Department of Radiology and Neuroradiology, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany.
Department of Neuroradiology, University Hospital of Aachen, 52074, Aachen, Germany.
Clin Neuroradiol. 2019 Jun;29(2):295-301. doi: 10.1007/s00062-017-0660-2. Epub 2018 Jan 9.
The Barrel device is an electrolytically detachable laser cut, closed-cell microstent that is used for neck reconstruction in wide-necked bifurcation and branching aneurysms to support coiling. The key feature is a barrel section that herniates over the aneurysmal ostium. The objective was to evaluate the safety, feasibility and the immediate and mid-term occlusion results of this new device.
The databases of two tertiary care centers were screened for all Barrel-based stent-assisted intracranial coil embolization of wide-necked aneurysms between June 2015 and September 2016. Case files and imaging data were retrospectively analyzed for angiographic and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications.
A total of 21 patients comprising 21 intracranial aneurysms (20 unruptured, 1 ruptured) were treated with the Barrel device and additional coiling of the aneurysm sac. All aneurysms were wide-necked, saccular bifurcation aneurysms defined by a dome/neck ratio ≤2. Immediate complete occlusion (RROC1) was observed in 19/21 (90%). An intra-interventional in-stent thrombus formation in two cases (10%) was medically resolved without neurological sequelae. A single case of symptomatic in-stent stenosis (5%) was cleared by balloon angioplasty. Follow-up (FU) was available in 20/21 cases (95%) after a median of 282 days (range: 17-591 days). At follow-up 19/20 aneurysms (95%) were completely occluded (RROC1).
The Barrel device showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms, warranting further investigation of the device.
Barrel 装置是一种电解可分离的激光切割、闭孔微支架，用于在宽颈分叉和分支动脉瘤中进行颈部重建，以支持线圈填塞。其关键特征是突出于动脉瘤口的桶状部分。目的是评估这种新装置的安全性、可行性以及即刻和中期闭塞结果。
2015 年 6 月至 2016 年 9 月，我们筛选了两家三级护理中心的数据库，以寻找所有基于 Barrel 的支架辅助颅内线圈栓塞治疗宽颈动脉瘤的病例。回顾性分析病例档案和影像学资料，以评估血管造影和临床结果参数，包括即刻和中期改良 Raymond-Roy 动脉瘤闭塞分类（RROC）率和手术并发症。
共 21 例患者（21 个颅内动脉瘤）接受了 Barrel 装置治疗和动脉瘤囊额外线圈填塞。所有动脉瘤均为宽颈、囊状分叉动脉瘤，定义为穹顶/颈部比≤2。21 个动脉瘤中有 19 个（90%）即刻完全闭塞（RROC1）。2 例（10%）术中支架内血栓形成经药物治疗后无神经后遗症。1 例症状性支架内狭窄（5%）经球囊血管成形术清除。21 例中有 20 例（95%）获得了中位数为 282 天（范围：17-591 天）的随访。随访时，20 个动脉瘤中的 19 个（95%）完全闭塞（RROC1）。
Barrel 装置在支架辅助线圈栓塞治疗宽颈颅内分叉动脉瘤的即刻和中期完全闭塞方面具有良好的安全性和令人鼓舞的效果，值得进一步研究该装置。
