The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK.
Neuroradiological Clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina.
Clin Neuroradiol. 2021 Mar;31(1):135-145. doi: 10.1007/s00062-019-00827-8. Epub 2019 Aug 21.
The use of flow diverters to treat aneurysms arising from small caliber parent vessels has been reported. This article reports the results of the first in experiences with the p48MW (p48 Movable Wire) in humans, a device specifically designed to target vessels 1.75-3 mm in diameter.
This monocentric study retrospectively reviewed the prospectively maintained database to identify all patients treated with the p48MW device between January 2017 and January 2019 at this institution. Patient demographics, aneurysm characteristics, angiographic and clinical follow-up were recorded as well as complications.
A total of 25 patients (20 female) with an average age of 55 ± 12.9 years (range 34-84) with 25 aneurysms were identified. The majority of the aneurysms was located in the anterior circulation (19/25, 76%). The average aneurysm dome width was 3.98 ± 3.6 mm (range 1.2-13 mm). Complete occlusion was seen in 18/24 (75%) aneurysms with neck remnants in 1/24 (4.2%) and continued aneurysm filling seen in the remaining cases (5/24, 20.8%). Adequate occlusion was seen in 79.2% of aneurysms (Raymond Roy Classification [RRC] grade I or II) during the follow-up period. There was a single technical complication with inappropriate deployment of the first p48MW. There was a single clinical complication (4%); however, the patient made a complete recovery (modified Rankin Scale [mRS] 0) and one patient died secondary to uncontrollable status epilepticus following acute subarachnoid hemorrhage unrelated to the treatment.
The p48MW is safe and effective for the treatment of aneurysms including those arising from distal vessels.
已有使用血流导向装置治疗起源于小口径载瘤动脉的动脉瘤的报道。本文报道了首例使用专门设计用于治疗 1.75-3mm 直径血管的 p48MW(p48 Movable Wire)的经验。
这项单中心研究回顾性分析了 2017 年 1 月至 2019 年 1 月期间该机构使用 p48MW 装置治疗的所有患者的前瞻性维护数据库。记录患者人口统计学、动脉瘤特征、血管造影和临床随访情况以及并发症。
共确定了 25 例(20 例女性)患者,平均年龄 55±12.9 岁(范围 34-84 岁),共 25 个动脉瘤。大多数动脉瘤位于前循环(19/25,76%)。平均动脉瘤瘤颈宽度为 3.98±3.6mm(范围 1.2-13mm)。24 个动脉瘤中,18 个(75%)完全闭塞,24 个中有 1 个(4.2%)瘤颈残留,其余病例(5/24,20.8%)继续出现动脉瘤内充盈。在随访期间,79.2%的动脉瘤(Raymond Roy 分级[RRC]Ⅰ或Ⅱ级)达到了充分的闭塞。有 1 例技术并发症(首次植入 p48MW 时不当放置),1 例临床并发症(4%),但患者完全恢复(改良 Rankin 量表[mRS]0 级),1 例患者因与治疗无关的急性蛛网膜下腔出血后无法控制的癫痫持续状态死亡。
p48MW 治疗动脉瘤是安全有效的,包括起源于远端血管的动脉瘤。