Awad Al-Wala, Moon Karam, Yoon Nam, Mazur Marcus D, Kalani M Yashar S, Taussky Philipp, McDougall Cameron G, Albuquerque Felipe C, Park Min S
Department of Neurosurgery, University of Utah Health Care, Salt Lake City, Utah.
Barrow Neurological Institute, Phoenix, Arizona; and.
Neurosurg Focus. 2017 Jun;42(6):E10. doi: 10.3171/2017.2.FOCUS1731.
OBJECTIVE Flow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms. METHODS The authors conducted a retrospective review of flow diversion with the Pipeline embolization device (PED) for the treatment of tandem aneurysms in a single session at 2 participating medical centers: University of Utah, Salt Lake City, Utah, and Barrow Neurological Institute, Phoenix, Arizona. Patient demographic data, aneurysm characteristics, treatment strategy and results, complications, and follow-up data were collected from the medical record and analyzed. RESULTS Between January 2011 and December 2015, 17 patients (12 female, 5 male) with a total of 38 aneurysms (mean size 4.7 ± 2.7 mm, mean ± SD) were treated. Sixteen patients had aneurysms in the anterior circulation, and 1 patient had tandem aneurysms in the posterior circulation. Twelve patients underwent only placement of a PED, whereas 5 underwent adjunctive coil embolization of at least 1 aneurysm. One PED was used in each of 9 patients, and 2 PEDs were required in each of 8 patients. There were 2 intraprocedural complications; however, in both instances, the patients were asymptomatic at the last follow-up. The follow-up imaging studies were available for 15 patients at a mean of 7 months after treatment (216 days, range 0-540 days). The mean initial Raymond score after treatment was 2.7 ± 0.7, and the mean final score was 1.3 ± 0.7. CONCLUSIONS In this series, the use of flow diversion for the treatment of tandem cerebral aneurysms had an acceptable safety profile, indicating that it should be considered as an effective therapy for this complicated subset of patients. Further prospective studies must be performed before more definitive conclusions can be made.
目的 血流导向已被证明是治疗对其他治疗方法无效的脑动脉瘤的有效手段。接受血流导向治疗的串联动脉瘤患者已被纳入先前报道的更大系列研究中；然而，尚无关于在单次手术中使用该技术治疗这类特殊患者亚群的专门报道。因此，作者分析了接受单次血流导向治疗串联动脉瘤患者的治疗结果。方法 作者对在2个参与研究的医疗中心（犹他大学，盐湖城，犹他州；巴罗神经学研究所，凤凰城，亚利桑那州）进行的单次使用Pipeline栓塞装置（PED）进行血流导向治疗串联动脉瘤的情况进行了回顾性分析。从病历中收集患者人口统计学数据、动脉瘤特征、治疗策略及结果、并发症和随访数据并进行分析。结果 在2011年1月至2015年12月期间，共治疗了17例患者（12例女性，5例男性），总计38个动脉瘤（平均大小4.7±2.7mm，均值±标准差）。16例患者的动脉瘤位于前循环，1例患者的串联动脉瘤位于后循环。12例患者仅接受了PED置入，而5例患者至少对1个动脉瘤进行了辅助弹簧圈栓塞。9例患者各使用1个PED，8例患者各需要2个PED。术中发生2例并发症；然而，在这两例中，患者在最后一次随访时均无症状。15例患者在治疗后平均7个月（216天，范围0 - 540天）可获得随访影像学检查结果。治疗后初始Raymond评分的均值为2.7±0.7，最终评分均值为1.3±0.7。结论 在本系列研究中，使用血流导向治疗串联脑动脉瘤具有可接受的安全性，表明应将其视为治疗这类复杂患者亚群的有效疗法。在得出更明确的结论之前，必须进行进一步的前瞻性研究。
