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用于治疗颅内动脉瘤的神经血管装置:新兴和未来技术。

Neurovascular devices for the treatment of intracranial aneurysms: emerging and future technologies.

机构信息

School of Medicine, European University of Cyprus, Nicosia, Cyprus.

Department of Interventional Neuroradiology, Henry Dunant Hospital, Athens, Greece.

出版信息

Expert Rev Med Devices. 2020 Mar;17(3):173-188. doi: 10.1080/17434440.2020.1733409.

Abstract

: Despite numerous advances in the endovascular treatment of intracranial aneurysms (IAs), treatment in cases of wide-neck, complex configurations or branching locations remains challenging. Apart from the paradigm shift introduced by flow diverters, several other devices have seen the light or are under development in order to address these challenges.: We performed a review of the novel implantable endovascular devices which have been introduced for the treatment of IAs, from 1 January 2014 to 1 September 2019, excluding classic flow diverter and intracranial stent designs.: Alternative designs have been proposed for the treatment of IAs at branching positions, which do not jail the side branches, with or without flow diversion effect, most of which with good initial outcomes. Endosaccular devices have also been proposed, some of which with lower initial total occlusion rates. Alternative materials such as biopolymers have also been proposed and are under bench research. Despite the challenges in the exploitation of some of the new devices, most of them seem to provide solutions to some current technical shortcomings. The exploitation of the biological phenomena and the physical properties of the devices will allow us to expand the therapeutic armamentarium for more complex IA cases.

摘要

尽管在颅内动脉瘤(IA)的血管内治疗方面取得了许多进展,但对于宽颈、复杂形态或分支部位的病例,治疗仍然具有挑战性。除了血流导向装置带来的范式转变外,为了应对这些挑战,还有其他几种设备已经问世或正在开发中。

我们回顾了 2014 年 1 月 1 日至 2019 年 9 月 1 日期间用于治疗颅内动脉瘤的新型植入式血管内装置,不包括经典的血流导向器和颅内支架设计。

已经提出了用于治疗分支部位动脉瘤的替代设计,这些设计不会限制侧支,有些具有或不具有血流导向作用,大多数具有良好的初始结果。也提出了血管内囊袋装置,其中一些初始完全闭塞率较低。还提出了替代材料,如生物聚合物,并正在进行基础研究。尽管一些新型设备的应用存在挑战,但它们中的大多数似乎为解决一些当前的技术缺陷提供了方案。对设备的生物学现象和物理特性的开发利用将使我们能够为更复杂的 IA 病例扩展治疗手段。

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