使用大直径（≥5.5毫米）Derivo栓塞装置治疗颅内动脉瘤，尤其关注直径7毫米和8毫米的装置。
Treatment of intracranial aneurysms with large-diameter (≥5.5 mm) Derivo Embolization Devices, with particular focus on 7 and 8 mm diameter devices.
作者信息
Goertz Lukas, Zopfs David, Kottlors Jonathan, Pennig Lenhard, Schob Stefan, Schlamann Marc, Kabbasch Christoph
机构信息
Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany.
Department of Radiology and Neuroradiology, University Hospital Halle, Halle, Germany.
出版信息
Interv Neuroradiol. 2024 May 5:15910199241248479. doi: 10.1177/15910199241248479.
OBJECTIVE
There are few studies on flow diverters with diameters >5 mm. We present our preliminary experience with the 5.5-8 mm Derivo Embolization Device (DED) implants for the treatment of cerebral aneurysms.
METHODS
A consecutive series of 26 patients (median age: 60 years) treated for 32 aneurysms in 26 procedures was retrospectively analyzed for procedural characteristics, complications, and mid-term angiographic results.
RESULTS
The median aneurysm size was 10.5 mm, 2 of 30 (6%) aneurysms were ruptured and 9 (28%) had a fusiform or dissecting morphology. DED implantation was performed in the internal carotid artery in 18 of 26 (69%) procedures and in the vertebrobasilar artery in 8 (31%). Device deployment failed in 1 (4%) procedure. The 7 and 8 mm implants were successfully deployed in 5 cases. Additional balloon angioplasty or stent implantation was performed in 3 (12%) cases to improve wall apposition. Complications included 1 (4%) major stroke and 2 (8%) minor strokes. Angiographic follow up at a mean of 6 months showed complete occlusion in 8 of30 (27%) aneurysms and favorable occlusion in 14 (47%).
CONCLUSIONS
The use of large diameter DEDs was safe and feasible. The mid-term occlusion rates are acceptable considering the complex subset of aneurysms studied. Further studies are warranted to define the indications for large-diameter DEDs and to evaluate their long-term efficacy.
目的
关于直径大于5毫米的血流导向装置的研究较少。我们展示了使用5.5 - 8毫米Derivo栓塞装置（DED）植入治疗脑动脉瘤的初步经验。
方法
回顾性分析连续26例患者（中位年龄：60岁），在26次手术中治疗32个动脉瘤，分析手术特征、并发症和中期血管造影结果。
结果
动脉瘤中位大小为10.5毫米，30个动脉瘤中有2个（6%）破裂，9个（28%）呈梭形或夹层形态。26次手术中有18次（69%）在颈内动脉进行DED植入，8次（31%）在椎基底动脉进行。1次（4%）手术中装置部署失败。7毫米和8毫米的植入物在5例中成功部署。3例（12%）进行了额外的球囊血管成形术或支架植入以改善贴壁情况。并发症包括1例（4%）严重卒中，2例（8%）轻度卒中。平均6个月的血管造影随访显示，30个动脉瘤中有8个（27%）完全闭塞，14个（47%）闭塞良好。
结论
使用大直径DED是安全可行的。考虑到所研究的动脉瘤复杂亚组，中期闭塞率是可以接受的。有必要进一步研究以明确大直径DED的适应证并评估其长期疗效。
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