目的：初步探讨第二代血流导向装置PED Flex（Pipeline Flex Embolization Device）在颅内大型及巨大型动脉瘤血管内介入治疗中的应用价值及安全性。方法：对首都医科大学宣武医院神经外科2018年3月25日至6月25日25例接受PED Flex治疗的未破裂颅内大型及巨大型动脉瘤患者的临床资料进行回顾性分析，内容包括手术操作过程、影像结果及并发症。结果：25例患者中，大型动脉瘤（直径≥ 10 mm）11例，巨大型动脉瘤（直径≥ 25 mm）14例。术后3例患者出现病灶对侧肢体肌力短暂性下降，1例短暂性失明，2例新发头痛症状，1例支架内急性血栓形成（急诊行取栓治疗），其余患者无PED Flex植入相关并发症。结论：PED Flex与前一代相比，结构上有不同程度的改进，术者的操作手法不同于前一代，其在治疗颅内大型、巨大型动脉瘤时相对安全、有效，同时也存在一定风险，须严格筛选患者并定制个体化治疗策略。

[1] BARROW D L,ALLEYNE C.Natural history of giant intracranial aneurysms and indications for intervention[J].Clin Neurosurg,1995,42:214-244.
[2] GRUBER A,KILLER M,BAVINZSKI G,et al.Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms:a 7-year,single-center experience.[J].Neurosurgery,1999,45(4):793-803.
[3] SLUZEWSKI M,MENOVSKY T,van ROOIJ W J,et al.Coiling of very large or giant cerebral aneurysms:long-term clinical and serial angiographic results[J].Ajnr Am J Neuroradiol,2003,24(2):257-262.
[4] ADEEB N,GRIESSENAUER C J,MOORE J,et al.Pipeline embolization device for recurrent cerebral aneurysms after microsurgical clipping[J].World Neurosurg,2016,93(9):341-345.
[5] PRESTIGIACOMO C J.Commentary:pipeline embolization device for small intracranial aneurysms:evaluation of safety and efficacy in a multicenter cohort[J].Neurosurgery,2017,80(4):588.
[6] MIYACHI S,HIRAMATSU R,OHNISHI H,et al.Usefulness of the pipeline embolic device for large and giant carotid cavernous aneurysms[J].Neurointervention,2017,12(2):83.
[7] 盖延廷,王威,刘旻谛,等.Pipeline栓塞装置治疗颅内动脉瘤的初步经验[J].中华神经外科杂志,2016,32(7):691-695.
[8] 蒋锋,王莉,袁婕,等.替罗非班在急性脑梗死支架取栓术中的临床应用[J].现代医学,2017,45(9):1247-1252.
[9] 白卫星,许斌,梁晓东,等.腔内置入血流导向装置治疗颈内动脉颅内段动脉瘤的短期疗效[J].中华放射学杂志,2016,50(2):114-117.
[10] ADEEB N,GRIESSENAUER C J,SHALLWANI H,et al.Pipeline embolization device in treatment of 50 unruptured large and giant aneurysms.[J].World Neurosurg,2017,105(9):232-237.
[11] SANTOSH B M,SHREYANSH S,CHETHAN P V R,et al.Treatment of unruptured intracranial aneurysms with the pipeline embolization device[J].JClin Neurosci,2014,21(1):6-11.
[12] WONG G K C,KWAN M C L,NG R Y T,et al.Flow diverters for treatment of intracranial aneurysms:current status and ongoing clinical trials[J]. J Clin Neurosci,2011,18(6):737-740.
[13] FIORELLA D,WOO H H,ALBUQUERQUE F C,et al.Definitive reconstruction of circumferential,fusiform intracranial aneurysms with the pipeline embolization device[J].Neurosurgery,2008,62(5):1115-1120.
[14] MARTÍNEZ-GALDÁMEZ M,LAMINS M,LAGIOS K G,et al.Periprocedural outcomes and early safety with the use of the Pipeline Flex Embolization Device with Shield Technology for unruptured intracranial aneurysms:preliminary results from a prospective clinical study[J].Neurointerv Surg,2017,9(8):772-776.
[15] STUDDARD W E,DAVIS D O,YOUNG S W.Cortical blindness after cerebral angiography.Case report[J].J Neurosurg,1981,54(2):240-244.
[16] 李建明,贾广志,尹华,等.脑血管造影并发双目失明的分析[J].中华神经外科杂志,2007,23(10):778-779.
[17] 李静伟,李桂林,陈圣攀,等.血流导向装置Pipeline联合弹簧圈在治疗颈内动脉大型和巨大型未破裂动脉瘤中的作用[J].中国脑血管病杂志,2018,15(1):4-9.