Aguilar Pérez Marta, Henkes Elina, Hellstern Victoria, Serna Candel Carmen, Wendl Christina, Bäzner Hansjörg, Ganslandt Oliver, Henkes Hans
Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.
Institut für Röntgendiagnostik, Zentrum für Neuroradiologie, Universitätsklinikum Regensburg, Regensburg, Germany.
Oper Neurosurg (Hagerstown). 2021 Mar 15;20(4):355-363. doi: 10.1093/ons/opaa425.
Flow diverters have become an important tool in the treatment of intracranial aneurysms, especially when dealing with difficult-to-treat or complex aneurysms. The p64 is the only fully resheathable and mechanically detachable flow diverter available for clinical use.
To evaluate the safety and effectiveness of p64 for the treatment of intracranial saccular unruptured aneurysms arising from the anterior circulation over a long-term follow-up period.
We retrospectively reviewed our prospectively maintained database to identify all patients who underwent treatment for an intracranial saccular (unruptured or beyond the acute hemorrhage phase) aneurysm arising from the anterior circulation with ≥1 p64 between December 2011 and December 2019. Fusiform aneurysms and dissections were excluded. Aneurysms with prior or concomitant saccular treatment (eg, coiling and clipping) were included. Aneurysms with parent vessel implants other than p64 were excluded. Anatomic features, intraprocedural complications, clinical outcome, as well as clinical and angiographic follow-ups were all recorded.
In total, 530 patients (388 females; median age 55.9 yr) with 617 intracranial aneurysms met the inclusion criteria. The average number of devices used per aneurysm was 1.1 (range 1-3). Mean aneurysm dome size was 4.8 mm (range 1-27 mm). Treatment-related morbimortality was 2.4%. Early, mid-term, and long-term angiographic follow-up showed complete or near-complete aneurysm occlusion in 76.8%, 89.7%, and 94.5%, respectively.
Treatment of intracranial saccular unruptured aneurysms of the anterior circulation using p64 is a safe and effective treatment option with high rate of occlusion at long-term follow-up and low morbimortality.
血流导向装置已成为治疗颅内动脉瘤的重要工具，尤其是在处理难以治疗或复杂的动脉瘤时。p64是唯一可完全重新鞘内插入且可机械拆卸的用于临床的血流导向装置。
评估p64治疗前循环未破裂颅内囊状动脉瘤的长期安全性和有效性。
我们回顾性分析了前瞻性维护的数据库，以确定2011年12月至2019年12月期间所有接受≥1枚p64治疗前循环颅内囊状（未破裂或超过急性出血期）动脉瘤的患者。排除梭形动脉瘤和夹层动脉瘤。包括先前或同时进行囊状治疗（如栓塞和夹闭）的动脉瘤。排除除p64外有母血管植入物的动脉瘤。记录解剖特征、术中并发症、临床结果以及临床和血管造影随访情况。
共有530例患者（388例女性；中位年龄55.9岁）的617个颅内动脉瘤符合纳入标准。每个动脉瘤使用的装置平均数量为1.1（范围1 - 3）。动脉瘤瘤顶平均大小为4.8 mm（范围1 - 27 mm）。治疗相关的病死率为2.4%。早期、中期和长期血管造影随访显示动脉瘤完全或接近完全闭塞的比例分别为76.8%、89.7%和94.5%。
使用p64治疗前循环未破裂颅内囊状动脉瘤是一种安全有效的治疗选择，长期随访闭塞率高且病死率低。
