Zhang Yongxin, Huang Qing-Hai, Fang Yibin, Yang Pengfei, Xu Yi, Hong Bo, Liu Jianmin
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China.
Korean J Radiol. 2017 Sep-Oct;18(5):852-859. doi: 10.3348/kjr.2017.18.5.852. Epub 2017 Jul 17.
The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and occluding complex aneurysms. Retreatment of recurrent aneurysms using the FD is challenging. We report our initial experience in the repair of aneurysm recurrence with the FD.
A database was reviewed prospectively, and 8 patients with 8 recurrent aneurysms (mean size, 16.7 mm) were identified. Four aneurysms had previously ruptured. The previous aneurysm treatment consisted of coiling in 1 aneurysm and single-stent-assisted coiling in 7 aneurysms. The procedural complications and clinical and angiographic outcomes were analyzed.
Six aneurysms were treated by using a single Tubridge FD alone, while the remaining 2 were treated with FD + coiling. The immediate results of the 8 aneurysms were that they all showed incomplete occlusion. Neither major ischemic nor hemorrhagic complications occurred; however, 1 patient experienced a vasospasm. Follow-up angiographies were available for 7 aneurysms; the mean follow-up was 16.9 months (7-36 months). Five aneurysms were completely occluded, whereas 2 had a residual neck. Severe asymptomatic stenosis of 1 parent artery of a vertebral artery dissecting aneurysm was found. All visible branches covered by the FD were patent. All patients were clinically assessed as having attained a favorable outcome (modified Rankin Scale score ≤ 2) at discharge and follow-up.
In selected patients, the Tubridge FD can provide a safe and efficient option for the retreatment of recurrent aneurysms. Nevertheless, attention should be paid to several technical points.
Tubridge血流导向装置（FD）是一种旨在重建载瘤动脉并闭塞复杂动脉瘤的新型装置。使用FD对复发性动脉瘤进行再次治疗具有挑战性。我们报告了我们使用FD修复动脉瘤复发的初步经验。
对一个数据库进行前瞻性回顾，确定了8例患有8个复发性动脉瘤（平均大小为16.7毫米）的患者。4个动脉瘤先前已破裂。先前的动脉瘤治疗包括1个动脉瘤采用单纯弹簧圈栓塞，7个动脉瘤采用单支架辅助弹簧圈栓塞。分析了手术并发症以及临床和血管造影结果。
6个动脉瘤仅使用单个Tubridge FD进行治疗，其余2个采用FD +弹簧圈栓塞治疗。8个动脉瘤的即刻结果均显示为不完全闭塞。未发生重大缺血性或出血性并发症；然而，1例患者出现血管痉挛。7个动脉瘤有随访血管造影；平均随访时间为16.9个月（7 - 36个月）。5个动脉瘤完全闭塞，2个有残余瘤颈。发现1例椎动脉夹层动脉瘤的1条载瘤动脉存在严重无症状狭窄。FD覆盖的所有可见分支均通畅。所有患者在出院时及随访时经临床评估均获得良好预后（改良Rankin量表评分≤2）。
在选定的患者中，Tubridge FD可为复发性动脉瘤的再次治疗提供一种安全有效的选择。尽管如此，仍应注意几个技术要点。
