Department of Neurosurgery, Juntendo University, Faculty of Medicine.
Department of Neuroendovascular Therapy, Juntendo University, Faculty of Medicine.
Neurol Med Chir (Tokyo). 2022 Oct 15;62(10):451-457. doi: 10.2176/jns-nmc.2022-0167. Epub 2022 Sep 6.
As of January 2021, the Surpass Streamline (SS) is the most recently approved flow diverter in Japan. A total of 28 Japanese patients, including 9 clinical trial patients, with 28 large or giant unruptured internal carotid artery (ICA) aneurysms, underwent SS embolization at Juntendo University Hospital. Procedural failure occurred in two patients due to the difficulty to navigate the device in the tortuous parent artery. Therefore, 26 patients with 26 aneurysms were available for clinical and anatomical assessments. Patients' mean age was 62.6 years (range 46-86), and 24 patients (92.3%) were female. Mean aneurysm size and neck width were 15.4 mm and 7.7 mm, respectively, with 20 saccular and 6 fusiform aneurysms. Seven aneurysms were symptomatic due to the aneurysmal mass effect. Twenty patients underwent a 6-month follow-up angiography to evaluate the degree of occlusion. Anatomical outcomes were 12 (60%) complete occlusion (CO), 4 (20%) residual neck (RN), and 4 (20%) residual aneurysm. Favorable aneurysm occlusion consisted of CO, and RN was achieved in 16 (80.0%). There were no significant device stenoses. Aneurysmal mass effect improved in one and was unchanged in eight patients. There were three device-related complications, namely, delayed aneurysm rupture, minor ischemic stroke, and device occlusion (11.5%). One patient with minor ischemic stroke fully recovered before 30 days, and our series showed 7.7% risk of major ipsilateral stroke and neurological death at 30 days. The SS embolization for large and giant unruptured ICA aneurysms offers satisfactory anatomical and clinical outcomes with a low risk of device-related complications.
截至 2021 年 1 月，Surpass Streamline（SS）是日本最近批准的血流导向装置。共有 28 名日本患者（包括 9 名临床试验患者）接受了 SS 栓塞治疗，这些患者均患有 28 个大型或巨大未破裂颈内动脉（ICA）动脉瘤。由于在迂曲的母动脉中导航设备困难，两名患者发生了手术失败。因此，26 名患者（26 个动脉瘤）可用于临床和解剖评估。患者的平均年龄为 62.6 岁（范围为 46-86 岁），24 名患者（92.3%）为女性。平均动脉瘤大小和颈部宽度分别为 15.4 毫米和 7.7 毫米，20 个为囊状，6 个为梭形。7 个动脉瘤因瘤体占位效应而出现症状。20 名患者接受了 6 个月的随访血管造影，以评估闭塞程度。解剖学结果为 12 个（60%）完全闭塞（CO）、4 个（20%）残余颈部（RN）和 4 个（20%）残余动脉瘤。有利的动脉瘤闭塞包括 CO 和 RN，达到 16 个（80.0%）。没有明显的器械狭窄。动脉瘤占位效应改善 1 例，8 例无变化。有 3 例与器械相关的并发症，即迟发性动脉瘤破裂、轻微缺血性中风和器械闭塞（11.5%）。1 例轻微缺血性中风患者在 30 天前完全恢复，我们的研究系列显示 30 天内同侧大卒中和神经死亡的风险为 7.7%。SS 栓塞治疗大型和巨大未破裂 ICA 动脉瘤，解剖学和临床结果满意，器械相关并发症风险低。
