Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts.
Baptist Cardiac and Vascular Institute, Miami, Florida.
Oper Neurosurg (Hagerstown). 2018 Apr 1;14(4):351-358. doi: 10.1093/ons/opx111.
Pericallosal artery aneurysm treatment may be challenging using traditional endovascular techniques.
To demonstrate the feasibility, efficacy, and safety of endovascular treatment of pericallosal artery aneurysm using flow diverters.
We performed a retrospective review of our institutional database from July 2013 through July 2016 and identified 7 subjects with a pericallosal artery aneurysm treated with the Pipeline embolization device (ev3 Neurovascular, Medtronic, Dublin, Ireland) and at least 1 follow-up angiogram. Technical feasibility, procedural complication, angiographic results, and clinical outcome were evaluated.
Placement of the Pipeline embolization device was successful in all cases without evidence of procedural complication. Five out of 7 subjects showed a complete aneurysm occlusion at 6- to 12-mo follow-up angiogram. The 2 subjects with persistent aneurysm filling showed decreased aneurysm sac volume on follow-up angiograms (96% and 60%). There was no evidence of in-implant stenosis or intimal hyperplasia. No thromboembolic or hemorrhagic complications were seen during the follow-up period. Only 1 patient had a transient change in Modified Rankin scale score from baseline as a result of different unrelated procedure.
Our preliminary results demonstrate feasibility of the use of flow diverter stent for treatment of aneurysms of the pericallosal artery with rate of aneurysm occlusion comparable to literature and without evidence of increased procedural or short-term morbidity. A long-term and larger cohort study is needed to validate our findings.
使用传统的血管内技术治疗胼周动脉动脉瘤可能具有挑战性。
展示使用血流导向装置对胼周动脉动脉瘤进行血管内治疗的可行性、疗效和安全性。
我们对 2013 年 7 月至 2016 年 7 月期间机构数据库进行了回顾性研究,共纳入 7 例使用 Pipeline 栓塞装置(ev3 神经血管,美敦力,都柏林,爱尔兰)治疗胼周动脉动脉瘤的患者,且至少有 1 次随访血管造影。评估了技术可行性、手术并发症、血管造影结果和临床结果。
所有患者均成功放置 Pipeline 栓塞装置,无手术并发症证据。7 例患者中有 5 例在 6-12 个月的随访血管造影中显示完全动脉瘤闭塞。2 例仍存在动脉瘤显影的患者,其动脉瘤瘤腔体积在随访中减少(96%和 60%)。无植入物内狭窄或内膜增生的证据。在随访期间,没有发生血栓栓塞或出血性并发症。只有 1 例患者因不同的非相关手术导致改良 Rankin 量表评分基线后短暂变化。
我们的初步结果表明,血流导向支架治疗胼周动脉动脉瘤是可行的,其动脉瘤闭塞率与文献报道相当,且无增加的手术或短期发病率的证据。需要进行长期和更大队列的研究来验证我们的发现。