Department of Interventional Neuroradiology, Dupuytren University Hospital, Limoges, France.
Department of Neurosurgery, Universidade de Brasília, Brasília, DF, Brazil.
Neurosurgery. 2018 Dec 1;83(6):1226-1233. doi: 10.1093/neuros/nyx618.
Flow-diverter stent (FDS) deployment can cause morphological and hemodynamic changes in the carotid siphon (CS), influencing the occlusion rate of aneurysms in this location.
To evaluate morphological changes to the CS after FDS deployment and their relationship with the rate of occlusion of intracranial aneurysms.
A cohort of 183 patients with CS aneurysms were treated by deployment of Pipeline® FDS (Medtronic Inc, Dublin, Ireland). Their CSs were classified as type U, V, C, or S, depending on morphology. The posterior and anterior bend angles were measured on strict lateral cerebral angiogram with digital subtraction before FDS deployment, immediately after deployment, and at 6 mo. Differences between angles were analyzed to identify any correlations with rates of aneurysm occlusion, using the O'Kelly-Marotta classification.
FDS deployment was associated with immediate changes in CS morphology. The mean anterior angle increased from 3.97 ± 25.06° to 22.05 ± 25.18° (P < .001) and the mean posterior angle increased from 71.98 ± 31.27° to 79.43 ± 31.80° (P < .001). Multivariate analysis revealed a progressive, statistically significant increase in frequency of complete (grade D) occlusion at 6-mo follow-up with increasing anterior bend angle (prevalence ratios (PR) = 1.42 for increases between 5.3° and 12°, P = .017; PR = 1.56 for increases between 12.1° and 27.6°, P = .002; PR = 1.83 for increases >27.6°, P < .001, all vs increases <5.3°).
FDS deployment induces changes in CS morphology. Specifically, increases in mean anterior angle are associated with better radiological results on 6-mo follow-up digital subtraction angiography.
血流导向装置（FDS）的植入会引起颈内虹吸段（CS）的形态和血流动力学改变，影响该部位颅内动脉瘤的闭塞率。
评估 FDS 植入后 CS 的形态变化及其与颅内动脉瘤闭塞率的关系。
对 183 例 CS 动脉瘤患者采用 Pipeline®FDS（美敦力公司，都柏林，爱尔兰）进行治疗。根据形态学将 CS 分为 U 型、V 型、C 型或 S 型。在 FDS 植入前、植入后即刻及 6 个月时，通过数字减影严格行侧位脑血管造影测量 CS 的后弯角和前弯角。分析角度的差异，采用 O'Kelly-Marotta 分类法，确定与动脉瘤闭塞率的相关性。
FDS 植入与 CS 形态的即刻改变相关。CS 前弯角由植入前的 3.97±25.06°增加至植入后的 22.05±25.18°（P＜0.001），CS 后弯角由植入前的 71.98±31.27°增加至植入后的 79.43±31.80°（P＜0.001）。多变量分析显示，随着前弯角的增加，6 个月时完全（grade D）闭塞的频率呈渐进性、有统计学意义的增加（优势比（OR）=1.42，5.3°至 12°增加，P=0.017；OR=1.56，12.1°至 27.6°增加，P=0.002；OR=1.83，＞27.6°增加，P＜0.001，均与 5.3°以下增加相比）。
FDS 植入会引起 CS 形态的改变。具体来说，平均前弯角的增加与 6 个月时数字减影血管造影的更好的影像学结果相关。
