Department of Radiology, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
Neuroradiol J. 2022 Aug;35(4):461-467. doi: 10.1177/19714009211049086. Epub 2021 Nov 7.
Flow diverting stents have revolutionized the treatment of intracranial aneurysms through endoluminal reconstruction of the parent vessel. Despite this, certain aneurysms require retreatment. The purpose of this study was to identify clinical and radiologic determinants of aneurysm retreatment following flow diversion.
A multicenter flow diversion database was evaluated to identify patients presenting with an unruptured, previously untreated aneurysm with a minimum of 12 months' clinical and angiographic follow-up. Univariate and multivariate logistic regression modeling was performed to identify determinants of retreatment.
We identified 189 aneurysms treated in 189 patients with a single flow-diverting stent. Mean age was 54 years, and 89% were female. Complete occlusion was achieved in 70.3% and 83.6% of patients at six and 12 months, respectively. Aneurysm retreatment with additional flow-diverting stents occurred in 5.8% of cases. Univariate analysis revealed that dome diameter 10 mm ( = 0.012), pre-clinoid internal carotid artery location ( = 0.012), distal > proximal parent vessel diameter ( = 0.042), and later dual antiplatelet therapy (DAPT) discontinuation ( < 0.001) were predictive of retreatment. Multivariate analysis identified discontinuation of DAPT 12 months ( = 0.003) as a strong determinant of retreatment with dome diameter 10 mm trending toward statistical significance ( = 0.064). Large aneurysm neck diameter, presence of aneurysm branch vessels, patient age, smoking history, and hypertension were not determinant of retreatment on multivariate analysis.
Prolonged DAPT is the most important determinant of aneurysm retreatment following single-device flow diversion. Abbreviating DAPT duration to only six months should be a consideration in this population, especially for patients with a large aneurysm dome diameter.
血流导向装置通过对载瘤血管的腔内重建，彻底改变了颅内动脉瘤的治疗方式。尽管如此，某些动脉瘤仍需要再次治疗。本研究旨在确定血流导向装置治疗后动脉瘤再次治疗的临床和影像学决定因素。
对多中心血流导向装置数据库进行评估，以确定存在未破裂、未经治疗的、有至少 12 个月临床和血管造影随访的患者。采用单变量和多变量逻辑回归模型来确定再次治疗的决定因素。
共纳入 189 名患者的 189 个动脉瘤，这些患者均接受了单个血流导向装置治疗。患者平均年龄为 54 岁，89%为女性。分别有 70.3%和 83.6%的患者在 6 个月和 12 个月时实现完全闭塞。有 5.8%的患者需要再次用血流导向装置进行治疗。单变量分析显示，瘤顶直径 10mm（ = 0.012）、颈内动脉床突上段（ = 0.012）、载瘤动脉远端直径>近端直径（ = 0.042）以及双联抗血小板治疗（DAPT）过早停药（ < 0.001）与再次治疗相关。多变量分析确定 DAPT 停药 12 个月（ = 0.003）是再次治疗的重要决定因素，瘤顶直径 10mm 也有统计学意义（ = 0.064）。大的瘤颈直径、存在动脉瘤分支血管、患者年龄、吸烟史和高血压在多变量分析中均不是再次治疗的决定因素。
延长 DAPT 是血流导向装置治疗后动脉瘤再次治疗的最重要决定因素。对于瘤顶直径较大的患者，应考虑将 DAPT 时间缩短至 6 个月。
