Litao Miguel S, Burkhardt Jan-Karl, Tanweer Omar, Raz Eytan, Huang Paul, Becske Tibor, Shapiro Maksim, Riina Howard, Nelson Peter K
Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA.
Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Neurol Int. 2021 May 7;13(2):195-201. doi: 10.3390/neurolint13020020.
Flow diverters such as the pipeline embolization device (PED) cause hemodynamic changes of the treated vessel segment. In posterior communicating artery (PcomA), aneurysms' unique anatomic consideration have to be taken in account due to the connection between the anterior and posterior circulation. We hypothesize that in conjunction with PcomA remodeling, there will also be remodeling of the ipsilateral P1 segment of the posterior cerebral artery (PCA) after PED treatment for PcomA aneurysms.
We retrospectively collected radiological as well as clinical data of PcomA aneurysm patients treated with PED including PcomA and P1 vessel diameters before and after treatment as well as patient and aneurysm characteristics.
Overall, 14 PcomA aneurysm patients were included for analysis and PED treatment was performed without complications in all patients. In 10 out of 14 patients (71%), a decrease in PcomA diameter was observed and there was a significant mean decrease of 0.78 mm in PcomA diameter on angiographic last follow-up (LFU) ( = 0.003). In the same patient population (10 out of 14 patients), there was meanwhile a significant mean increase of 0.43 mm in the ipsilateral P1 segment diameter observed ( = 0.015). These vessel remodeling effects were in direct correlation with aneurysm occlusion since all of these patients showed aneurysm occlusion at LFU while 29% showed only partial occlusion without vessel remodeling effects. A decrease in PcomA diameter was directly associated with aneurysm occlusion ( = 0.042). There were no neurologic complications on LFU.
In the treatment of PcomA aneurysms with PED, the P1 segment of the PCA increases in diameter while the PcomA diameter decreases. Our results suggest that this remodeling effect is associated with aneurysm occlusion and decrease of PcomA is hemodynamically compensated for by an increase in the ipsilateral P1 diameter.
血流导向装置，如Pipeline栓塞装置（PED），会引起治疗血管段的血流动力学变化。在后交通动脉（PcomA），由于前循环和后循环之间的连接，动脉瘤独特的解剖学因素必须被考虑在内。我们假设，在PED治疗PcomA动脉瘤后，伴随着PcomA重塑，同侧大脑后动脉（PCA）的P1段也会发生重塑。
我们回顾性收集了接受PED治疗的PcomA动脉瘤患者的影像学和临床数据，包括治疗前后的PcomA和P1血管直径以及患者和动脉瘤的特征。
总体而言，纳入14例PcomA动脉瘤患者进行分析，所有患者均顺利进行PED治疗，无并发症发生。14例患者中有10例（71%）观察到PcomA直径减小，血管造影末次随访（LFU）时PcomA直径平均显著减小0.78mm（P = 0.003）。在同一患者群体（14例患者中的10例）中，同时观察到同侧P1段直径平均显著增加0.43mm（P = 0.015）。这些血管重塑效应与动脉瘤闭塞直接相关，因为所有这些患者在LFU时均显示动脉瘤闭塞，而29%的患者仅显示部分闭塞，无血管重塑效应。PcomA直径减小与动脉瘤闭塞直接相关（P = 0.042）。LFU时无神经并发症。
在使用PED治疗PcomA动脉瘤时，PCA的P1段直径增加而PcomA直径减小。我们的结果表明，这种重塑效应与动脉瘤闭塞相关，PcomA直径减小在血流动力学上通过同侧P1直径增加得到补偿。
