Clipping of recanalized intracerebral aneurysms initially treated by the Woven EndoBridge device
Clipping of recanalized intracerebral aneurysms initially treated by the Woven EndoBridge device
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DOI：
10.1136/neurintsurg-2019-014903
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发表时间：
2019-08-01
影响因子：
4.8
通讯作者：
Litre, Claude Fabien
中科院分区：
文献类型：
--
作者：
Pierot, Laurent;Bannery, Christophe;Litre, Claude Fabien
背景与目的编织桥阻断囊内血流是治疗颅内动脉瘤，尤其是宽颈分叉动脉瘤的一种安全有效的方法。然而，中期和长期随访成像可显示动脉瘤残留或再通，因此有时需要再治疗。在大多数情况下，再治疗采用血管内入路。本系列报道并分析了在WEB治疗后再通或不完全闭塞的动脉瘤的夹闭。方法前瞻性收集自2011年6月开始使用WEB设备治疗的所有患者，并将其纳入当地数据库。其中，因动脉瘤残留而行夹持治疗的患者纳入本系列。结果在2011年6月至2019年2月期间，使用WEB装置治疗的130例动脉瘤患者中，有4例（3.1%）因不完全闭塞（2例）和动脉瘤再通（2例）而手术夹持。4个动脉瘤中3个（75%）位于大脑中动脉，1个位于前交通动脉（25.0%）。4例患者中有1例（25%）动脉瘤破裂。使用WEB进行初始治疗后10-54个月进行夹持。手术暴露显示WEB装置在所有病例的动脉瘤囊内。除1例外，其余病例均可顺利进行剪断。对照DSA显示两个动脉瘤完全闭塞，两个颈部残余。结论采用WEB治疗囊内血流中断后，夹持术是治疗动脉瘤残留的可行方法。
Background and purpose Intrasaccular flow disruption using the Woven EndoBridge (WEB) is a safe and effective method to treat intracranial aneurysms, particularly wide neck bifurcation aneurysms. However mid term and long term follow-up imaging can show aneurysm remnant or recanalization, and retreatment is therefore sometimes necessary. In most cases, retreatment is performed using an endovascular approach. The present series reports and analyzes aneurysm clipping of recanalized or incompletely occluded aneurysms following WEB treatment.Methods All patients treated with the WEB device since the beginning of our experience in June 2011 were prospectively collected in a local database. Among them, patients who were retreated by clipping for aneurysm remnants were included in the present series.Results In the cumulative population of 130 patients with aneurysms treated by the WEB device from June 2011 to February 2019, 4 patients (3.1%) were retreated with surgical clipping due to incomplete occlusion (2 patients) and aneurysm recanalization (2 patients). Three of the four aneurysms retreated (75%) were located in the middle cerebral artery and one in the anterior communicating artery (25.0%). The aneurysm was ruptured in 1 of 4 patients (25%). Clipping was performed 10-54 months after initial treatment with the WEB. Surgical exposure showed that the WEB device was inside the aneurysm sac in all cases. Clipping was easily performed in all but 1 case. Control DSA showed complete occlusion in two aneurysms and a neck remnant in two.Conclusion Clipping is a feasible option for treating aneurysm remnants following initial treatment with intrasaccular flow disruption using the WEB.