Martio Artur Eduardo, Cunha Samuel Luís Scaravonatto Baldo, Manzato Luciano Bambini, Perini Felipe, Vanzin José Ricardo
Division of Interventional Neuroradiology, Hospital de Clínicas de Passo Fundo, RS, Brazil.
Brain Circ. 2025 Mar 21;11(1):89-93. doi: 10.4103/bc.bc_69_24. eCollection 2025 Jan-Mar.
Flow-diverting stents have been increasingly utilized for the treatment of intracranial aneurysms, especially when there are factors that go against coil embolization, such as wide neck and large aneurysm size. However, its use does not guarantee success, especially in giant lesions, and failure to obtain aneurysmal obliteration can result in long-term instability of the aneurysmal wall, leading to aneurysmal growth and late rupture. We present the case of a 65-year-old woman who suffered from a late aneurysmal dilation and rupture, 2 years and 4 months after flow-diverting treatment of a giant ophthalmic segment aneurysm. Although not fully understood, the pathophysiology of this phenomenon has one necessary factor: incomplete aneurysmal obliteration. When this scenario is present, two main factors take place: the augmentation of intrasaccular blood flow after stent delivery and the local inflammation caused by partial thrombus formation and the presence of the stent itself. To prevent this complication, complete aneurysmal obliteration must be assured, and the use of combined techniques is encouraged.
血流导向支架已越来越多地用于治疗颅内动脉瘤，尤其是在存在不利于弹簧圈栓塞的因素时，如宽颈和大动脉瘤尺寸。然而，其使用并不能保证成功，尤其是在巨大病变中，未能实现动脉瘤闭塞可能导致动脉瘤壁长期不稳定，从而导致动脉瘤生长和晚期破裂。我们报告了一例65岁女性病例，该患者在对巨大眼动脉段动脉瘤进行血流导向治疗后2年4个月出现动脉瘤晚期扩张和破裂。尽管对此现象的病理生理学尚未完全了解，但有一个必要因素：动脉瘤未完全闭塞。当出现这种情况时，会发生两个主要因素：支架置入后瘤内血流增加以及部分血栓形成和支架本身存在引起的局部炎症。为预防这种并发症，必须确保动脉瘤完全闭塞，并鼓励使用联合技术。
