CURATIVE ENDOVASCULAR RECONSTRUCTION OF CEREBRAL ANEURYSMS WITH THE PIPELINE EMBOLIZATION DEVICE: THE BUENOS AIRES EXPERIENCE
CURATIVE ENDOVASCULAR RECONSTRUCTION OF CEREBRAL ANEURYSMS WITH THE PIPELINE EMBOLIZATION DEVICE: THE BUENOS AIRES EXPERIENCE
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DOI：
10.1227/01.neu.0000339109.98070.65
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发表时间：
2009-04-01
期刊：
影响因子：
4.8
通讯作者：
Fiorella, David
中科院分区：
文献类型：
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作者：
Lylyk, Pedro;Miranda, Carlos;Fiorella, David
目的：管道栓塞器(PED)(加利福尼亚州门洛帕克的栗子医疗技术公司)是一种新型的微导管血管内支架，旨在实现对导致宽颈和梭形颅内动脉瘤的载瘤动脉的根治性重建。我们报告了我们对53名患者进行PED的初步围术期经验和中期随访结果。方法：选择患有大型和巨大宽颈、非囊性和复发的颅内动脉瘤的患者进行治疗。所有患者在手术前都接受了至少72小时的双重抗血小板药物的预治疗，治疗后继续服用这两种药物至少6个月。结果：53例患者，年龄11~77岁，平均55.2岁，女性48例，共63个颅内动脉瘤接受了PED治疗。包括小(n=33)、大(n=22)和巨型(n=8)宽颈动脉瘤。总共使用了72个儿科护理设备。44个动脉瘤采用单一PED治疗，17个动脉瘤采用2个重叠PED治疗，2个动脉瘤采用3个重叠PED治疗。治疗至最后一次数字减影血管造影的平均时间为5.9个月(1~22个月)。术后3个月(42个月)、6个月(28个月)和12个月(18个月)的动脉瘤完全闭塞率分别为56%、93%和95%。在12个月的随访检查中，唯一保持通畅的动脉瘤是以前用支架支持的弹簧圈治疗过的。预先存在的腔内支架的存在可能限制了该动脉瘤PED重建的疗效。在随访期内，无动脉瘤显示血管造影术闭塞恶化(即无血管再通)。在研究期间没有遇到重大并发症(中风或死亡)。3名患者(5%)，均为巨大动脉瘤，在PED治疗后，经历了原有脑神经病变的一过性加重和头痛。3例均经皮质类固醇治疗，1个月内症状消失。结论：PED血管内重建术是治疗部分宽颈、大型、巨型脑动脉瘤的一种安全、持久、有效的方法。在本研究中，在12个月的随访检查时，完全闭塞率接近100%。到目前为止，在连续的血管造影随访中没有观察到血管造影复发。
OBJECTIVES: The Pipeline embolization device (PED) (Chestnut Medical Technologies, Inc., Menlo Park, CA) is a new microcatheter-delivered endovascular construct designed to achieve the curative reconstruction of the parent arteries giving rise to wide-necked and fusiform intracranial aneurysms. We present our initial periprocedural experience with the PED and midterm follow-up results for a series of 53 patients.METHODS: Patients harboring large and giant wide-necked, nonsaccular, and recurrent intracranial aneurysms were selected for treatment. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least 6 months after treatment. A control digital subtraction angiogram was typically performed at 3, 6, and 12 months.RESULTS: Fifty-three patients (age range, 11-77 years; average age, 55.2 years; 48 female) with 63 intracranial aneurysms were treated with the PED. Small (n = 33), large (n = 22), and giant (n = 8) wide-necked aneurysms were included. A total of 72 PEDs were used. Treatment was achieved with a single PED in 44 aneurysms, with 2 overlapping PEDs in 17 aneurysms, and with 3 overlapping PEDs in 2 aneurysms. The mean time between the treatment and last follow-up digital subtraction angiogram was 5.9 months (range, 1-22 months). Complete angiographic occlusion was achieved in 56%, 93%, and 95% of aneurysms at 3 (n = 42), 6 (n = 28), and 12 (n = 18) months, respectively. The only aneurysm that remained patent at the time of the 12-month follow-up examination had been treated previously with stent-supported coiling. The presence of a preexisting endoluminal stent may have limited the efficacy of the PED reconstruction in this aneurysm. No aneurysms demonstrated a deterioration of angiographic occlusion during the follow-up period (i.e., no recanalizations). No major complications (stroke or death) were encountered during the study period. Three patients (5%), all with giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the PED treatment. All 3 were treated with corticosteroids, and these symptoms resolved within 1 month.CONCLUSION: Endovascular reconstruction with the PED represents a safe, durable, and curative treatment of selected wide-necked, large and giant cerebral aneurysms. The rate of complete occlusion at the time of the 12-month follow-up examination approached 100% in the present study. To date, no angiographic recurrences have been observed during serial angiographic follow-up.