Saied Ahmed, Elsaid Nada, Joshi Krishna, Gomaa Mohamed, Amer Talal, Saad Mohamed, Lopes Demetrius
Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Neurology, Mansoura University, Mansoura, Egypt.
Interv Neurol. 2020 Jan;8(2-6):220-230. doi: 10.1159/000502058. Epub 2019 Sep 11.
Stent-assisted coiling (SAC) leads to significant changes in the vascular angle altering the bifurcation geometry and the hemodynamics at the bifurcation apex. It is believed that the stent alone exerts this effect, but other possible factors have not been studied.
To study the factors contributing to angular remodeling following SAC of bifurcation aneurysms including the anatomical, stent-related, and coil-related factors.
We reviewed 43 basilar and carotid bifurcation aneurysms treated by SAC using Neuroform EZ ( = 28), Enterprise ( = 8), and Lvis Jr. ( = 7) stents. The bifurcation angle between the mother and stented daughter vessel was measured in 4 settings: pretreatment, poststenting, postcoiling, and at delayed follow-up (6-12 months). The degree of stent-induced angular remodeling was calculated by subtracting the poststenting bifurcation angle from the pretreatment one, while the coil-induced angular remodeling was calculated as the difference between the postcoiling and poststenting bifurcation angle. The immediate postprocedural degree of angular remodeling is the sum of the stent- and coil-induced angular remodeling. We studied the effect of several factors including the pretreatment bifurcation angle, aneurysm site, diameter of parent vessel, stent type, stent length in the daughter vessel, postoperative actual in situ coil size, and packing density.
The mean degree of stent-induced and coil-induced angular remodeling was 10.2 (0-47) and 4.53 (-7 to 30), respectively. The immediate postprocedural and delayed angular remodeling was 14.8 (-4 to 47) and 4.75 (-12 to 40), respectively. The degree of immediate remodeling was significantly affected by the actual in situ coil size ( = 0.017), and the pretreatment bifurcation angle ( = 0.024). Linear regression was carried out and the pretreatment bifurcation angle was defined as a predictor. The degree of delayed remodeling is significantly affected only by the pretreatment bifurcation angle ( = 0.011).
Immediate angular remodeling following SAC of bifurcation aneurysms can happen after stenting or coiling or both. This is the first study reporting the role of the coils as an additional factor beside the stent in inducing immediate angular changes; this effect is correlated to the size of the coils. The pretreatment bifurcation angle is the most consistent factor affecting the degree of both immediate and delayed angular remodeling.
支架辅助弹簧圈栓塞术（SAC）会导致血管角度发生显著变化，从而改变分叉处的几何形状以及分叉顶端的血流动力学。人们认为仅支架就能产生这种效果，但尚未对其他可能的因素进行研究。
研究导致分叉动脉瘤SAC术后角度重塑的因素，包括解剖学因素、支架相关因素和弹簧圈相关因素。
我们回顾了43例采用Neuroform EZ（n = 28）、Enterprise（n = 8）和Lvis Jr.（n = 7）支架进行SAC治疗的基底动脉和颈动脉分叉动脉瘤。在4个阶段测量母血管与置入支架的分支血管之间的分叉角度：术前、置入支架后、弹簧圈栓塞后以及延迟随访（6 - 12个月）。支架诱导的角度重塑程度通过术前分叉角度减去置入支架后的分叉角度来计算，而弹簧圈诱导的角度重塑程度则计算为弹簧圈栓塞后与置入支架后的分叉角度之差。术后即刻的角度重塑程度是支架和弹簧圈诱导的角度重塑之和。我们研究了几个因素的影响，包括术前分叉角度、动脉瘤部位、母血管直径、支架类型、分支血管内的支架长度、术后实际原位弹簧圈大小以及填充密度。
支架诱导和弹簧圈诱导的角度重塑平均程度分别为10.2（0 - 47）和4.53（-7至30）。术后即刻和延迟的角度重塑分别为14.8（-4至47）和4.75（-12至40）。即刻重塑程度受到实际原位弹簧圈大小（P = 0.017）和术前分叉角度（P = 0.024）的显著影响。进行了线性回归分析，并将术前分叉角度定义为一个预测因子。延迟重塑程度仅受到术前分叉角度的显著影响（P = 0.011）。
分叉动脉瘤SAC术后的即刻角度重塑可在置入支架或弹簧圈栓塞或两者之后发生。这是第一项报道弹簧圈作为除支架之外在诱导即刻角度变化中起额外作用的研究；这种效应与弹簧圈大小相关。术前分叉角度是影响即刻和延迟角度重塑程度的最一致因素。
