Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic.
Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
J Neurointerv Surg. 2021 Jul;13(7):631-636. doi: 10.1136/neurintsurg-2020-016790. Epub 2020 Oct 20.
Indications for flow diversion stent (FDS) treatment are expanding. However, there is still a lack of evidence for the long-term outcome in distally located aneurysms in the M2 segment of the middle cerebral artery (MCA) and beyond.
Consecutive subjects (from June 2013 to August 2020) with MCA aneurysms in the M2 segment or beyond treated with FDS were reviewed retrospectively. The primary endpoints for clinical safety were the absence of mortality, stroke event, re-rupture of the aneurysm, and worsening of clinical symptoms. The primary endpoint for treatment efficacy was complete/near-complete occlusion at follow-up after 12 months.
23 patients were identified: 7 aneurysms were located in the M2 segment of the MCA, 4 in the M2-M3 bifurcation, 2 in M3, 3 in M3-4 branching, and 2 in M4; 5 aneurysms were located in M2 with extension into the M1-M2 bifurcation. 13 aneurysms were of fusiform morphology, 8 sacculofusiform, and 2 saccular. 16 aneurysms were of highly suspected dissecting etiology. The median diameter of the parent vessel was 2.1 mm proximally and 2 mm distally. The median time of the follow-up was 30 months (range 16 months to 6 years). Complete/near complete occlusion was observed in 14/20 patients (70%) and one stable remodeling (5%) was seen at 12 months. 22 patients (95.6%) had an excellent clinical outcome (mRS 0-1) at 6 months. Technical challenges associated with the deployment of FDS occurred in 8.7% of cases. Severe complications, intraparenchymal hemorrhage and re-rupture of the aneurysm occurred in 2 patients (8.7%).
Flow diversion of distally located aneurysms is technically feasible with low morbidity and mortality.
血流导向装置（FDS）治疗的适应证正在扩大。然而，对于大脑中动脉（MCA）M2 段及更远部位的远端动脉瘤的长期结果仍缺乏证据。
回顾性分析 2013 年 6 月至 2020 年 8 月期间连续接受 FDS 治疗的 MCA 动脉瘤患者。临床安全性的主要终点为无死亡率、卒中事件、动脉瘤再破裂和临床症状恶化。治疗效果的主要终点为 12 个月后随访时完全/近完全闭塞。
共纳入 23 例患者：7 例动脉瘤位于 MCA M2 段，4 例位于 M2-M3 分叉处，2 例位于 M3 段，3 例位于 M3-4 分支处，2 例位于 M4 段；5 例动脉瘤位于 M2 段，延伸至 M1-M2 分叉处。13 例动脉瘤呈梭形形态，8 例呈囊状梭形，2 例呈囊状。16 例动脉瘤高度怀疑为夹层病因。母血管近端直径中位数为 2.1mm，远端直径中位数为 2mm。中位随访时间为 30 个月（16 个月至 6 年）。20 例患者中的 14 例（70%）达到完全/近完全闭塞，1 例（5%）在 12 个月时出现稳定重塑。6 个月时 22 例患者（95.6%）临床预后良好（mRS 0-1）。FDS 植入时发生技术挑战的病例占 8.7%。2 例患者（8.7%）发生严重并发症，即脑实质内出血和动脉瘤再破裂。
对于远端动脉瘤，血流导向装置的治疗技术是可行的，且发病率和死亡率较低。
