Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea.
Yonsei Med J. 2022 Apr;63(4):349-356. doi: 10.3349/ymj.2022.63.4.349.
The purpose of this study was to report the author's experiences in treating large (10-25 mm) and giant (>25 mm) intracranial aneurysms (IAs) using a single Flow Re-direction Endoluminal Device (FRED) without assistant coiling, with a focus on procedure-related complications.
A total of 33 patients who were treated with FRED between January 2018 and July 2020 were retrospectively reviewed. The timing of procedure-related complications was chronologically categorized as acute (within 7 days), subacute (8 to 21 days), and delayed (after 21 days) periods. Follow-up angiography was performed at 2 to 27 months (mean 9.7 months), and clinical follow-up was performed at 1 to 31 months (mean 14.1 months) in all patients.
Six (18.2%) patients experienced procedure-related complications, including 2 (6.1%) in acute period, 1 (3.0%) in subacute period, and 3 (9.1%) in delayed period. Thromboembolic complications occurred in 5 (15.2%) patients and hemorrhagic complications in 1 (3.0%). Permanent morbidity and mortality rates were 3.0% each. Non-internal carotid artery (ICA) location of IAs (odds ratio 6.532; 95% confidence interval, 1.335-17.816; =0.034) was the only independent risk factor for procedure-related complications on multivariate logistic regression analysis.
The procedure-related complication rate was 18.2% in this study. Procedure-related complications might increase when treating large and giant IAs located on a non-ICA, especially on the middle cerebral artery. Therefore, it may be suggested that neurointerventionists and endovascular neurosurgeons should pay attention to the location of IAs when treating large and giant IAs with a single FRED.
本研究旨在报告作者使用单个血流导向装置（Flow Re-direction Endoluminal Device，FRED）治疗 10-25mm 大和>25mm 巨大颅内动脉瘤（intracranial aneurysms，IAs）的经验，重点关注与手术相关的并发症。
回顾性分析 2018 年 1 月至 2020 年 7 月期间接受 FRED 治疗的 33 例患者。根据时间顺序将手术相关并发症分为急性期（7 天内）、亚急性期（8-21 天）和迟发性（21 天后）。所有患者均进行了 2-27 个月（平均 9.7 个月）的随访血管造影检查，1-31 个月（平均 14.1 个月）的临床随访。
6 例（18.2%）患者发生与手术相关的并发症，其中 2 例（6.1%）发生在急性期，1 例（3.0%）发生在亚急性期，3 例（9.1%）发生在迟发性。血栓栓塞并发症发生在 5 例（15.2%）患者中，出血性并发症发生在 1 例（3.0%）患者中。永久性发病率和死亡率均为 3.0%。多变量逻辑回归分析显示，非颈内动脉（internal carotid artery，ICA）部位的 IAs（比值比 6.532；95%置信区间，1.335-17.816；=0.034）是手术相关并发症的唯一独立危险因素。
本研究中手术相关并发症发生率为 18.2%。当治疗位于非 ICA、尤其是大脑中动脉上的大型和巨大型 IAs 时，手术相关并发症的发生率可能会增加。因此，建议神经介入医师和血管神经外科医师在使用单个 FRED 治疗大型和巨大型 IAs 时应注意 IAs 的位置。
