抄録
Conventional coil embolization for large carotid cavernous aneurysms (CCAs) is limited because of inadequate ability to prevent recurrence or reduce mass effects. Although trapping of the parent artery may be the most radical treatment, it also has a risk of ischemic complications due to intracranial perfusion disorders associated with external-internal arterial bypass. We present the results of 20 patients with large CCAs successfully treated using a flow-diverter (PipelineTM embolic device: PED) and discuss the safety and efficacy of this device.
Twenty patients (19 women), mean age 71.3 years old, with large CCAs greater than 10 mm in maximum diameter, including 4 giant CCAs, were treated with the PED over a period of 3 years. Preoperative dual antiplatelet therapy was administrated and PED deployment over the orifice of the aneurysm with post-dilatation using a microballoon for sufficient stent apposition was performed in all cases. Two patients required multiple telescoping stents. Clinical and radiological evaluation with magnetic resonance imaging (MRI) was performed at 1, 3, and 6 months. Angiographic follow-up was performed at 6 months.
The PED was satisfactorily deployed in all patients. Post-angiogram imaging showed stagnation of contrast with an eclipse sign in 17 cases. One patient with a complex giant aneurysm required 5 telescoping stents and encountered temporary ischemic symptoms due to the complex techniques. Of 15 patients with ocular motor impairment, improvement of symptoms was observed in 11, including 6 with complete resolution of symptoms during 3 to 6 months of follow-up. However, 7 patients demonstrated temporary worsening at 2 weeks postoperatively, with subsequent marked recovery within 3 months. Angiography at the 6-month follow-up showed complete occlusion in 64% (7/11) of patients, and MRI showed reduction of aneurysm volume in 82% (9/11).
Use of a flow-diverter for large CCAs provided clinical and radiological efficacy in all of our cases. Postoperatively, the PED was capable of shrinking aneurysm size and improving symptoms caused by a mass effect, without sacrificing the parent artery. Further analysis and follow-up of these cases will be necessary to verify the long-term results.
