Boxberg Frederik, Al-Tibi Mohammad, Schulz Katharina, Lanfermann Heinrich, Schlunz-Hendann Martin, Grieb Dominik
Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Neurointervention. 2024 Jul;19(2):74-81. doi: 10.5469/neuroint.2024.00066. Epub 2024 Apr 18.
We report our initial experience with endovascular embolization of intracranial aneurysms using this new self-expanding open-cell stent system (pEGASUS stent system) with the antithrombogenic hydrophilic polymer coating.
We retrospectively reviewed all patients treated with stent-assisted coiling or the Woven EndoBridge device using the pEGASUS stent system between September 2022 and June 2023. Demographic, clinical, and angiographic data were analyzed as well as short-term follow-up, including procedural complication rates and aneurysmal occlusion rates using the Raymond-Roy occlusion classification (RROC).
Twelve patients with 12 wide-necked intracranial aneurysms were treated with the pEGASUS stent system, including 2 acutely ruptured aneurysms embolized in an emergency setting. The treated aneurysms were located at the anterior communicating artery (25.0%), the basilar artery (50.0%), the middle cerebral artery (16.7%), and the internal carotid artery (8.3%). All stents were deployed successfully. Immediate complete aneurysmal occlusion (RROC class I) was achieved in 83.3% (10/12) and near-complete occlusion (RROC II) in 16.7% (2/12). No periprocedural complications occurred in patients treated in the elective setting. A single case of intraoperative in-stent thrombus formation occurred during the treatment of an acutely ruptured basilar aneurysm and was resolved with intravenous Tirofiban. No other periprocedural complications occurred. Eleven out of 12 patients were available for follow up (mean 7.4 months). Complete aneurysmal occlusion without in-stent stenosis (ISS) was seen in 10 patients (90.9%). One patient (9.1%) showed aneurysmal reperfusion (RROC IIIb) with asymptomatic moderate ISS.
Our initial results demonstrate that the pEGASUS stent system appears to be a safe and effective device for stent assisted embolization of wide-necked intracranial aneurysms. More data is necessary to evaluate long-term follow-up.
我们报告了使用这种新型自膨式开孔支架系统（pEGASUS支架系统）及抗血栓形成亲水性聚合物涂层对颅内动脉瘤进行血管内栓塞的初步经验。
我们回顾性分析了2022年9月至2023年6月期间使用pEGASUS支架系统接受支架辅助弹簧圈栓塞或编织型血管桥接装置治疗的所有患者。分析了人口统计学、临床和血管造影数据以及短期随访结果，包括手术并发症发生率和使用雷蒙德-罗伊闭塞分级（RROC）的动脉瘤闭塞率。
12例患有12个宽颈颅内动脉瘤的患者接受了pEGASUS支架系统治疗，其中包括2例在急诊情况下栓塞的急性破裂动脉瘤。治疗的动脉瘤位于前交通动脉（25.0%）、基底动脉（50.0%）、大脑中动脉（16.7%）和颈内动脉（8.3%）。所有支架均成功植入。83.3%（10/12）的患者实现了即刻完全动脉瘤闭塞（RROC I级），16.7%（2/12）的患者实现了近乎完全闭塞（RROC II级）。择期治疗的患者未发生围手术期并发症。1例急性破裂基底动脉瘤治疗期间发生术中支架内血栓形成，经静脉注射替罗非班后得到解决。未发生其他围手术期并发症。12例患者中有11例进行了随访（平均7.4个月）。10例患者（90.9%）实现了无支架内狭窄（ISS）的完全动脉瘤闭塞。1例患者（9.1%）出现动脉瘤再灌注（RROC IIIb级），伴有无症状的中度ISS。
我们的初步结果表明，pEGASUS支架系统似乎是一种用于宽颈颅内动脉瘤支架辅助栓塞的安全有效的装置。需要更多数据来评估长期随访情况。
