Bender Matthew T, Hurtado Christopher, Jiang Bowen, Campos Jessica K, Huang Judy, Tamargo Rafael J, Lin Li-Mei, Coon Alexander L, Colby Geoffrey P
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, University of California Irvine, Orange, California, USA.
Interv Neurol. 2018 Feb;7(1-2):110-117. doi: 10.1159/000485133. Epub 2017 Dec 16.
The prevalence of cerebral aneurysms is increased in fibromuscular dysplasia (FMD). The presence of FMD may serve as discouragement to elective endovascular aneurysm treatment. Outcomes of endovascular intervention for aneurysms through vessels affected by FMD have not been reported.
A prospectively maintained database of patients undergoing intracranial embolization was reviewed for patients with FMD who underwent endovascular aneurysm treatment.
A total of 1,025 patients were screened and 31 (3.0%) had cerebrovascular FMD. These patients underwent a total of 43 embolization procedures; 27 of these procedures were performed through an affected vessel. All but 1 patient were female and the average age was 62 years. "String-of-pearls"-type FMD was the most common subtype (90%). The internal carotid arteries were more commonly affected (65%) than the vertebral arteries (48%). All patients underwent treatment of cerebral aneurysms, most of which (87%) were incidentally discovered; 6 patients (19%) also had incidental vessel dissection. The average aneurysm size was 7.1 mm. The morphology was saccular in 93% of the cases, and 86% were in the anterior circulation. The most commonly performed treatment was flow diversion (67%), in the majority of cases by pipeline embolization. Other procedures performed were coiling (19%), stent-coiling (12%), and intrasaccular flow disruption (2%). All but 1 procedure (98%) were successful. There were no major complications; 1 patient experienced a transient ischemic attack. Follow-up angiography was performed in 88% of the cases, without evidence for disease progression after treatment. The average time to last angiographic follow-up was 17 months (±13).
Elective embolization of intracranial aneurysms can be performed safely through vessels affected by FMD.
纤维肌发育不良（FMD）患者中脑动脉瘤的患病率增加。FMD的存在可能不利于选择性血管内动脉瘤治疗。尚未有关于通过受FMD影响的血管进行动脉瘤血管内介入治疗的结果报道。
回顾前瞻性维护的接受颅内栓塞治疗患者的数据库，以查找接受血管内动脉瘤治疗的FMD患者。
共筛查了1025例患者，其中31例（3.0%）患有脑血管FMD。这些患者共接受了43次栓塞手术；其中27次手术是通过受影响的血管进行的。除1例患者外均为女性，平均年龄为62岁。“串珠样”型FMD是最常见的亚型（90%）。颈内动脉比椎动脉更常受累（65%对48%）。所有患者均接受了脑动脉瘤治疗，其中大多数（87%）是偶然发现的；6例患者（19%）还伴有偶然的血管夹层。动脉瘤平均大小为7.1mm。93%的病例形态为囊状，86%位于前循环。最常用的治疗方法是血流导向（67%），大多数情况下采用管道栓塞。其他手术方法包括弹簧圈栓塞（19%）、支架辅助弹簧圈栓塞（12%）和囊内血流阻断（2%）。除1例手术（98%）外均成功。无重大并发症；1例患者发生短暂性脑缺血发作。88%的病例进行了随访血管造影，治疗后无疾病进展的证据。最后一次血管造影随访的平均时间为17个月（±13）。
颅内动脉瘤的选择性栓塞可以通过受FMD影响的血管安全进行。
