Resumen
INTRODUCCIÓN:Los aneurismas disecantes de la arteria basilar tienen un curso clínico impredecible que, eventualmente, evoluciona a un accidente cerebrovascular hemorrágico o isquémico grave. Por otro lado, su abordaje terapéutico es controvertido y no existen líneas claras de tratamiento.
CASO CLÍNICO:Presentamos el caso de una mujer de 28 años con un infarto del tallo cerebral secundario a aneurisma disecante de la arteria basilar, tratado exitosamente con dispositivo endoluminal redireccionador de flujo (FRED).
CONCLUSIÓN:El tratamiento endovascular con FRED de los aneurismas disecantes parece ofrecer ventajas sobre las técnicas quirúrgicas abiertas y stents tradicionales, en casos seleccionados.
Citas
Kim BM, Suh SH, Park SI, Shin YS, Chung EC, Lee MH, et al. Management and clinical outcome of acute basilar artery dissection. AJNR Am J Neuroradiol. 2008;29(10):1937-41.
Han Z, Leung TW, Lam W, Soo Y, Wong KS. Spontaneous basilar artery dissection. Hong Kong Med J. 2007;13(2):144-6.
Pozzati E, Andreoli A, Padovani R, Nuzzo Y Dissecting aneurysms of the basilar artery. Neurosurgery. 1995;36:254-8.
Yoshimoto Y, Hoya K, Tanaka Y, Uchida T. Basilar artery dissection. J Neurosurg. 2005;102:476-81.
Hosoda K, Fujita S, Kawaguchi T, Shose, Yonezawa K, Shirakuni T, et al. Spontaneous dissecting aneurysms of the basilar artery presenting "with a subarachnoid hemorrhage. Report of two cases. J Neurosurg. 1991;75:628-33.
Masson C, Krespy Y, Masson M, Colombani JM. Magnetic resonance imaging in basilar artery dissection. Stroke. 1993;24:1264-6.
Guillon B, Brunereau L, Biousse V, Djouhri H, Lévy C, Bousser MG: Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology. 1999;53:117-22.
Medel RC, Carter LP. En Carter LP, Spetzler RF, editores. Intracranial arterial injury. Neurovascular surgery. Nueva York: McGraw Hill; 1995. p. 1301-4. Disponible en:
Yilmaz F, Arslan E, Qzlem M, Kavalci C, Ciliz D, Sever B. A rare presentation of stroke: basilary artery dissection. J Med Cases. 2013;4(1):43-5.
Pilz P, Hartjes HJ. Fibromuscular dysplasia and multiple dissecting aneurysms of intracranial arteries. A further cause of moyamoya syndrome. Stroke. 1976; 7: 393-8.
Pozzati E, Andreoli A, Padovani R, Nuzzo G. Dissectimg aneurysms of the basilar artery: clinical study. Neurosurgery. 1995;36:254-8.
Malek AM, Higashida RT, Halbach VV, et al. Tandem intra-cranial stent deployment for treatment of an iatrogenic, flow limiting, basilar artery dissection: technical case report. Neurosurgery. 1999:45:919-24.
Willing SJ, Skidmore F, Donaldson J, Nobo UL, Chernukha K. Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement: report of two cases. Am J Neuroradiol. 2003;24:985-9.
Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A. Endovascular treatment of cerebral aneurysms using flow-diverter devices: A systematic review. Neuroradiol J. 2015;28(4):365-75.
Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms current status. Stroke. 2013;44:2046-54.
Pierot L. Flow diverter stents in the treatment of intracranial aneurysms: Where are we? J Neuroradiol. 2011 Mar;38(1):40-6.
Diaz Q, Gist TL, Manjarez G, Qrozco F, Almeida R. Treatment of 14 intracranial aneurysms with the FRED system. J Neurointerv Surg. 2014;6(8):614-7.
Mõhlenbruch IMA, Herweh C, Jestaedt L, Stampfl S, Schõnenberger S, et al. The FRED flow-diverter stent for intracranial aneurysms: clinical study to assess safety and efficacy. AJNR Am J Neuroradiol. 2015 Jun;36(6):1155 61.
Luecking H, Engelhorn T, Lang S, Goelitz P, Kloska S, Roessler K, et al. FRED flow diverter: a study on safety and efficacy in a consecutive group of 50 patients. AJNR Am J Neuroradiol. 2017 Jan 19. doi: 10.3174/ajnr.A5052.
Tejada J, Sandoval M, Charry J, Fonnegra A. Uso dispositivo redireccionador de flujo pipeline® para tratamiento endovascular de aneurisma intracraneal distal gigante. Rev Argent Neuroc. 2015;29(4):164-7.
Fiorella D, Kelly ME, Albuquerque FC, et al. Curative reconstruction of a giant midbasilar trunk aneurysm with the Pipeline embolization device. Neurosurgery. 2009;64:212-7.
de Vries J, Boogaarts J, Van Norden A, Wakhloo AK. New generation of Flow Diverter (surpass) for unruptured intracranial aneurysms: a prospective single-center study in 37 patients. Stroke. 2013;44(6):1567-77.

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