Department of Medical Imaging, Royal Hobart Hospital, Tasmania, Australia.
Department of Interventional Neuroradiology, Prince of Wales Hospital, New South Wales, Australia.
J Neurointerv Surg. 2018 Jun;10(6):560-565. doi: 10.1136/neurintsurg-2017-013399. Epub 2017 Sep 29.
Stent assisted coil embolization (SACE) of bifurcation aneurysms is challenging. Heterogeneous results have been achieved to date, but largely for laser cut stents. While braided stents offer multiple technical advantages, their long term efficacy has yet to be validated.
To report the first long term 18 month results for the durability of bifurcation aneurysms treated with braided stents.
Over a 4 year period, 59 consecutive patients with 60 bifurcation aneurysms underwent elective braided SACE across three Australian neurovascular centers. 17 of these aneurysms underwent T- or Y-shaped stent constructs. All patients had immediate, 6 month and 18 month clinical and radiological follow-up. Radiological assessment was made on modified Raymond-Roy occlusion scores while clinical assessment was based on the modified Rankin Scale. Subgroup analysis of 17 aneurysms treated with multi-stent constructs was conducted.
6 month follow-up data were available for 59 aneurysms and 18 month follow-up data for 58 aneurysms. Satisfactory aneurysm occlusion was achieved in 97% at inception and at 6 months, and 98% at 18 months. Good neurological outcomes were achieved in 95% at 18 months. Similar satisfactory results were achieved with the multi-stent construct cohort. Intraprocedural thromboembolic events were recorded in 5% and delayed events in 2%. Technical complications were found in 5%. All complication rate was 13%.
Braided SACE was safe, efficacious, and durable at the long term 18 month follow-up, including for multi-stent constructs. Preliminary results indicate favorable clinical and radiological outcomes compared with laser cut stents.
分叉部动脉瘤的支架辅助弹簧圈栓塞术（SACE）具有挑战性。迄今为止，已经取得了不同的结果，但主要是针对激光切割支架。虽然编织支架具有多种技术优势，但它们的长期疗效尚未得到验证。
报告首例使用编织支架治疗分叉部动脉瘤的 18 个月长期结果。
在 4 年期间，来自澳大利亚 3 个神经血管中心的 59 例 60 个分叉部动脉瘤患者连续接受了选择性编织 SACE。其中 17 个动脉瘤采用 T 形或 Y 形支架构建。所有患者均进行即时、6 个月和 18 个月的临床和影像学随访。影像学评估采用改良 Raymond-Roy 闭塞评分，临床评估基于改良 Rankin 量表。对 17 个采用多支架构建的动脉瘤进行亚组分析。
59 个动脉瘤中有 59 个获得 6 个月的随访数据，58 个动脉瘤获得 18 个月的随访数据。初始和 6 个月时，动脉瘤闭塞的满意度达到 97%，18 个月时达到 98%。18 个月时，95%的患者获得了良好的神经功能结局。多支架构建队列也取得了类似的满意结果。术中记录到 5%的血栓栓塞事件和 2%的迟发性事件。发现 5%的技术并发症。总并发症发生率为 13%。
在 18 个月的长期随访中，编织 SACE 是安全、有效且持久的，包括多支架构建。初步结果表明，与激光切割支架相比，该方法具有更好的临床和影像学结局。
