Department of Radiology, CHU of Poitiers, Poitiers, Vienne, France.
Laboratoire Des Technologies Innovantes, University of Picardie Jules Vernes, Amiens, France.
J Neurointerv Surg. 2018 Dec;10(12):1174-1178. doi: 10.1136/neurintsurg-2018-013803. Epub 2018 May 25.
Intracranial aneurysm recanalization after endovascular treatment (EVT) remains a major problem. The goal of this study was to find new predictive factors of recanalization after EVT of middle cerebral artery (MCA) bifurcation aneurysms.
96 MCA bifurcationaneurysms, ruptured or unruptured, treated by EVT between Septembre 2009 and December 2014, were retrospectively included. Clinical parameters and aneurysm characteristics were recorded. From the initial three-dimensional DSA, spatial coordinates found on parent and daughter arteries of MCA bifurcations gave four different flow angle values; inflow, outflows 1 and 2, and the global outflow angle (the sum of the two outflow angles). Inter- and intra-observer reproducibilities of three-dimensional angle value measurements were performed.
Recanalization occurred in 25 cases (26%) and retreatment was performed in 11 cases (11%). Only 1 patient (1%) had rebleeding. Univariate analysis established the following as predictive factors of recanalization: high blood pressure (P=0.014), aneurysm height (P<0.001), aneurysm width (P<0.001), neck size (P<0.001), postoperative occlusion class (P=0.040), percentage of packing volume (P<0.001), as well as the two outflow angles (P=0.006 and 0.045), and the global outflow angle (P<0.001). Multivariate analysis revealed two independent risk factors for recanalization: the global outflow angle (OR=1.05; 95% CI 1.02 to 1.08; P<0.002) and aneurysm width (OR=0.67; 95% CI 0.46 to 0.96; P=0.031). A global outflow angle threshold <192° was found to be a risk factor for recanalization (OR=13.75; 95% CI 4.46 to 42.44), with a sensitivity of 80% and specificity of 77%.
This study emphasizes that a new parameter, the global outflow angle, can be predictive of recanalization for MCA bifurcation aneurysms treated by EVT.
血管内治疗（EVT）后颅内动脉瘤再通仍然是一个主要问题。本研究的目的是寻找大脑中动脉（MCA）分叉部动脉瘤 EVT 后再通的新预测因素。
回顾性纳入 2009 年 9 月至 2014 年 12 月期间接受 EVT 治疗的 96 例 MCA 分叉部破裂或未破裂动脉瘤。记录临床参数和动脉瘤特征。从初始的三维 DSA 中，MCA 分叉处母动脉和子动脉上的空间坐标给出了四个不同的血流角度值：流入角、流出角 1 和 2 以及总流出角（两个流出角之和）。进行了三维角度值测量的组内和组间观察者可重复性检验。
25 例（26%）发生再通，11 例（11%）进行了再治疗。仅 1 例（1%）患者再出血。单因素分析确定了以下是再通的预测因素：高血压（P=0.014）、动脉瘤高度（P<0.001）、动脉瘤宽度（P<0.001）、颈部大小（P<0.001）、术后闭塞分级（P=0.040）、填塞体积百分比（P<0.001）以及两个流出角（P=0.006 和 0.045）和总流出角（P<0.001）。多因素分析显示，再通的两个独立危险因素是总流出角（OR=1.05；95%CI 1.02 至 1.08；P<0.002）和动脉瘤宽度（OR=0.67；95%CI 0.46 至 0.96；P=0.031）。发现总流出角<192°是再通的危险因素（OR=13.75；95%CI 4.46 至 42.44），其敏感性为 80%，特异性为 77%。
本研究强调，一个新的参数，即总流出角，可以预测 EVT 治疗的 MCA 分叉部动脉瘤再通。
