Department of Radiology, Hacettepe University Hospitals, 06100, Ankara, Turkey.
Department of Neurosurgery, Ankara Numune Hospital, Ankara, Turkey.
Clin Neuroradiol. 2018 Dec;28(4):585-592. doi: 10.1007/s00062-017-0609-5. Epub 2017 Jul 26.
Bioresorbable vascular scaffolds (BVS) have changed practice patterns in cardiology. These resorbable stents have not yet been utilized in the cerebrovascular circulation. We report the initial experiences with these devices in interventional neuroradiology.
A retrospective review of clinical presentations, imaging findings and follow-up results of all patients treated using a BVS by our neurovascular team was carried out using hospital electronic charts and the hospital radiographic archive system. Treatment was performed only if patients had a non-tortuous cerebrovascular anatomy suitable for navigation by the bulky BVS.
In this study 9 patients (5 women, mean age 51.3 years) were treated with Absorb or DeSolve scaffolds without permanent morbidity or mortality, 5 had intracranial or vertebral artery stenosis and in 4 patients with cerebral aneurysms scaffold-assisted coiling was performed. At a mean follow-up of 22.3 months, 1 parent artery in the aneurysm group was occluded and the remaining BVSs showed no significant restenosis. Fusiform luminal enlargement was demonstrated in one aneurysm patient. In two patients treated for stenosis, transient intra-arterial filling defects resembling BVS struts (scaffold silhouette) was demonstrated on early follow-up angiograms. In the patient with parent artery occlusion (who was judged to have unjailed the internal carotid bifurcation) and in the patient with luminal remodeling, we were able to discontinue all antiplatelet medications at 3 years without any consequences.
Absorbable stent technology has potential applications in interventional neuroradiology. We suggest that BVS should be optimized for cerebral circulation if prospective studies are to be undertaken for cerebrovascular applications of BVS.
生物可吸收血管支架（BVS）改变了心脏病学的实践模式。这些可吸收支架尚未在脑血管循环中使用。我们报告了我们的神经介入团队在介入神经放射学中使用这些器械的初步经验。
通过医院电子病历和医院放射影像存档系统，对我们的神经介入团队使用 BVS 治疗的所有患者的临床表现、影像学发现和随访结果进行回顾性分析。只有当患者具有适合大体积 BVS 导航的非扭曲性脑血管解剖结构时，才进行治疗。
本研究中，9 例患者（5 例女性，平均年龄 51.3 岁）接受了 Absorb 或 DeSolve 支架治疗，无永久性并发症或死亡率。其中 5 例为颅内或椎动脉狭窄，4 例为脑动脉瘤患者行支架辅助弹簧圈治疗。平均随访 22.3 个月后，动脉瘤组的 1 条母动脉闭塞，其余 BVS 未见明显再狭窄。1 例动脉瘤患者出现管腔梭形扩大。在 2 例因狭窄而接受治疗的患者中，早期随访血管造影显示短暂性动脉内充盈缺损，类似于 BVS 支架（支架轮廓）。在母动脉闭塞的患者（判断为颈内动脉分叉未再通）和管腔重塑的患者中，我们能够在 3 年内停用所有抗血小板药物，且无任何后果。
可吸收支架技术在介入神经放射学中有潜在的应用。如果要进行 BVS 在脑血管应用的前瞻性研究，我们建议应优化 BVS 以适应脑血管循环。
