Department of Biomedicine, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
Neuroradiology, Maurizio Bufalini Hospital, Cesena, Emilia-Romagna, Italy.
J Neurointerv Surg. 2020 Jul;12(7):688-694. doi: 10.1136/neurintsurg-2019-015558. Epub 2020 Feb 12.
The management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed.
We retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed.
Seven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt-Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3-72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up.
The best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.
破裂的后循环穿支动脉瘤（rPCPA）的治疗仍存在争议。我们介绍了使用血流导向装置（FD）治疗 rPCPA 的经验，并在中期至长期随访中评估其安全性和有效性。还提出了 rPCPA 的诊断和治疗算法。
我们回顾性分析了 2013 年 1 月至 2019 年 7 月期间，在我们机构接受 FD 治疗的所有连续 rPCPA 患者的数据。记录了临床表现、治疗时机、围手术期并发症以及临床和血管造影结果，并进行了中期至长期随访。还对使用 FD 治疗 rPCPA 的文献进行了系统回顾。
7 名患者的 7 个 rPCPA 接受了 FD 治疗。所有患者表现为非典型蛛网膜下腔出血分布和低至中度 Hunt-Hess 分级。初始血管造影显示 rPCPA 的比例为 29%。在 57%的病例中，FD 在诊断后 2 天内插入。即刻动脉瘤闭塞率为 14%，首次随访（平均 2.4 个月）为 71%。平均随访 33 个月（3-72 个月）时，发生 1 例迟发性缺血性并发症。6 名患者改良 Rankin 量表（mRS）评分 0 分，1 名患者末次随访 mRS 评分 4 分。
rPCPA 的最佳治疗方法仍不清楚，但 FD 似乎比其他治疗方法的并发症发生率更低。需要进一步的研究来证实 FD 在 rPCPA 中的作用。
