Department of Neurosurgery, Juntendo University Faculty of Medicine, Japan.
Department of Neurosurgery, National Defense Medical College, Japan.
Neuroradiol J. 2022 Feb;35(1):77-85. doi: 10.1177/19714009211026925. Epub 2021 Jun 29.
Among all stents available for neuroendovascular therapy, the low-profile visible intraluminal support stent bears the highest metal coverage ratio. We deployed a low-profile visible intraluminal support stent with a delivery wire or/and microcatheter system push action to shorten the low-profile visible intraluminal support stent and thus achieve a flow diversion effect. We report our single-institution experience with the use of low-profile visible intraluminal support stents for intentionally shortened deployment (shortening group) and non-shortened deployment (non-shortening group) for unruptured intracranial aneurysms.
We retrospectively reviewed the medical records of 130 patients with 131 intracranial aneurysms who were treated with low-profile visible intraluminal support stent-assisted coil embolization from February 2016-January 2019. All perioperative complications were noted. Every 6 months, we re-examined the patients with cerebral angiography or magnetic resonance angiography. The outcomes of aneurysm occlusion were evaluated by the modified Raymond-Roy occlusion classification. We used the finite element method and computational fluid dynamics to investigate the hemodynamics after shortened low-profile visible intraluminal support stent deployment.
Immediately after treatment, the modified Raymond-Roy occlusion classification was significantly better in the shortening group than in the non-shortening group (<0.05). The latest angiographic outcomes showed the same tendency. Hemodynamic analysis by computational fluid dynamics suggested an adequate flow diversion effect with the use of our intentional shortening method.
Stent-assisted coil embolization using this technique showed good results of a high complete occlusion rate and low complication rate. These findings suggest that shortened low-profile visible intraluminal support stent deployment yields a flow diversion effect and may lead to early intra-aneurysmal thrombus formation.
在可用于神经血管内治疗的所有支架中，低轮廓可视内支架具有最高的金属覆盖率。我们使用低轮廓可视内支架输送线或/和微导管系统推送动作来缩短低轮廓可视内支架，从而实现血流改道效果。我们报告了我们单机构使用低轮廓可视内支架进行故意缩短（缩短组）和非缩短（非缩短组）部署治疗未破裂颅内动脉瘤的经验。
我们回顾性分析了 2016 年 2 月至 2019 年 1 月期间采用低轮廓可视内支架辅助线圈栓塞治疗的 130 例 131 个颅内动脉瘤患者的病历。记录所有围手术期并发症。每 6 个月，我们用脑血管造影或磁共振血管造影对患者进行复查。采用改良 Raymond-Roy 闭塞分类评估动脉瘤闭塞的结果。我们使用有限元法和计算流体动力学研究缩短低轮廓可视内支架后血流动力学的变化。
治疗后即刻，缩短组改良 Raymond-Roy 闭塞分类明显优于非缩短组（<0.05）。最新的血管造影结果也显示出相同的趋势。计算流体动力学的血流动力学分析表明，使用我们的故意缩短方法可以获得充分的血流改道效果。
使用这种技术的支架辅助线圈栓塞显示出良好的高完全闭塞率和低并发症率的结果。这些发现表明缩短低轮廓可视内支架的部署可以产生血流改道效果，并可能导致早期瘤内血栓形成。
