysms with complex morphology.
We retrospectively examined a prospectively maintained database of patients treated with SFD devices between July 2008 and December 2013 at 1 of 4 institutions in Spain. Data regarding patient demographics, aneurysm characteristics, and technical procedure were analyzed. Angiographic and clinical findings were recorded during the procedure and at 12 months postoperatively.
A total of 175 SFD devices were implanted in 157 patients (women/men: 119/38; mean, median, and range of age: 56.2, 56.7, and 19-80 years, respectively), who were treated in a delayed manner (3-6 months from the event) for 180 aneurysms (165 unruptured and 15 ruptured). Adverse events (acute and delayed) were observed in 28.7% of cases (45/157), and most were resolved (19.1%; 30/157). Six months after the procedure, total morbidity and mortality were 9.6% (15/157) and 3.2% (5/157), respectively. Long-term imaging follow-up showed complete occlusion, neck remnants, and residual aneurysm in 78.1% (100/128), 14.0% (18/128), and 7.8% (10/128) of cases, respectively.
The SFD device is an effective tool for the treatment of challenging aneurysms, and allows complete occlusion within a year of the procedure in most patients, with morbidity and mortality comparable to those previously reported for similar devices.
血流导向技术已成为治疗复杂脑血管病变的一种重要的基于支架的栓塞工具。我们在此报告4家西班牙中心使用SILK血流导向装置（SFD）的经验。
评估SFD在血管内治疗形态复杂的颅内动脉瘤中的安全性和有效性。
我们回顾性研究了2008年7月至2013年12月期间在西班牙4家机构之一接受SFD装置治疗的患者的前瞻性维护数据库。分析了患者人口统计学、动脉瘤特征和技术操作的数据。在手术过程中和术后12个月记录血管造影和临床结果。
共157例患者植入了175个SFD装置（女性/男性：119/38；年龄均值、中位数和范围分别为56.2、56.7和19 - 80岁），这些患者对180个动脉瘤进行了延迟治疗（事件发生后3 - 6个月）（165个未破裂，15个破裂）。28.7%的病例（45/157）观察到不良事件（急性和延迟性），大多数得到解决（19.1%；30/157）。术后6个月，总发病率和死亡率分别为9.6%（15/157）和3.2%（5/157）。长期影像学随访显示，分别有78.1%（100/128）、14.0%（18/128）和7.8%（10/128）的病例完全闭塞、颈部残留和动脉瘤残留。
SFD装置是治疗具有挑战性动脉瘤的有效工具，并且在大多数患者中能在手术一年内实现完全闭塞，其发病率和死亡率与先前报道的类似装置相当。
