Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany.
Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany.
Neuroradiology. 2020 Aug;62(8):1019-1028. doi: 10.1007/s00234-020-02389-w. Epub 2020 Mar 5.
The management of residual or persistent intracranial aneurysms after flow-diversion therapy is not well defined in the literature. In this multicentric study, we report clinical and angiographic outcomes of 11 patients that underwent retreatment for 12 aneurysms initially treated with flow-diverter stents.
The median patient age was 53 years. Aneurysms (median size, 7.3 mm) were located at the internal carotid artery in 9 cases, and at the posterior circulation in 3. Treatment strategies, complications, and angiographic outcome were retrospectively assessed.
Retreatment was feasible in all cases and performed by overlapping flow-diverter implantation. Overall, 12 side vessels were covered during retreatment, whereof 10 (83.3%) remained patent until mid-term follow-up. There were no further technical or symptomatic complications and no treatment-related morbidity. Angiographic follow-up (median, 17 months) showed improved aneurysm occlusion in all patients. Complete or near-complete aneurysm occlusion was achieved in 11 aneurysms (91.7%).
Required retreatment after failed flow-diversion therapy can be performed with adequate safety and efficacy by placement of additional flow-diverter stents.
在文献中，对于血流导向装置治疗后残留或持续颅内动脉瘤的处理尚无明确规定。在这项多中心研究中，我们报告了 11 例患者的临床和血管造影结果，这些患者因 12 个动脉瘤而接受了再次治疗，这些动脉瘤最初采用血流导向装置支架治疗。
患者的中位年龄为 53 岁。9 例动脉瘤位于颈内动脉，3 例位于后循环。回顾性评估了治疗策略、并发症和血管造影结果。
所有病例均可行再次治疗，并通过重叠血流导向器植入进行。总体而言，在再次治疗过程中覆盖了 12 个侧支血管，其中 10 个（83.3%）在中期随访时仍然保持通畅。没有进一步的技术或症状性并发症，也没有与治疗相关的发病率。血管造影随访（中位数为 17 个月）显示所有患者的动脉瘤闭塞均得到改善。11 个动脉瘤（91.7%）达到完全或接近完全闭塞。
通过放置额外的血流导向器支架，可以安全有效地对血流导向装置治疗失败后的动脉瘤进行再次治疗。
