Hanihara Mitsuto, Yoshioka Hideyuki, Kanemaru Kazuya, Hashimoto Koji, Shimizu Masahiro, Nishigaya Kazuyuki, Fukamachi Akira, Kinouchi Hiroyuki
Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan.
Department of Neurosurgery, Kantoh Neurosurgical Hospital, Kumagaya, Japan.
World Neurosurg. 2019 Jun;126:e439-e446. doi: 10.1016/j.wneu.2019.02.070. Epub 2019 Feb 28.
Wrap-clipping is one of the recommended treatments for ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). However, the long-term clinical and angiographic outcomes of this procedure have not yet been elucidated. The present study examined the long-term efficacy of wrap-clipping using a polytetrafluoroethylene membrane, an ideal wrapping material, for BBAs.
The data from 9 patients with ruptured BBAs treated at our institutes from 2007 to 2016 were retrospectively analyzed. Wrap-clipping was performed with advanced monitoring techniques, including fluorescence video angiography and endoscopy. Angiographic follow-up was achieved using 3-dimensional computed tomography angiography or digital subtraction angiography. Clinical outcomes were assessed using the modified Rankin scale.
Wrap-clipping was performed without any permanent morbidity in all patients. Endoscopy visualized accurate margins of the aneurysmal pathological wall with high magnification and revealed the position of the clip blades and the surrounding perforators in the dead angles of the microscope. Fluorescence video angiography could confirm the blood flow of the ICA and the surrounding arteries. Regrowth of the aneurysm owing to the presence of a neck remnant occurred 1 month after treatment in 1 case that was repaired surgically. However, no other recurrence of BBAs or progression of ICA stenosis was observed by angiography with a mean follow-up period of 37 months. No repeat rupture or ischemic complications occurred, and all patients had a modified Rankin scale score of 0 with a mean follow-up period of 61 months.
Wrap-clipping using a polytetrafluoroethylene membrane for ruptured BBAs is a useful and acceptable procedure with long-term effectiveness. The effectiveness of this method can be ensured using modern monitoring methods.
包裹夹闭术是颈内动脉（ICA）血泡样动脉瘤（BBAs）破裂的推荐治疗方法之一。然而，该手术的长期临床和血管造影结果尚未阐明。本研究探讨了使用理想的包裹材料聚四氟乙烯膜对BBAs进行包裹夹闭术的长期疗效。
回顾性分析2007年至2016年在我们机构接受治疗的9例破裂BBAs患者的数据。采用荧光视频血管造影和内镜等先进监测技术进行包裹夹闭术。使用三维计算机断层扫描血管造影或数字减影血管造影进行血管造影随访。使用改良Rankin量表评估临床结果。
所有患者均顺利完成包裹夹闭术，无永久性并发症。内镜以高倍放大显示动脉瘤病理壁的准确边界，并揭示了夹片在显微镜死角处的位置以及周围穿支血管。荧光视频血管造影可确认ICA和周围动脉的血流情况。1例手术修复的患者在治疗后1个月因颈部残留而出现动脉瘤复发。然而，平均随访37个月的血管造影未观察到其他BBAs复发或ICA狭窄进展。无再次破裂或缺血性并发症发生，平均随访61个月时所有患者的改良Rankin量表评分为0。
使用聚四氟乙烯膜对破裂BBAs进行包裹夹闭术是一种有效且可接受的方法，具有长期有效性。使用现代监测方法可确保该方法的有效性。
