Mahajan Anshu, Das Biplab, Narang Karanjit Singh, Jha Ajaya Nand, Singh Varindera Paul, Sapra Harsh, Goel Gaurav
Department of Neurointerventional surgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
Department of Neurosurgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
World Neurosurg. 2018 Dec;120:e1061-e1070. doi: 10.1016/j.wneu.2018.09.011. Epub 2018 Sep 11.
Use of a Surpass flow diverter (FD) device in the treatment of acutely ruptured aneurysm has not been well studied and reported in the literature.
We retrospectively reviewed patients with subarachnoid hemorrhage who were treated by Surpass FD placement at our hospital between June 2016 and March 2018. Detailed analysis of medical records was performed to obtain patient age, gender, clinical history, Hunt and Hess grade, Fisher grade, results of radiographic and procedural details including technical success and complication, clinical outcome, and follow-up angiographic results.
Our search identified 16 patients with 16 aneurysms who were treated with Surpass FD, of which 13 aneurysms (81%) were in the anterior circulation and 3 (19%) were in the posterior circulation. Aneurysm size ranged from 1.1 to 16 mm, with a mean of 4 mm. The mean delay between subarachnoid hemorrhage and endovascular treatment was 5 days (range, 3-20 days). Only 1 Surpass FD was used in each patient, ranging in size from 3 × 25 mm to 4 × 50 mm. Fifteen patients (94%) achieved favorable clinical outcome (modified Rankin Scale score 0-1) at 3 months. One patient died of invasive fungal infection. Angiographic follow-up results were assessed by O'Kelly-Marotta grading scale in 15 surviving patients and showed a grade D result (no filling) in 13/15 aneurysms (87%) at 3 and 6 months.
A Surpass FD device is a feasible option for the treatment of ruptured intracranial aneurysms that are difficult to treat by conventional clipping and coiling; however, larger and comparative studies with long-term follow-up are needed to confirm its safety and efficacy.
在急性破裂动脉瘤的治疗中使用Surpass血流导向装置（FD）尚未得到充分研究且文献报道较少。
我们回顾性分析了2016年6月至2018年3月在我院接受Surpass FD置入治疗的蛛网膜下腔出血患者。对病历进行详细分析，以获取患者的年龄、性别、临床病史、Hunt和Hess分级、Fisher分级、影像学及手术细节结果，包括技术成功率和并发症、临床结局以及随访血管造影结果。
我们的检索共纳入16例接受Surpass FD治疗的动脉瘤患者，其中13例（81%）动脉瘤位于前循环，3例（19%）位于后循环。动脉瘤大小为1.1至16毫米，平均4毫米。蛛网膜下腔出血至血管内治疗的平均延迟时间为5天（范围3至20天）。每位患者仅使用1个Surpass FD，尺寸范围为3×25毫米至4×50毫米。15例患者（94%）在3个月时获得良好临床结局（改良Rankin量表评分0 - 1）。1例患者死于侵袭性真菌感染。15例存活患者通过O'Kelly - Marotta分级量表评估血管造影随访结果，显示在3个月和6个月时，13/15例（87%）动脉瘤为D级结果（无显影）。
对于常规夹闭和栓塞治疗困难的破裂颅内动脉瘤，Surpass FD装置是一种可行的治疗选择；然而，需要更大规模的长期对照研究来证实其安全性和有效性。
