Volker Maus, Anastasios Mpotsaris, Jan Borggrefe, Nuran Abdullayev, Thomas Liebig, Franziska Dorn, Pantelis Stavrinou, De-Hua Chang, Christoph Kabbasch
Department of Diagnostic and Interventional Neuroradiology, University Hospital Cologne, Cologne, Germany.
Department of Neuroradiology, Charité, Berlin, Germany.
Neurointervention. 2018 Mar;13(1):32-40. doi: 10.5469/neuroint.2018.13.1.32. Epub 2018 Mar 2.
The aim of this study was to evaluate the technical feasibility and rate of mid-term occlusion in aneurysms treated solely with the Pipeline Embolization Device (PED) in a German tertiary care university hospital.
Forty-nine non-consecutive intracranial aneurysms underwent endovascular treatment using the PED exclusively between March 2011 and May 2017 at our institution. Primary endpoint was a favorable aneurysm occlusion defined as OKM C1-3 and D (O'Kelly Marotta Scale). Secondary endpoints were retreatment rate and delayed complications. Median follow-up was 200 days.
The mean aneurysm size was 7.1 ± 5.3 mm. Forty-four aneurysms were located in the anterior circulation (90%). Ten aneurysms were ruptured (20%). Branching vessels from the sac were observed in 11 aneurysms (22%). Favorable obliteration immediately after PED placement was seen in 13/49 aneurysms (27%), of those nine aneurysms were completely occluded (18%). Angiographic and clinical follow-up was available for 45 cases (92%); 36/45 aneurysms (80%) were occluded completely and 40/45 aneurysms (89%) showed a favorable occlusion result. A branching vessel arising from the aneurysm sac was associated with incomplete occlusion (P < .05). All electively treated patients had good outcome (mRS 0). Three aneurysms (6%) required additional treatment due to aneurysm recurrence.
In our series, treatment of intracranial aneurysms with the PED was associated with favorable occlusion rates and low complication rates at mid-term follow-up. The presence of branching vessels arising from the aneurysms sac was predictive for an incomplete occlusion.
本研究旨在评估在德国一家三级护理大学医院中，仅使用Pipeline栓塞装置（PED）治疗动脉瘤的技术可行性和中期闭塞率。
2011年3月至2017年5月期间，我们机构对49例非连续性颅内动脉瘤仅采用PED进行血管内治疗。主要终点是定义为OKM C1-3和D（奥凯利·马罗塔量表）的良好动脉瘤闭塞。次要终点是再治疗率和延迟并发症。中位随访时间为200天。
动脉瘤平均大小为7.1±5.3mm。44个动脉瘤位于前循环（90%）。10个动脉瘤破裂（20%）。在11个动脉瘤（22%）中观察到瘤囊分支血管。PED置入后立即出现良好闭塞的有13/49个动脉瘤（27%），其中9个动脉瘤完全闭塞（18%）。45例（92%）有血管造影和临床随访；36/45个动脉瘤（约80%）完全闭塞，40/45个动脉瘤（约89%）显示良好的闭塞结果。来自动脉瘤瘤囊的分支血管与闭塞不完全相关（P<0.05）。所有择期治疗的患者预后良好（改良Rankin量表评分为0）。3个动脉瘤（6%）因动脉瘤复发需要额外治疗。
在我们的系列研究中，使用PED治疗颅内动脉瘤在中期随访时具有良好的闭塞率和低并发症发生率。来自动脉瘤瘤囊的分支血管的存在预示着闭塞不完全。
