Pipeline Flexを用いた大型・巨大脳動脈瘤治療の初期成績とpitfalls

抄録

The Pipeline Flex (PF) (Covidien/Medtronic, Irvine, CA, USA) is an endovascular microcatheter delivery system for the curative reconstruction of parent arteries harboring large/giant and wide-necked intracranial aneurysms. We describe our initial experience and complications associated with use of the PF system. Between November 2015 and June 2017, 34 intracranial aneurysms involving the internal carotid artery between the petrous and superior hypophyseal segments underwent 37 endovascular treatments with the PF system. A total of 14 complications were experienced in 12 procedures. The mean follow-up duration was 11.2 months. Seven major complications, defined as ipsilateral stroke, occurred during 6 procedures: 3 procedure-related ischemic strokes, 1 delayed ischemic stroke, 2 delayed intracerebral hemorrhages, and 1 carotid cavernous fistula resulting from delayed aneurysmal rupture. In 1 patient, symptoms were still present 3 months after the procedure. Of the other 7 complications, 6 recovered completely by 3 months after the procedure. The complication rate for treatment with PF was 32.4% (12/37). At 3 months after the procedure, the morbidity rate was 5.9% (2/34) and the mortality rate was 0%. Angiographic follow-up examination of 20 aneurysms at 6 months revealed no filling (0%) in 7 aneurysms, entry remnant (< 5%) in 9, and subtotal filling (5-95%) in 4. This finding suggests that PF placement is effective for the treatment of large/giant and widenecked intracranial aneurysms.