van Veenendaal Penelope, Maingard Julian, Kok Hong Kuan, Ranatunga Dinesh, Buckenham Tim, Chandra Ronil V, Lee Michael J, Brooks Duncan Mark, Asadi Hamed
Interventional Radiology Unit - Monash Imaging, Monash Health, Melbourne, Australia.
Interventional Neuroradiology Unit, Monash Health, Melbourne, Australia.
CVIR Endovasc. 2020 Jun 28;3(1):33. doi: 10.1186/s42155-020-00125-2.
Visceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular treatment is now first line in many centres, but preservation of arterial flow may be difficult in unfavourable anatomy including wide necked aneurysms, parent artery tortuosity and proximity to arterial bifurcations. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs. The CASPER stent is a low profile dual-layer braided nitinol stent designed for carotid stenting with embolic protection and flow-diversion properties. We report the novel use of the CASPER stent for the treatment of VRAAs. We present a case series describing the treatment of six patients with VRAAs using the CASPER stent.
Six patients with unruptured VRAAs were treated electively. There were three splenic artery aneurysms and three renalartery aneurysms. Aneurysms were treated with the CASPER stent, with or without loose aneurysm coil packing or liquid embolic depending on size and morphology. All stents were successfully deployed with no immediate or periprocedural complications. Four aneurysms completely occluded after serial imaging follow up with one case requiring repeat CASPER stenting for complete occlusion. In one patient a single aneurysm remained patent at last follow up, A single case was complicated by delated splenic infarction and surgical splenectomy.
Preliminary experience with the CASPER stent suggests it is technically feasible and effective for use in the treatment of VRAAs.
内脏和肾动脉动脉瘤（VRAAs）并不常见，但破裂时死亡率很高。目前，血管内治疗在许多中心是一线治疗方法，但在解剖结构不利的情况下，包括宽颈动脉瘤、母动脉迂曲以及靠近动脉分叉处，保留动脉血流可能很困难。血管内支架置入术，尤其是血流导向术，用于神经血管介入治疗颅内动脉瘤，但在VRAAs治疗中较少使用。CASPER支架是一种低轮廓双层编织镍钛诺支架，设计用于颈动脉支架置入术，具有栓塞保护和血流导向特性。我们报告了CASPER支架在VRAAs治疗中的新用途。我们展示了一个病例系列，描述了使用CASPER支架治疗6例VRAAs患者的情况。
6例未破裂的VRAAs患者接受了择期治疗。其中有3例脾动脉瘤和3例肾动脉瘤。根据动脉瘤的大小和形态，使用CASPER支架进行治疗，可联合或不联合松散的动脉瘤弹簧圈填塞或液体栓塞剂。所有支架均成功置入，无即刻或围手术期并发症。在系列影像学随访后，4例动脉瘤完全闭塞，1例患者需要再次置入CASPER支架以实现完全闭塞。在最后一次随访时，1例患者的单个动脉瘤仍保持通畅状态。1例患者出现延迟性脾梗死并接受了脾脏切除术。
CASPER支架的初步经验表明，其用于治疗VRAAs在技术上是可行且有效的。
