重复流量转移用于对不完全封闭的大型复杂症状性脑动脉瘤进行再治疗:回顾一系列病例
Ahmed Kashkoush1,2, Mohamed E El-Abtah3, Mark A Davison1,2
1Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA.
Operative neurosurgery (Hagerstown, Md.)
|January 22, 2024
概括
使用重叠流量转移器 (FD) 重复流量转移用于大型内动脉瘤,显示残留物大小减少,但往往持续填充. 需要进行进一步的研究,以优化这些复杂病例的治疗.
科学领域:
- 神经外科 神经外科
- 干预性神经辐射学
- 血管神经学 血管神经学
背景情况:
- 对于大额头内动脉瘤在重复的流量转移后的放射性阻塞率存在有限的数据.
- 流量转移器 (FD) 用于治疗复杂动脉瘤,但对再治疗策略的了解较少.
研究的目的:
- 评估大脑内动脉瘤患者重复流量转移与重叠的FD的临床和血管学结果.
- 评估使用FD重复治疗内动脉瘤的疗效和安全性.
主要方法:
- 对前性维护的大脑血管手术数据库 (2017-2021) 的回顾性审查.
- 确定接受重叠FD重复治疗的大型 (>10毫米) 脑动脉瘤的患者.
- 在最后一次随访时,使用O'Kelly-Marotta (OKM) 尺度对血管学阻塞进行了分级.
主要成果:
- 七名患有大型内动脉瘤 (中位宽18毫米) 的患者接受了重叠的FDs的治疗.
- 最常见的位置是眼睛的内动脉和基底干;4个状动脉瘤和3个状动脉瘤.
- 在14个月的血管学随访中位数,封闭度是OKM A (n=1),B (n=2),C (n=3) 和D (n=0). 两名患者需要开放的手术管理.
结论:
- 重复的流量转移与重叠的FD在大型内动脉瘤中导致残留物大小减少,但往往是高等级的持久填充 (OKM A/B).
- 症状改善与OKM C相关,而症状恶化与OKM A/B相关.
- 需要进行更长的随访时间的大型研究,以完善治疗策略,以便在重新治疗后对非典型动脉瘤残留物进行治疗.
更多相关视频
相关概念视频
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...


