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血流导向装置治疗手术治疗后残余和复发颅内动脉瘤。

Flow Diversion Therapy of Remnant and Recurrent Intracranial Aneurysms Treated Surgically.

机构信息

Istanbul Medipol University, International School of Medicine, Radiology Department, Interventional Neuroradiology Section, Istanbul, Turkey.

出版信息

Turk Neurosurg. 2023;33(4):601-609. doi: 10.5137/1019-5149.JTN.41653-22.2.

Abstract

AIM

To evaluate the safety and efficacy of flow diverter stents (FDSs) for treating remnant or recurrent intracranial aneurysms that were treated surgically.

MATERIAL AND METHODS

The patients who were treated with FDSs due to remnant or recurrent intracranial aneurysms after microsurgery were included in the study. The patients' demographics, treatment histories, aneurysm features, complications associated with flow diversion, and neurological and angiographic follow-up findings were evaluated.

RESULTS

Twenty patients (eight males) with 20 aneurysms were included in the study. Of 20 aneurysms, 18 (90%) were in the anterior, and two (10%) were in the posterior circulation. The initial treatment methods were clipping in 17 (85%) and wrapping in three (15%) aneurysms. The endovascular procedure was successful in all patients. In three patients (15%), periprocedural and postprocedural complications were encountered. No hemorrhagic complications were detected on cone-beam computed tomography. One patient with a basilary aneurysm died because of brain stem ischemia. The total morbimortality was 5%. The mean length of follow-up was 13.7 ± 7.3 months in 18 patients. The first angiographic follow-up (3-6 months) revealed the complete occlusion in 7 of 11 aneurysms (63.6%). By contrast, 16 aneurysms (94.1%) were occluded at the last angiographic follow-up, one aneurysm (5.9%) was still filling.

CONCLUSION

An FDS seems effective, safe, and extremely attractive in treating remnant and recurrent intracranial aneurysms treated surgically.

摘要

目的

评估血流导向装置(FDS)治疗显微手术后残留或复发的颅内动脉瘤的安全性和有效性。

材料和方法

本研究纳入了因显微手术后残留或复发颅内动脉瘤而接受 FDS 治疗的患者。评估了患者的人口统计学资料、治疗史、动脉瘤特征、与血流分流相关的并发症以及神经学和血管造影随访结果。

结果

本研究纳入了 20 例(8 例男性)20 个动脉瘤患者。20 个动脉瘤中,18 个(90%)位于前循环,2 个(10%)位于后循环。初始治疗方法为夹闭 17 个(85%),包裹 3 个(15%)动脉瘤。所有患者的血管内治疗均获得成功。3 例(15%)患者发生围手术期和术后并发症。锥形束 CT 未发现出血性并发症。1 例基底动脉瘤患者因脑干缺血死亡,总病死率为 5%。18 例患者的中位随访时间为 13.7±7.3 个月。11 个动脉瘤中有 7 个(63.6%)在首次血管造影随访(3-6 个月)时完全闭塞,而在最后一次血管造影随访时,16 个动脉瘤(94.1%)完全闭塞,1 个动脉瘤(5.9%)仍在显影。

结论

FDS 治疗显微手术后残留或复发的颅内动脉瘤安全有效,极具吸引力。

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