Department of Neurosurgery, Buddhist Tzu-Chi General Hospital and Tzu-Chi University, Hualien, Taiwan, ROC.
Department of Radiology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2022 Jul 1;85(7):754-758. doi: 10.1097/JCMA.0000000000000726. Epub 2022 Mar 31.
Endovascular aneurysm coiling is a minimally invasive method to manage intracranial aneurysms. However, aneurysm coiling may fail in very small aneurysms (VSAs); thus, flow diverter (FD) is recommended as an alternative in these difficult aneurysms. Herein, we report our experience and outcomes of FD to treat VSA of the internal carotid artery (ICA).
Over a 3-year period, a total of 70 patients with 87 unruptured VSAs of the ICA were managed by FD. There were 54 men and 16 women, with a mean age of 57 (range, 41-75) years. We retrospectively assessed the clinical data, aneurysm characteristics, and angiographic as well as clinical outcomes of patients treated by FD and compared with larger aneurysms.
Fifty aneurysms (58%) were located in the supraclinoid ICA, followed by paraclinoid ICA (n = 31, 36%) and cavernous ICA (n = 6, 7%). Most aneurysms (n = 72, 83%) were between 2 and 3 mm in size. The mean aneurysm size was 2.3 mm (range, 1.5-3 mm). Follow-up angiographic data (mean, 13 months) were available in 54 patients with 68 aneurysms. Successful FD deployment in an ideal position to bride aneurysm was achieved in 86 of 87 aneurysms (99%). Complete obliteration (CO) was achieved in 63 aneurysms (93%). Compared with larger aneurysms (>3 mm), VSAs had the tendency to achieve CO ( p < 0.05) in a midterm follow-up. Two patients (2.8%) had intraprocedural complications, including in-stent thrombosis (n = 1) and distal embolism (n = 1). One patient (1.4%) suffered from mild limb weakness.
The use of FD to manage VSA was technically feasible, and the procedure was simpler than those of larger aneurysms. FD stenting of VSAs was confirmed to be effective and safe and had higher CO rate than those in larger aneurysms in a midterm angiographic follow-up.
血管内动脉瘤弹簧圈栓塞术是一种微创方法，用于治疗颅内动脉瘤。然而，在非常小的动脉瘤（VSAs）中，动脉瘤弹簧圈栓塞术可能会失败；因此，建议在这些困难的动脉瘤中使用血流导向装置（FD）作为替代方法。在此，我们报告使用 FD 治疗颈内动脉（ICA）VSAs 的经验和结果。
在 3 年期间，共有 70 名患者的 87 个未破裂的 ICA VSAs 通过 FD 治疗。其中 54 名男性和 16 名女性，平均年龄 57 岁（范围，41-75 岁）。我们回顾性评估了通过 FD 治疗的患者的临床资料、动脉瘤特征、血管造影和临床结果，并与较大的动脉瘤进行了比较。
50 个动脉瘤（58%）位于前交通段 ICA，其次是后交通段 ICA（n = 31，36%）和海绵窦段 ICA（n = 6，7%）。大多数动脉瘤（n = 72，83%）的大小在 2 至 3mm 之间。平均动脉瘤大小为 2.3mm（范围，1.5-3mm）。54 名患者的 68 个动脉瘤有随访的血管造影数据（平均 13 个月）。87 个动脉瘤中的 86 个（99%）成功地将 FD 放置在理想的位置以桥接动脉瘤。63 个动脉瘤（93%）达到完全闭塞（CO）。与较大的动脉瘤（>3mm）相比，VSAs 在中期随访中更倾向于达到 CO（p<0.05）。两名患者（2.8%）发生术中并发症，包括支架内血栓形成（n=1）和远端栓塞（n=1）。一名患者（1.4%）出现轻度肢体无力。
使用 FD 治疗 VSAs 在技术上是可行的，并且操作比治疗较大的动脉瘤更简单。FD 支架置入术治疗 VSAs 在中期血管造影随访中被证实是有效和安全的，并且 CO 率高于较大的动脉瘤。
