Adeeb N, Moore J M, Griessenauer C J, Foreman P M, Shallwani H, Dmytriw A A, Shakir H, Siddiqui A H, Levy E I, Davies J M, Harrigan M R, Thomas A J, Ogilvy C S
From the Neurosurgical Service (N.A., J.M.M., C.J.G., A.A.D., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama.
AJNR Am J Neuroradiol. 2017 Aug;38(8):1605-1609. doi: 10.3174/ajnr.A5221. Epub 2017 May 18.
Tandem aneurysms are defined as multiple aneurysms located in close proximity on the same parent vessel. Endovascular treatment of these aneurysms has rarely been reported. Our aim was to evaluate the safety and efficacy of a single Pipeline Embolization Device for the treatment of tandem aneurysms of the internal carotid artery.
A retrospective analysis of consecutive aneurysms treated with the Pipeline Embolization Device between 2009 and 2016 at 3 institutions in the United States was performed. Cases included aneurysms of the ICA treated with a single Pipeline Embolization Device, and they were divided into tandem versus solitary. Angiographic and clinical outcomes were compared.
The solitary group (median age, 58 years) underwent 184 Pipeline Embolization Device procedures for 184 aneurysms. The tandem group (median age, 50.5 years) underwent 34 procedures for 78 aneurysms. Aneurysms were primarily located along the paraophthalmic segment of the ICA in both the single and tandem groups (72.3% versus 78.2%, respectively, = .53). The median maximal diameters in the solitary and tandem groups were 6.2 and 6.7 mm, respectively. Complete occlusion on the last angiographic follow-up was achieved in 75.1% of aneurysms in the single compared with 88.6%% in the tandem group ( = .06). Symptomatic thromboembolic complications were encountered in 2.7% and 8.8% of procedures in the single and tandem groups, respectively ( = .08).
Tandem aneurysms of the ICA can be treated with a single Pipeline Embolization Device with high rates of complete occlusion. While there appeared to be a trend toward higher thromboembolic complication rates, this did not reach statistical significance.
串联动脉瘤定义为位于同一母血管上且位置紧邻的多个动脉瘤。关于这些动脉瘤的血管内治疗鲜有报道。我们的目的是评估使用单一密网支架（Pipeline Embolization Device）治疗颈内动脉串联动脉瘤的安全性和有效性。
对2009年至2016年间美国3家机构使用密网支架治疗的连续性动脉瘤病例进行回顾性分析。病例包括使用单一密网支架治疗的颈内动脉动脉瘤，并分为串联型与孤立型。比较血管造影和临床结果。
孤立型组（中位年龄58岁）对184个动脉瘤进行了184次密网支架手术。串联型组（中位年龄50.5岁）对78个动脉瘤进行了34次手术。单发型和串联型组的动脉瘤主要位于颈内动脉眼段旁（分别为72.3%和78.2%，P = 0.53）。孤立型组和串联型组的最大直径中位数分别为6.2和6.7毫米。末次血管造影随访时，孤立型组75.1%的动脉瘤实现完全闭塞，而串联型组为88.6%（P = 0.06）。孤立型组和串联型组手术中出现症状性血栓栓塞并发症的比例分别为2.7%和8.8%（P = 0.08）。
颈内动脉串联动脉瘤可用单一密网支架治疗，完全闭塞率较高。虽然血栓栓塞并发症发生率似乎有升高趋势，但未达到统计学意义。
