Endovascular WEB Flow Disruption in Middle Cerebral Artery Aneurysms: Preliminary Feasibility, Clinical, and Anatomical Results in a Multicenter Study
Endovascular WEB Flow Disruption in Middle Cerebral Artery Aneurysms: Preliminary Feasibility, Clinical, and Anatomical Results in a Multicenter Study
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DOI：
10.1227/01.neu.0000429860.04276.c1
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发表时间：
2013-07-01
期刊：
影响因子：
4.8
通讯作者：
Lubicz, Boris
中科院分区：
文献类型：
--
作者：
Pierot, Laurent;Klisch, Joachim;Lubicz, Boris
背景技术背景：解剖结构不良（宽颈、不良形态）的大脑中动脉（MCA）动脉瘤的血管内治疗通常具有挑战性。血流中断与WEB是一个潜在的有趣的血管内治疗这种类型的aneurysm.OBJECTIVE：报告在一个多中心系列的初步治疗经验MCA动脉瘤血流中断的WEB.METHODS：33例34 MCA动脉瘤与WEB在5个欧洲中心进行了治疗。成功部署WEB的能力，程序和设备相关的不良事件，发病率和死亡率的治疗，以及短期血管造影随访结果进行了分析。结果：大多数治疗的动脉瘤未破裂（85.3%），并在5和10毫米（85.3%）之间，颈部尺寸≥ 4毫米（88.2%）。由于缺乏适当的器械尺寸，34个动脉瘤中有1个（2.9%）的治疗失败。33个动脉瘤中有29个（87.9%）仅使用WEB进行治疗。33个动脉瘤中有4个（12.1%）进行了额外治疗（弹簧圈栓塞术和/或支架植入术）。治疗的死亡率为0.0%，发病率为3.1%（术中破裂，1个月随访时改良兰金量表评分为3分）。在短期随访（范围，2-12个月），充分闭塞（完全闭塞或颈部残留）观察到83.3%的动脉瘤。结论：WEB血流中断似乎是一种有前途的技术，用于治疗复杂的MCA动脉瘤，特别是那些与宽颈或不利的圆顶-颈比。
BACKGROUND: The endovascular treatment of middle cerebral artery (MCA) aneurysms with unfavorable anatomy (wide neck, unfavorable morphology) is frequently challenging. Flow disruption with the WEB is a potentially interesting endovascular treatment for this type of aneurysm.OBJECTIVE: To report in a multicenter series the preliminary treatment experience of MCA aneurysms with flow disruption by the WEB.METHODS: Thirty-three patients with 34 MCA aneurysms were treated with the WEB in 5 European centers. The ability to successfully deploy the WEB, procedure-and device-related adverse events, morbidity and mortality of the treatment, and short-term angiographic follow-up results were analyzed.RESULTS: Most treated aneurysms were unruptured (85.3%) and were between 5 and 10 mm (85.3%) with a neck size >= 4 mm (88.2%). The treatment failed in 1 of the 34 aneurysms (2.9%) owing to a lack of appropriate device size. Treatment was performed exclusively with the WEB in 29 of 33 aneurysms (87.9%). Additional treatment (coiling and/or stenting) was used in 4 of 33 aneurysms (12.1%). Mortality of the treatment was 0.0% and morbidity was 3.1% (intraoperative rupture with modified Rankin Scale score of 3 at the 1-month follow-up). In short-term follow-up (range, 2-12 months), adequate occlusion (total occlusion or neck remnant) was observed in 83.3% of aneurysms.CONCLUSION: WEB flow disruption seems to be a promising technique for the treatment of complex MCA aneurysms, particularly those with a wide neck or unfavorable dome-to-neck ratio.