血流导向装置治疗颅内动脉瘤的研究进展

Research Progress on the Treatment of Intracranial Aneurysms with Flow Diverters

颅内动脉瘤(IAs)的血管内治疗在过去几十年中有了长足的发展。弹簧圈栓塞无法治疗所有动脉瘤,发生动脉瘤的载瘤动脉亦需要治疗,以及常规介入在治疗复杂动脉瘤的局限性推进了技术进步。颅内支架最初是为栓塞宽颈动脉瘤时支持弹簧圈而研发的。早期对支架状管状编织结构的研究孕育出了一种更复杂的结构,后来被称为分流器(flow diverter, FD),并进入临床应用。FDs最初用于治疗宽颈大或巨大的颈内动脉瘤。随后,我们见证了FDs应用的爆发式增长,并对其不断进行改进,引来了其在血管内治疗中的广泛应用。本文中,我们将从其作用机制及在不同场景下使用的优缺点做一综述。

Endovascular treatment of intracranial aneurysms (IAs) has evolved considerably over the past decades. The technological advances have been driven by the experience that coils fail to com-pletely exclude all IAs from the blood circulation, the need to treat the diseased parent vessel segment leading to the aneurysm formation, and expansion of endovascular therapy to treat more complex IAs. Stents were initially developed to support the placement of coils inside wide neck aneurysms. However, early work on stent-like tubular braided structure led to a more sophisticated construct that then later was coined as a flow diverter (FD) and found its way into clinical application. FDs were initially used to treat wide-neck large and giant internal carotid artery aneu-rysms. We have witnessed an explosion in the application of FDs and subsequently their modifica-tions leading to their ubiquitous use in endovascular therapy.