Feng Shao-Wei, Luo Chao-Bao, Lee Chien-Hui, Chang Feng-Chi, Lin Chung-Jung
Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2022 Mar 1;85(3):358-363. doi: 10.1097/JCMA.0000000000000619.
Endovascular coil embolization is an important method for managing intracranial aneurysms. However, aneurysm coiling may fail or be insufficient in geographically difficult aneurysms. A flow-diverter stent (FDS) is an alternative in these difficult coiling aneurysms. Thus, this study reports the experience and outcome of FDS management of intracranial aneurysms.
Over 29 months, FDS treated 125 patients with 163 intracranial unruptured aneurysms. This study enrolled 31 men and 94 women, ranging from 17 to 81 years (mean, 58 years). Clinical data, aneurysm characteristics, and angiographic and clinical outcomes of patients treated by FDS were retrospectively assessed.
The current study found 151 (93%) aneurysms in the internal carotid artery. Most aneurysms (n = 118; 72%) were small (<7 mm). The mean aneurysm size was 6.2 mm (range, 2-38 mm). Follow-up angiography was available in 53 patients with 74 aneurysms (mean, 13 months). Successful FDS deployment in an ideal position was found in 125 of 130 patients (96%). Complete obliteration (CO) was achieved in 58 aneurysms (78%) in the mean 13-month angiographic follow-up. Smaller aneurysms (<7 mm) had a CO tendency than larger aneurysms (p < 0.01) in midterm follow-up. Seven patients (5.6%) had intraprocedural complications (in-stent thrombosis, three patients; distal embolic, two patients; iatrogenic carotid-cavernous fistula, and subarachnoid hemorrhage, one patient). Two patients (1.6%) suffered from permanent procedure-related morbidity (n = 1) or mortality (n = 1). No late hemorrhagic events or stent displacement occurred during the follow-up period.
Despite few procedural complications and some pieces of evidence of insufficient aneurismal treatment in a midterm angiographic follow-up, FDS was effective and safe in managing intracranial unruptured aneurysms, particularly in smaller aneurysms, which had better CO than larger ones.
血管内弹簧圈栓塞术是治疗颅内动脉瘤的重要方法。然而，对于形态复杂的动脉瘤，弹簧圈栓塞可能失败或效果不佳。血流导向支架（FDS）是这些复杂动脉瘤的一种替代治疗方法。因此，本研究报告了FDS治疗颅内动脉瘤的经验和结果。
在29个月的时间里，FDS治疗了125例患者的163个颅内未破裂动脉瘤。本研究纳入了31名男性和94名女性，年龄在17至81岁之间（平均58岁）。对FDS治疗患者的临床资料、动脉瘤特征以及血管造影和临床结果进行回顾性评估。
本研究发现151个（93%）动脉瘤位于颈内动脉。大多数动脉瘤（n = 118；72%）较小（<7mm）。动脉瘤平均大小为6.2mm（范围2 - 38mm）。53例患者的74个动脉瘤（平均13个月）有随访血管造影资料。130例患者中有125例（96%）成功将FDS放置于理想位置。在平均13个月的血管造影随访中，58个动脉瘤（78%）实现了完全闭塞（CO）。中期随访中，较小的动脉瘤（<7mm）比大动脉瘤有更高的CO倾向（p < 0.01）。7例患者（5.6%）发生术中并发症（支架内血栓形成3例；远端栓塞2例；医源性颈内动脉海绵窦瘘和蛛网膜下腔出血各1例）。2例患者（1.6%）出现永久性手术相关并发症（1例）或死亡（1例）。随访期间未发生迟发性出血事件或支架移位。
尽管术中并发症较少，且中期血管造影随访有一些动脉瘤治疗不充分的证据，但FDS治疗颅内未破裂动脉瘤有效且安全，尤其是对于较小的动脉瘤，其CO效果优于较大动脉瘤。
