Kilburg Craig, Taussky Philipp, Kalani M Yashar S, Park Min S
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
Neurosurg Focus. 2017 Jun;42(6):E7. doi: 10.3171/2017.2.FOCUS1755.
The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion. A 40-year-old woman presented with a history of headaches that led to the identification of an unruptured Spetzler-Martin Grade V, right parietooccipital AVM associated with 3 aneurysms of the ipsilateral internal carotid artery. Initial attempts at balloon-assisted coil embolization of the aneurysms were unsuccessful. The patient underwent placement of a flow-diverting stent across the diseased vessel; a 6-month follow-up angiogram demonstrated complete occlusion of the aneurysms. In the second case, a 57-year-old man presented with new-onset seizures, and an unruptured Spetzler-Martin Grade V, right frontal AVM associated with an irregular, wide-necked anterior communicating artery aneurysm was identified. The patient underwent placement of a flow-diverting stent, and complete occlusion of the aneurysm was observed on a 7-month follow-up angiogram. These 2 cases illustrate the potential for use of flow diversion as a treatment strategy for feeding artery aneurysms associated with AVMs. Because of the need for dual antiplatelet medications after flow diversion in this patient population, however, this strategy should be used judiciously.
血流导向支架在颅内动脉瘤治疗中的应用越来越普遍，目前其使用范围已超出最初在颈内动脉近端的获批范围。尽管血流导向治疗脑动脉瘤越来越常见，但尚无关于其用于治疗与动静脉畸形（AVM）相关的血流相关性脑动脉瘤的报道。作者报告了2例采用血流导向治疗AVM相关动脉瘤的病例。一名40岁女性，有头痛病史，经检查发现未破裂的Spetzler-Martin Ⅴ级右侧顶枕部AVM，伴有同侧颈内动脉的3个动脉瘤。最初尝试对动脉瘤进行球囊辅助弹簧圈栓塞未成功。该患者在病变血管处植入了血流导向支架；6个月后的随访血管造影显示动脉瘤完全闭塞。在第二例中，一名57岁男性因新发癫痫就诊，发现未破裂的Spetzler-Martin Ⅴ级右侧额叶AVM，伴有一个不规则、宽颈的前交通动脉瘤。该患者接受了血流导向支架植入，7个月后的随访血管造影显示动脉瘤完全闭塞。这2例病例说明了血流导向作为治疗与AVM相关的供血动脉动脉瘤的一种治疗策略的潜力。然而，由于该患者群体在血流导向后需要使用双重抗血小板药物，因此应谨慎使用这一策略。
