Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Clin Neurol Neurosurg. 2020 Jun;193:105782. doi: 10.1016/j.clineuro.2020.105782. Epub 2020 Mar 19.
Flow diversion is a popular technique used to treat ordinary small, as well as complex internal carotid artery (ICA) aneurysms. We describe aneurysm occlusion rates, complications and patient outcomes in patients with ICA aneurysms treated with flow diverter stents.
We identified all consecutive patients with ICA aneurysms that were treated with flow diverter stents between 2014 and 2019 at our institution. We divided the aneurysms into two anatomic subgroups (cavernous and supraclinoid segments). All the imaging studies and medical records were reviewed for relevant features in relation to aneurysms, complications and patient outcomes.
A total of 62 patients with 76 ICA aneurysms (72 unruptured; 4 ruptured) were treated with 70 flow diversion procedures, including six re-treatments. Complete aneurysm occlusion was achieved in 61 % of patients at 6-month follow-up (cavernous 69 %, supraclinoid 58 %), and in 69 % at the latest follow-up (mean of 18 months). Postprocedural intracranial ischemia or hemorrhage was seen in 24 % of patients, including two aneurysm ruptures after flow diversion, and related major long-term functional decline or mortality was seen in 6% of patients. Preprocedural dysfunction of extraocular muscles or vision disturbance improved moderately at best (40-60 %). At the latest follow-up, 54 patients (87 %) were functionally independent (mRS ≤2).
Flow diversion for cavernous and supraclinoid ICA aneurysms demonstrated acceptable results, but complex aneurysm features cause uncertainty in predicting aneurysm occlusion probability. Patients should be informed of the non-negligible rate of complications, and of only moderate improvement rate of cranial nerve dysfunctions.
血流导向装置是一种常用于治疗普通小以及复杂颈内动脉（ICA）动脉瘤的技术。我们描述了在我们机构接受血流导向支架治疗的 ICA 动脉瘤患者的动脉瘤闭塞率、并发症和患者结局。
我们确定了 2014 年至 2019 年期间在我们机构接受血流导向支架治疗的所有连续 ICA 动脉瘤患者。我们将动脉瘤分为两个解剖亚组（海绵窦和床突上段）。所有影像学研究和病历均进行了回顾，以了解与动脉瘤、并发症和患者结局相关的特征。
共有 62 名患者的 76 个 ICA 动脉瘤（72 个未破裂；4 个破裂）接受了 70 次血流导向治疗，包括 6 次再治疗。6 个月随访时，61%的患者达到完全动脉瘤闭塞（海绵窦 69%，床突上段 58%），最新随访时为 69%（平均 18 个月）。24%的患者出现术后颅内缺血或出血，包括 2 例血流导向后动脉瘤破裂，6%的患者出现严重的长期功能下降或死亡。术前眼外肌功能障碍或视力障碍仅中度改善（40-60%）。在最新随访时，54 名患者（87%）功能独立（mRS≤2）。
对于海绵窦和床突上段 ICA 动脉瘤，血流导向治疗结果可接受，但复杂的动脉瘤特征导致动脉瘤闭塞概率的预测存在不确定性。应告知患者并发症的发生率不可忽视，颅神经功能障碍的改善率仅为中度。
