Dodier Philippe, Frischer Josa M, Wang Wei-Te, Auzinger Thomas, Mallouhi Ammar, Serles Wolfgang, Gruber Andreas, Knosp Engelbert, Bavinzski Gerhard
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
World Neurosurg. 2018 May;113:e568-e578. doi: 10.1016/j.wneu.2018.02.096. Epub 2018 Feb 23.
To report long-term results after Pipeline Embolization Device (PED) implantation, characterize complex and standard aneurysms comprehensively, and introduce a modified flow disruption scale.
We retrospectively reviewed a consecutive series of 40 patients harboring 59 aneurysms treated with 54 PEDs. Aneurysm complexity was assessed using our proposed classification. Immediate angiographic results were analyzed using previously published grading scales and our novel flow disruption scale.
According to our new definition, 46 (78%) aneurysms were classified as complex. Most PED interventions were performed in the paraophthalmic and cavernous internal carotid artery segments. Excellent neurologic outcome (modified Rankin Scale 0 and 1) was observed in 94% of patients. Our data showed low permanent procedure-related mortality (0%) and morbidity (3%) rates. Long-term angiographic follow-up showed complete occlusion in 81% and near-total obliteration in a further 14%. Complete obliteration after deployment of a single PED was achieved in all standard aneurysms with 1-year follow-up. Our new scale was an independent predictor of aneurysm occlusion in a multivariable analysis. All aneurysms with a high flow disruption grade showed complete occlusion at follow-up regardless of PED number or aneurysm complexity.
Treatment with the PED should be recognized as a primary management strategy for a highly selected cohort with predominantly complex intracranial aneurysms. We further show that a priori assessment of aneurysm complexity and our new postinterventional angiographic flow disruption scale predict occlusion probability and may help to determine the adequate number of per-aneurysm devices.
报告Pipeline栓塞装置（PED）植入后的长期结果，全面描述复杂和标准动脉瘤的特征，并引入一种改良的血流中断分级标准。
我们回顾性分析了连续40例患者，这些患者共59个动脉瘤接受了54枚PED治疗。使用我们提出的分类方法评估动脉瘤的复杂性。采用先前发表的分级标准和我们新的血流中断分级标准分析即刻血管造影结果。
根据我们的新定义，46个（78%）动脉瘤被分类为复杂动脉瘤。大多数PED干预操作在眼动脉段和海绵窦段颈内动脉进行。94%的患者获得了良好的神经功能结局（改良Rankin量表评分为0和1）。我们的数据显示永久性手术相关死亡率低（0%），发病率也低（3%）。长期血管造影随访显示81%的动脉瘤完全闭塞，另有14%接近完全闭塞。所有标准动脉瘤在1年随访时，植入单枚PED后均实现完全闭塞。在多变量分析中，我们的新分级标准是动脉瘤闭塞的独立预测因素。所有血流中断分级高的动脉瘤在随访时均显示完全闭塞，无论PED数量或动脉瘤复杂性如何。
对于主要为复杂颅内动脉瘤的高度选择的患者群体，PED治疗应被视为主要的治疗策略。我们进一步表明，对动脉瘤复杂性的先验评估以及我们新的介入后血管造影血流中断分级标准可预测闭塞概率，并可能有助于确定每个动脉瘤所需的合适装置数量。
