Rinaldo Lorenzo, Brinjikji Waleed, Cloft Harry, Lanzino Giuseppe, Gonzalez L Fernando, Kan Peter, Castilla Leonardo Rangel
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2019 Jul;127:e1232-e1236. doi: 10.1016/j.wneu.2019.04.112. Epub 2019 Apr 19.
Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined.
We performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model.
There were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7%). Complete aneurysm occlusion was observed in 34 patients (69.4%). Complete occlusion was less common for patients with a FPC (43.7% vs. 81.8%; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95% confidence interval 0.14-0.89; P = 0.029).
Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.
血流导向（FD）已成为治疗后交通动脉（PCOM）动脉瘤的一种有效治疗方式。胎儿后循环（FPC）是否会影响FD术后PCOM动脉瘤的闭塞率仍未确定。
我们进行了一项回顾性队列研究，对多个机构中PCOM动脉瘤FD治疗的结果进行了回顾。主要关注的结局是最后一次随访时动脉瘤完全闭塞。记录FPC的存在情况（定义为PCOM直径大于P1段），并使用Cox比例风险模型研究其与动脉瘤完全闭塞的关系。
有49例接受FD治疗的PCOM动脉瘤患者符合纳入分析标准。16例患者（32.7%）存在FPC。34例患者（69.4%）观察到动脉瘤完全闭塞。FPC患者的完全闭塞情况较少见（43.7%对81.8%；P = 0.007）。有和没有FPC的患者，闭塞的中位时间分别为51个月和6个月（P = 0.002）。使用多变量Cox比例风险模型，FPC与最后一次随访时完全闭塞的几率降低相关（风险比0.35，95%置信区间0.14 - 0.89；P = 0.029）。
我们的结果表明，FD治疗与FPC相关的PCOM动脉瘤的疗效降低。这些发现可能会影响该部位动脉瘤的治疗选择。
