Department of Neuroscience, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Neuroradiological Unit, University of Turin, Turin, Italy.
Department of Interventional Radiology and Neuroradiology, S. Giovanni Bosco Hospital, Turin, Italy.
Neuroradiology. 2022 Oct;64(10):2031-2037. doi: 10.1007/s00234-022-03003-x. Epub 2022 Jun 30.
Flow diversion changed the approach to complex intracranial aneurysms, leading to a widespread use and a rapid technological evolution. Indeed, indications continued to expand, including ruptured intracranial aneurysms in selected cases. Recently, new devices have been designed specifically to target smaller vessels. Therefore, we conducted a multicenter study to evaluate clinical outcome, complications, and occlusion rate of patients with ruptured aneurysms treated with new generation low profile Silk Vista Baby (SVB) flow diverter stent (FD).
We performed a retrospective observational study on consecutive patients who underwent treatment with SVB for ruptured aneurysms at 12 Italian centers. Primary end point was favorable clinical outcome rate, defined as modified ranking score (mRS) of 0-2 at the 3 months. Secondary outcomes were complication rate, aneurysm re-rupture, and complete aneurysm occlusion at last radiological follow-up.
Twenty-five patients were included; at 3 months' follow-up, 19 patients (79.1%) had favorable clinical outcome (mRS 0-2). Three patients (12.5%) died during follow-up. In-stent thrombosis occurred in two cases (8.3%), managed with glycoprotein IIb/IIIA and intra-stent angioplasty, without clinical consequences. In 18 (85.7%) patients, complete occlusion at 3 months was demonstrated. No rebleeding occurred during follow-up. Presentation with unfavorable World Federation of Neurosurgical Societies grading system (WFNS) and posterior circulation location were both significantly correlated with unfavorable clinical outcome (p = 0.005 and p = 0.02).
Our data suggests that low profile FD treatment of ruptured intracranial aneurysms located distally of the circle of Willis is feasible. New generation low profile FD may represent an alternative option in carefully selected cases.
血流导向装置改变了复杂颅内动脉瘤的治疗方法，导致其广泛应用和快速技术发展。事实上，适应证不断扩大，包括某些情况下的破裂颅内动脉瘤。最近，专门设计了新的装置来针对更小的血管。因此，我们进行了一项多中心研究，以评估用新一代低轮廓 Silk Vista Baby（SVB）血流导向装置（FD）治疗破裂动脉瘤患者的临床结果、并发症和闭塞率。
我们对 12 个意大利中心连续接受 SVB 治疗破裂动脉瘤的患者进行了回顾性观察性研究。主要终点是良好的临床结果率，定义为 3 个月时改良 Rankin 量表（mRS）为 0-2。次要结局为并发症发生率、动脉瘤再破裂和最后影像学随访时完全动脉瘤闭塞。
共纳入 25 例患者；在 3 个月的随访中，19 例（79.1%）患者具有良好的临床结果（mRS 0-2）。3 例（12.5%）患者在随访期间死亡。支架内血栓形成发生在 2 例（8.3%）中，采用糖蛋白 IIb/IIIa 和支架内血管成形术治疗，无临床后果。18 例（85.7%）患者在 3 个月时完全闭塞。随访期间无再出血。不良的世界神经外科学会分级系统（WFNS）表现和后循环部位与不良的临床结果显著相关（p=0.005 和 p=0.02）。
我们的数据表明，位于 Willis 环远端的低轮廓 FD 治疗破裂颅内动脉瘤是可行的。新一代低轮廓 FD 可能是在仔细选择的病例中的另一种选择。
