Waqas Muhammad, Vakharia Kunal, Levy Bennett R, Housley Steven B, Dossani Rimal H, Gong Andrew, Cappuzzo Justin, Levy Elad I
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Brain Circ. 2020 Dec 29;6(4):274-279. doi: 10.4103/bc.bc_54_20. eCollection 2020 Oct-Dec.
Intraprocedural rupture (IPR) of an intracranial aneurysm is the most feared complication of primary and stent-assisted coiling because it carries a high risk of morbidity and mortality. The endovascular strategy applied to control IPR depends on the cause of the rupture and stage of the procedure. Rupture during primary or stent-assisted coiling is traditionally managed with the use of continued packing, balloon microcatheter placement, or in rare cases, with parent artery sacrifice. In this technical note, we describe the use of temporary coiling of the parent artery to control IPR in three cases. Temporary parent artery coiling creates a subocclusive state, resulting in aneurysmal blood flow reduction without interruption of blood flow to the distal territory. Flow reduction combined with the thrombogenicity of the previously deployed coils results in hemostasis. In the cases presented here, IPR occurred during the late stage of coiling. In each case, parent artery coiling was performed along with heparin reversal. After confirmation of hemostasis, the coils were retrieved to restore normal blood flow. We demonstrate that the technique of temporary parent artery coiling may be a safe and effective option for the management of IPR during primary or stent-assisted coiling.
颅内动脉瘤术中破裂（IPR）是原发性和支架辅助弹簧圈栓塞最可怕的并发症，因为它具有很高的发病和死亡风险。用于控制IPR的血管内策略取决于破裂原因和手术阶段。原发性或支架辅助弹簧圈栓塞过程中的破裂传统上采用持续填塞、球囊微导管置入，或在极少数情况下采用牺牲载瘤动脉的方法进行处理。在本技术报告中，我们描述了在三例病例中使用载瘤动脉临时弹簧圈栓塞来控制IPR的情况。载瘤动脉临时弹簧圈栓塞会造成次全闭塞状态，从而减少动脉瘤内的血流，同时不中断向远端区域的血流。血流减少与先前置入弹簧圈的致血栓性相结合可实现止血。在此处介绍的病例中，IPR发生在弹簧圈栓塞的后期。在每例病例中，均在进行载瘤动脉弹簧圈栓塞的同时逆转肝素抗凝作用。确认止血后，取出弹簧圈以恢复正常血流。我们证明，载瘤动脉临时弹簧圈栓塞技术可能是原发性或支架辅助弹簧圈栓塞过程中处理IPR的一种安全有效的选择。
