Giorgianni Andrea, Vinacci Gabriele, Agosti Edoardo, Molinaro Stefano, Terrana Alberto Vito, Casagrande Federica, Vizzari Francesco Alberto, Baruzzi Fabio, Locatelli Davide
ASST Settelaghi, Ospedale di Circolo e Fondazione Macchi, Department of Neuroradiology, Varese, Italy.
Turk Neurosurg. 2022;32(1):160-165. doi: 10.5137/1019-5149.JTN.33423-20.3.
To discuss the use of flow modulation in treating ruptured aneurysms of the proximal segment of the anterior cerebral artery (A1 aneurysms). A1 aneurysms are rare, constituting approximately 1% of all intracranial aneurysms.
We report a left A1 aneurysm with a wide neck and small sac (3 × 1.8 mm). In order to treat the lesion, a flow diverter (4 × 12?18 mm, FRED, Microvention) was placed from M1 to the proximal end of the paraophthalmic internal carotid artery, without directly covering the neck of the aneurysm. No procedural bleeding occurred. During stent deployment, abciximab was infused. A day after the procedure, double antiplatelet therapy was initiated for 1 month, followed by single antiplatelet therapy for another 3 months. Due to the aneurysm morphology, we opted for a competitive flow diversion, covering the parent artery origin and leaving the A1A neck uncovered. A decreased flow into the aneurysmal parent artery gradually promoted aneurysm sac thrombosis. Both digital subtraction angiography at a 12-month follow-up and computed tomography angiography 24-month follow-up confirmed the regular patency of the stent and resolution of the aneurysm. In addition, the competitive modulation of flow in the ipsilateral anterior cerebral artery results in the narrowing of the vessel.
A1 aneurysm endovascular treatment is often challenging. Coiling or assisted coiling is the most frequently employed. Although flow diverter stent (FDS) is a consolidated technique for treating ruptured intracranial blister-like and dissecting aneurysms, its role in treating intracranial saccular ruptured aneurysms has to be elucidated. However, more number of case studies is needed to confirm the efficacy and safety of an FDS in treating ruptured A1 aneurysms.
探讨血流调节在治疗大脑前动脉近端破裂动脉瘤（A1段动脉瘤）中的应用。A1段动脉瘤较为罕见，约占所有颅内动脉瘤的1%。
我们报告一例左侧A1段动脉瘤，瘤颈宽且瘤囊小（3×1.8毫米）。为治疗该病变，将一个血流导向装置（4×12 - 18毫米，FRED，Microvention公司）从M1段放置至眼段颈内动脉近端，未直接覆盖动脉瘤颈。术中未发生出血。在支架置入过程中，输注了阿昔单抗。术后一天开始进行为期1个月的双联抗血小板治疗，随后再进行3个月的单联抗血小板治疗。鉴于动脉瘤形态，我们选择了竞争性血流导向，覆盖载瘤动脉起始部，使A1A段瘤颈未被覆盖。流入动脉瘤载瘤动脉的血流减少逐渐促进瘤囊血栓形成。12个月随访时的数字减影血管造影和24个月随访时的计算机断层血管造影均证实支架通畅且动脉瘤消失。此外，同侧大脑前动脉血流的竞争性调节导致血管狭窄。
A1段动脉瘤的血管内治疗通常具有挑战性。最常用的方法是栓塞或辅助栓塞。尽管血流导向支架（FDS）是治疗颅内破裂水泡样和夹层动脉瘤的成熟技术，但其在治疗颅内囊状破裂动脉瘤中的作用仍有待阐明。然而，需要更多的病例研究来证实FDS治疗破裂A1段动脉瘤的有效性和安全性。
