Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.
Department of Neurology, The First Hospital of Jilin University, Changchun, China.
Neuroradiol J. 2020 Dec;33(6):451-464. doi: 10.1177/1971400920953299. Epub 2020 Aug 27.
Though flow diverter is a safe and efficient modality, some patients can experience delayed aneurysmal rupture. The mechanism of delayed rupture is still obscure to us.
We performed a systematic search in the PubMed database for patients with delayed rupture of intracranial aneurysms after flow diverter placement.
A total of 36 articles reporting on 60 patients were included in the final analysis. Of the 49 patients with description of presenting symptoms, six (12.2%) patients were incidentally diagnosed, 39 (87.8%) patients were admitted for aneurysmal rupture or mass effect. Multiple flow diverters were used in 38.3% (18/47) of the patients. Coil assistance was applied in 13.0% (7/54) of the patients. Delayed aneurysmal rupture led to intracranial hemorrhage or carotid-cavernous sinus fistula (CCF) in 76.8% (43/56) and 23.2% (13/56) of the patients, respectively. Of the 55 patients with description of outcome, 14 (25.5%) patients achieved good recovery, one (1.8%) patient was severely disabled, 40 (72.7%) patients died. All of the patients in the CCF group survived and experienced good recovery.
Increased intra-aneurysmal pressure, destabilization of the aneurysm wall by intra-aneurysmal thrombus, persistent residual intra-aneurysmal flow, characteristics of the specific aneurysm, and mechanical injury by the flow diverter might conjointly contribute to the final delayed rupture. There has been no established preventive measure to decrease the incidence of delayed rupture yet. The treatment and outcome depend on the presentation of delayed rupture. Patients presenting with aneurysm-related intracranial hemorrhage have a dismal outcome. Those presenting with CCFs usually have a satisfactory recovery.
尽管血流导向装置是一种安全有效的治疗方法，但部分患者可能会出现迟发性动脉瘤破裂。目前我们对迟发性破裂的机制仍知之甚少。
我们在 PubMed 数据库中进行了系统检索，以查找接受血流导向装置治疗后发生迟发性颅内动脉瘤破裂的患者。
最终共有 36 篇文章、60 例患者纳入了分析。在描述首发症状的 49 例患者中，6 例（12.2%）为偶然发现，39 例（87.8%）因动脉瘤破裂或占位效应就诊。47 例患者使用了多个血流导向装置（38.3%），54 例患者中有 7 例（13.0%）接受了线圈辅助栓塞。76.8%（43/56）和 23.2%（13/56）的患者分别因迟发性动脉瘤破裂导致颅内出血或颈内动脉海绵窦瘘（CCF）。在有结局描述的 55 例患者中，14 例（25.5%）患者恢复良好，1 例（1.8%）患者严重残疾，40 例（72.7%）患者死亡。CCF 组所有患者均存活且恢复良好。
瘤内压力升高、瘤内血栓导致的动脉瘤壁不稳定、持续的瘤内残留血流、特定动脉瘤的特征以及血流导向装置的机械损伤可能共同导致迟发性破裂。目前尚无降低迟发性破裂发生率的既定预防措施。治疗和结局取决于迟发性破裂的表现。破裂与动脉瘤相关的颅内出血患者预后不良。出现 CCF 的患者通常恢复良好。
