Department of Interventional Radiology, Military Institute of Medicine, Warsaw, Poland.
PLoS One. 2020 Jun 4;15(6):e0233981. doi: 10.1371/journal.pone.0233981. eCollection 2020.
We aimed to examine aneurysm hemodynamics with intra-saccular pressure measurement, and compare the effects of coiling, stenting and stent-assisted coiling in proximal segments of intracranial circulation. A cohort of 45 patients underwent elective endovascular coil embolization (with or without stent) for intracranial aneurysm at our department. Arterial pressure transducer was used for all measurements. It was attached to proximal end of the microcatheter. Measurements were taken in the parent artery before and after embolization, at the aneurysm dome before embolization, after stent implantation, and after embolization. Stent-assisted coiling was performed with 4 different stents: LVIS and LVIS Jr (Microvention, Tustin, CA, USA), Leo (Balt, Montmorency, France), Barrel VRD (Medtronic/ Covidien, Irvine, CA, USA). Presence of the stent showed significant reverse correlation with intra-aneurysmal pressure-both systolic and diastolic-after its implantation (r = -0.70 and r = -0.75, respectively), which was further supported by correlations with stent cell size-r = 0.72 and r = 0.71, respectively (P<0.05). Stent implantation resulted in significant decrease in diastolic intra-aneurysmal pressure (p = 0.046). Systolic or mean intra-aneurysmal pressure did not differ significantly. Embolization did not significantly change the intra-aneurysmal pressure in matched pairs, regardless of the use of stent (p>0.05). In conclusion, low-profile braided stents show a potential to divert blood flow, there was significant decrease in diastolic pressure after stent placement. Flow-diverting properties were related to stent porosity. Coiling does not significantly change the intra-aneurysmal pressure, regardless of packing density.
我们旨在通过囊内压力测量来检查动脉瘤的血流动力学，并比较颅内循环近端血管内治疗中线圈填塞、支架置入和支架辅助线圈填塞的效果。我们科室的一组 45 名患者接受了择期的颅内动脉瘤血管内线圈栓塞（伴或不伴支架）。所有测量均使用动脉压力传感器，将其连接到微导管的近端。栓塞前和栓塞后测量母动脉、栓塞前动脉瘤瘤顶、支架植入后和栓塞后的压力。使用 4 种不同的支架进行支架辅助线圈填塞：LVIS 和 LVIS Jr（Microvention，加利福尼亚州图森市）、Leo（Balt，蒙莫朗西，法国）、Barrel VRD（美敦力/柯惠，加利福尼亚州欧文市）。支架置入后，支架内存在与瘤内压力呈显著负相关，无论是收缩压还是舒张压（r = -0.70 和 r = -0.75，分别），支架细胞大小与压力之间的相关性进一步支持了这一结论（r = 0.72 和 r = 0.71，分别）（P<0.05）。支架置入导致舒张期瘤内压力显著下降（p = 0.046）。收缩压或平均瘤内压力无显著差异。栓塞在配对中均未显著改变瘤内压力，无论是否使用支架（p>0.05）。总之，低剖面编织支架具有改变血流的潜力，支架置入后舒张期压力显著下降。血流改道特性与支架孔隙率有关。无论填塞密度如何，线圈填塞均不会显著改变瘤内压力。
