Cohen José E, Henkes Hans, Gomori John Moshe, Rajz Gustavo, Leker Ronen
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
Neuroradiologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, Germany.
J Clin Med. 2021 Nov 11;10(22):5249. doi: 10.3390/jcm10225249.
Flow diversion is a promising option in selected patients with acutely ruptured microaneurysms. In this article, we reviewed our experience. Patients with acute spontaneous subarachnoid hemorrhage (SAH) after rupture of a blister-like or saccular microaneurysm (≤2 mm maximal diameter) at a nonbranching ICA site treated from January 2016 to June 2019 using flow diversion as standalone therapy were included in this study. An EVD was usually placed preventively. Antiplatelet effects of pre-procedure DAPT were evaluated (target PRU, 80-160). After the intervention, DAPT was continued for ≥6 months, aspirin-indefinitely. Angiographic controls were obtained. Fifteen patients (12 female; mean age, 46.4 years) with 15 ruptured ICA microaneurysms (mean diameter, 1.8 mm) were included. An EVD was placed in 12 patients (75%) before DAPT administration and stenting. PRU values immediately before FDS were 1-134 (mean, 72.1). One patient died 27 days after flow diversion due to a suspected fulminant pulmonary embolism. Aneurysms were completely occluded at the 6-12-month angiographic follow-up in 14/14 surviving patients, with no rebleeding at a mean of 14 months. Late mRS was 0-2 in 13/14 patients and 3 in one due to sequelae of the original hemorrhage. Flow diversion provided robust aneurysm rebleeding control. Angiographic follow-up confirmed complete aneurysm occlusion in all the cases.
血流导向术是治疗部分急性破裂微小动脉瘤患者的一种有前景的选择。在本文中，我们回顾了我们的经验。纳入2016年1月至2019年6月期间在非分支颈内动脉部位因水泡样或囊状微小动脉瘤（最大直径≤2mm）破裂导致急性自发性蛛网膜下腔出血（SAH）并采用血流导向术作为单一治疗方法的患者。通常预防性放置脑室外引流（EVD）。评估术前双联抗血小板治疗（DAPT）的抗血小板效果（目标血小板反应单位[PRU]，80 - 160）。干预后，继续进行DAPT治疗≥6个月，阿司匹林持续服用。进行血管造影复查。纳入15例患者（12例女性；平均年龄46.4岁），有15个破裂的颈内动脉微小动脉瘤（平均直径1.8mm）。12例患者（75%）在进行DAPT治疗和支架置入术前放置了EVD。血流导向装置（FDS）置入前PRU值为1 - 134（平均72.1）。1例患者在血流导向术后27天因疑似暴发性肺栓塞死亡。在14例存活患者的6 - 12个月血管造影随访中，动脉瘤完全闭塞，平均14个月时无再出血。14例患者中有13例末次改良Rankin量表（mRS）评分为0 - 2分，1例因原出血后遗症评分为3分。血流导向术能有效控制动脉瘤再出血。血管造影随访证实所有病例动脉瘤均完全闭塞。
