From the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
From the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
AJNR Am J Neuroradiol. 2018 Nov;39(11):2057-2063. doi: 10.3174/ajnr.A5803. Epub 2018 Oct 4.
Flow diversion with intermediate-porosity stents (braided stents) has been recently reported for distally located small aneurysms. The aim of this study was to evaluate the flow-diversion effect of LEO stents on covered vessels and for aneurysms treated with sole stent-placement therapy.
We retrospectively evaluated the following outcomes: 1) remodeling of covered side branches and perforators (extra-aneurysmal flow remodeling), and 2) the occlusion rate of aneurysms treated with sole stent-placement therapy (intra-aneurysmal flow remodeling).
Seventy-six patients with 98 covered vessels were studied. Overall, 89 covered arteries (91%) were normal, 7 showed narrowing (7%), and 2 (2%) were occluded (1 posterior communicating artery and 1 MCA) without related complications (mean DSA follow-up, 14 months). Univariate and multivariate analyses highlighted smoking ( = .03) and the length of follow-up ( = .002) as factors associated with arterial remodeling. Of the 17 Sylvian (lenticulostriate arteries) and 7 basilar perforators, 1 (4%) group of Sylvian perforators covered with double stents had asymptomatic remodeling. Ten aneurysms (mean size, 3.5 mm) were treated with LEO stents as stent monotherapy (5 recanalized after coiling and 5 directly treated with the LEO). Complete occlusion (Raymond-Roy I) was achieved in 70% of aneurysms (mean follow-up, 14 months). The Raymond-Roy I occlusion rate among recanalized aneurysms and those directly treated with LEO stents was 80% and 60%, respectively ( = .9).
The rate of flow remodeling on the covered arteries and perforators was 9% and 4%, respectively, and was clinically irrelevant in all cases. Complete occlusion of aneurysms treated with sole stent-placement therapy was 70%. These data stress the flow-diversion properties of LEO stents.
最近有研究报道，使用中间孔隙率支架（编织支架）对位于远端的小动脉瘤进行血流改道。本研究旨在评估 LEO 支架对覆盖血管和单纯支架置入治疗的动脉瘤的血流改道效果。
我们回顾性评估了以下结果：1）覆盖的侧支和穿支（瘤外血流重塑）的重塑情况，2）单纯支架置入治疗的动脉瘤的闭塞率（瘤内血流重塑）。
76 例患者的 98 支被覆盖的血管被研究。总的来说，89 支（91%）被覆盖的动脉正常，7 支（7%）出现狭窄，2 支（2%）闭塞（1 支后交通动脉和 1 支 MCA，无相关并发症）（平均 DSA 随访时间为 14 个月）。单因素和多因素分析表明，吸烟（P =.03）和随访时间（P =.002）是与动脉重塑相关的因素。在 17 支大脑中动脉（纹状体动脉）和 7 支基底动脉穿支中，1 支（4%）双支架覆盖的大脑中动脉穿支出现无症状重塑。10 个动脉瘤（平均大小为 3.5 毫米）采用 LEO 支架进行单纯支架治疗（5 个在弹簧圈后再通，5 个直接用 LEO 治疗）。70%的动脉瘤（平均随访时间为 14 个月）达到完全闭塞（Raymond-Roy I 级）。再通动脉瘤和直接用 LEO 支架治疗的动脉瘤的 Raymond-Roy I 级闭塞率分别为 80%和 60%（P =.9）。
覆盖血管和穿支的血流重塑率分别为 9%和 4%，在所有情况下均无临床意义。单纯支架置入治疗的动脉瘤完全闭塞率为 70%。这些数据强调了 LEO 支架的血流改道特性。
