Gölitz Philipp, Struffert Tobias, Hoelter Philip, Eyüpoglu Ilker, Knossalla Frauke, Doerfler Arnd
Department of Neuroradiology, University of Erlangen-Nuremberg, Germany
Department of Neuroradiology, University of Erlangen-Nuremberg, Germany.
Interv Neuroradiol. 2016 Feb;22(1):76-83. doi: 10.1177/1591019915609166. Epub 2015 Oct 29.
Our study aimed to evaluate the efficiency of flow-diverting stents (FDS) in treating unruptured, intradural dissecting aneurysms of the vertebral artery (VADAs). Additionally, the effect of FDS on the aneurysmal flow pattern was investigated by performing in vivo flow analysis using parametric color coding (PCC).
We evaluated 11 patients with unruptured, intradural VADAs, treated with FDS. Pre- and postinterventional DSA-series were postprocessed by PCC, and time-density curves were calculated. The parameters aneurysmal inflow-velocity, outflow-velocity and relative time-to-peak (rTTP) were calculated. Pre- and postinterventional values were compared and correlated with the occlusion rate after six months.
Follow-up DSA detected 10 aneurysms occluded, meaning an occlusion rate of 91%. No procedure-related morbidity and mortality was found. Flow analyses revealed a significant reduction of aneurysmal inflow- velocity and prolongation of rTTP after FDS deployment. Concerning aneurysm occlusion, the postinterventional outflow-velocity turned out to be a marginally statistically significant predictor. A definite threshold value (-0.7 density change/s) could be determined for the outflow-velocity that allows prediction of complete aneurysm occlusion with high sensitivity and specificity (100%).
Using FDS can be considered an efficient and safe therapy option in treating unruptured, intradural VADA. From in vivo flow analyses the postinterventional aneurysmal outflow-velocity turned out to be a potential predictor for later complete aneurysm occlusion. Here, it might be possible to determine a threshold value that allows prediction of aneurysm occlusion with high specificity and sensitivity. As fast, applicable and easy-to-handle tool, PCC could be used for procedural monitoring and might contribute to further treatment optimization.
本研究旨在评估血流导向支架（FDS）治疗未破裂的椎动脉硬脊膜内夹层动脉瘤（VADA）的疗效。此外，通过使用参数颜色编码（PCC）进行体内血流分析，研究FDS对动脉瘤血流模式的影响。
我们评估了11例接受FDS治疗的未破裂椎动脉硬脊膜内夹层动脉瘤患者。介入治疗前后的DSA序列通过PCC进行后处理，并计算时间密度曲线。计算动脉瘤流入速度、流出速度和相对峰值时间（rTTP）等参数。比较介入治疗前后的值，并与6个月后的闭塞率进行相关性分析。
随访DSA检测到10个动脉瘤闭塞，闭塞率为91%。未发现与手术相关的 morbidity和死亡率。血流分析显示，FDS置入后动脉瘤流入速度显著降低，rTTP延长。关于动脉瘤闭塞，介入治疗后的流出速度是一个边缘具有统计学意义的预测指标。可以确定流出速度的一个明确阈值（-0.7密度变化/秒），该阈值能够以高灵敏度和特异性（100%）预测动脉瘤完全闭塞。
使用FDS可被认为是治疗未破裂椎动脉硬脊膜内夹层动脉瘤的一种有效且安全的治疗选择。从体内血流分析来看，介入治疗后的动脉瘤流出速度是后期动脉瘤完全闭塞的一个潜在预测指标。在此，有可能确定一个阈值，能够以高特异性和灵敏度预测动脉瘤闭塞。作为一种快速、适用且易于操作的工具，PCC可用于手术监测，并可能有助于进一步优化治疗。
