Use of a Polytetrafluoroethylene-Coated Vascular Plug for Focal Intracranial Parent Vessel Sacrifice for Fusiform Aneurysm Treatment

作者：Carlson Andrew P^*; Abbas Mohammad; Hall Patricia; Taylor Christopher

来源：Operative Neurosurgery, 2017, 13(5): 596-602.

DOI：10.1093/ons/opx006

• Aneurysm
• Endovascular embolization
• Subarachnoid hemorrhage
• Vertebral dissection

BACKGROUND: Fusiform intracranial aneurysms are challenging due to the circumferential nature of the disease. Endovascular parent vessel sacrifice with coils may be a treatment option, but typically requires a long vessel segment to induce complete cessation of flow.
OBJECTIVE: We evaluate early clinical experience with the intracranial use of the microvascular plug (MVP; Medtronic, Dublin, Ireland) device and to compare to previous coil-only techniques for vertebral artery sacrifice for fusiform vertebral aneurysm.
METHODS: We reviewed patients treated with the MVP for intracranial aneurysms at our institution. As a case-control study, we located 6 control patients who underwent coiling alone for vertebral artery sacrifice. The number of implants, fluoroscopy time, and procedural charges were compared using unpaired t-tests.
RESULTS: Twelve patients underwent vessel sacrifices with MVP. Eight were for vertebral artery dissecting aneurysms. Comparing only vertebral aneurysms, the mean implants was 7 in the MVP group (n = 8) and 19.5 in the coiling group (n = 6; P = .0015). Mean fluoroscopy time was 17.62 min in the MVP group compared to 24.2 min in the coiling group (P = .07). Procedural costs were less in the MVP group ($19 667.38) compared to coiling ($44 909.50, P = .05). There were no technical failures and no cases with persistent flow in the parent vessel at the end of the procedure.
CONCLUSION: The MVP is a cost-effective device for focal intracranial vessel occlusion in select patients. This is an important tool for cerebrovascular surgeons, particularly in cases of ruptured dissecting vertebral aneurysms.

• 出版日期2017-10