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Flow-diverting stent and delayed intracranial bleeding: the case for discussing acquired von Willebrand disease

机译：流动转移支架和延迟颅内出血：讨论冯维尔布朗疾病的案例

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摘要

A unique feature of the flow-diverting stent (FDS) has rendered it useful in the endovascular treatment of selected intracranial aneurysms for the last decade. Delayed aneurysmal rupture and intracranial parenchymal bleeding are two leading hemorrhagic complications after FDS. It has recently been shown for the first time that there is a relationship between FDS and reduced level of vWF activity in patients undergoing endovascular cerebral aneurysm treatment. Here, the current literature is reviewed in the context of this novel finding to propose an illustrative scenario that conceptually links implantation of FDS to delayed intracranial bleeding, through the mechanism of shear-induced activation of vWF. In this scenario, after FDS implantation, sustained release of activated vWF in association with platelets plays a pivotal role in the mechanisms of delayed intracranial hemorrhages.
机译：在过去的十年中，分流支架（FDS）的一个独特功能使其在选择性颅内动脉瘤的血管内治疗中发挥了作用。延迟性动脉瘤破裂和颅内实质出血是FDS术后两种主要的出血并发症。最近有研究首次表明，在接受血管内脑动脉瘤治疗的患者中，FDS与vWF活性水平降低之间存在关系。本文结合这一新发现对当前文献进行了综述，提出了一个说明性方案，从概念上讲，通过剪切诱导的vWF激活机制，将FDS植入与迟发性颅内出血联系起来。在这种情况下，FDS植入后，活化的vWF与血小板的持续释放在迟发性颅内出血的机制中起着关键作用。

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