From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
From the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
AJNR Am J Neuroradiol. 2021 Jun;42(6):1087-1092. doi: 10.3174/ajnr.A7125. Epub 2021 Apr 15.
Few reports described flow diversion for ICA bifurcation aneurysms. Our aim was to provide further insight into flow diversion for ICA bifurcation aneurysms difficult to treat with other strategies.
Consecutive patients receiving flow diverters for unruptured ICA bifurcation aneurysms were collected. Aneurysm occlusion (O'Kelly-Marotta grading scale) and clinical outcomes were evaluated.
Twenty saccular ICA bifurcation aneurysms were treated with the Pipeline Embolization Device deployed from the M1 to the ICA, covering the aneurysm and the A1 segment. All patients presented with an angiographic visualized contralateral flow from the anterior communicating artery. Mean aneurysm size was 6.5 (SD, 3.2) mm (range, 4.5-20 mm). All lesions had an unfavorable dome-to-neck ratio (mean/median, 1.6/1.6; range, 0.8-2.8; interquartile range = 0.5) or aspect ratio for coiling (mean/median = 1.5/1.55; range, 0.8-2.5; interquartile range = 0.6). One was a very large aneurysm (20 mm). Nineteen medium-sized lesions were completely occluded during the angiographic follow-up (13 months). No cases of aneurysm rupture or retreatment were reported. No adverse events were described. Aneurysm occlusion was associated with the asymptomatic flow modification of the covered A1 that was occluded and contralaterally filled among 10 patients (50%), narrowed among 9 patients (45%), and unchanged in 1 subject (5%). There was no difference in the mean initial diameter of the occluded (2.1 [SD 0.4] mm; range, 1.6-3 mm) and narrowed (2 [SD, 0.2] mm; range, 1.7-2.6 mm) A1 segments.
Medium-sized unruptured ICA bifurcation aneurysms with unfavorable morphology for coiling can be treated with M1 ICA flow diversion. Aneurysm occlusion is associated with flow modifications of the covered A1 that seems safe in the presence of a favorable collateral anatomy through the anterior communicating artery complex.
鲜有报道描述颈内动脉分叉部动脉瘤的血流导向装置治疗。我们旨在为难以通过其他策略治疗的颈内动脉分叉部动脉瘤的血流导向装置治疗提供更多见解。
连续收集接受血流导向装置治疗未破裂颈内动脉分叉部动脉瘤的患者。评估动脉瘤闭塞（O'Kelly-Marotta 分级）和临床结果。
20 个囊状颈内动脉分叉部动脉瘤使用 Pipeline 栓塞装置从 M1 到颈内动脉进行治疗，覆盖动脉瘤和 A1 段。所有患者均显示前交通动脉对侧显影的血流。平均动脉瘤大小为 6.5（SD，3.2）mm（范围，4.5-20mm）。所有病变均具有不利的瘤颈比（平均/中位数，1.6/1.6；范围，0.8-2.8；四分位距=0.5）或适合线圈栓塞的形态比（平均/中位数=1.5/1.55；范围，0.8-2.5；四分位距=0.6）。1 例为巨大动脉瘤（20mm）。19 例中等大小的病变在血管造影随访期间完全闭塞（13 个月）。无动脉瘤破裂或再治疗病例报告。未发生不良事件。10 例患者（50%）发现被覆盖的 A1 闭塞且对侧充盈发生无症状血流改变，9 例患者（45%）发现 A1 狭窄，1 例患者（5%）发现 A1 未变。闭塞（2.1 [SD，0.4]mm；范围，1.6-3mm）和狭窄（2 [SD，0.2]mm；范围，1.7-2.6mm）A1 段的初始平均直径无差异。
对于不适合线圈栓塞的中等大小未破裂颈内动脉分叉部动脉瘤，可以采用颈内动脉 M1 段血流导向装置治疗。动脉瘤闭塞与被覆盖的 A1 段的血流改变相关，在前交通动脉复合体存在有利的侧支解剖结构的情况下，这种血流改变似乎是安全的。
