Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
Sana Kliniken Duisburg, Duisburg, Germany.
Interv Neuroradiol. 2023 Dec;29(6):623-630. doi: 10.1177/15910199221121398. Epub 2022 Aug 18.
Little data exists on endovascular treatment of complex intracranial aneurysms with the Acandis Acclino low-profile self-expanding closed-cell stent systems and is mainly limited to short- or midterm results. We report our long-term, single-centre experience with three generations of Acclino stents treating complex intracranial aneurysms.
62 wide-necked intracranial aneurysms were treated electively using 88 Acclino stent systems. Single stent-assisted coiling was the preferred treatment in 38 cases and the kissing-Y stenting technique in 24 cases. We analysed demographic data and long-term follow-up results.
All stents were successfully deployed with immediate complete (Raymond Roy occlusion classification, RROC I) or near-complete occlusion (RROC II) achieved in 93,5%. Follow-up was available in 55 cases with a mean follow-up of 36 months (range 9-80 months). Long-term RROC I or II was achieved in 49 cases (89,1%). Three cases of stable residual aneurysmal filling were observed (5,5%). Seven aneurysms (12,7%) demonstrated a worsening on follow-up leading either to a neck remnant (4 cases, 7,3%) or to an aneurysm recurrence (3 cases, 5,5%). One recurrent aneurysm was retreated with coilembolization (1,8%). The directly procedural-related complication rate was 4,8%. Seven cases of clinically silent in-stent stenosis (12,7%; morbidity n = 0) were detected on long-term follow-up, six of them using the kissing-Y stenting technique.
Endovascular treatment of various intracranial aneurysms using the Acandis Acclino stent systems is safe and efficient with high aneurysm occlusion rates combined with low complication rates on long-term follow-up. Overall, rates of in-stent stenosis are low but may depend on the treatment technique (single stent-assisted coiling versus kissing-Y stenting with coiling).
使用 Acandis Acclino 低剖面自膨式闭孔支架系统治疗复杂颅内动脉瘤的相关数据较少，且主要限于短期或中期结果。我们报告了使用三代 Acclino 支架治疗复杂颅内动脉瘤的长期单中心经验。
62 例宽颈颅内动脉瘤采用 88 个 Acclino 支架系统进行选择性治疗。38 例采用单支架辅助弹簧圈技术，24 例采用 Y 型支架吻合法。我们分析了人口统计学数据和长期随访结果。
所有支架均成功植入，即刻完全闭塞（Raymond Roy 闭塞分级，RROC I）或接近完全闭塞（RROC II）率为 93.5%。55 例获得随访，平均随访时间为 36 个月（9-80 个月）。49 例获得长期 RROC I 或 II 级结果（89.1%）。3 例稳定的残余动脉瘤充盈（5.5%）。7 例（12.7%）在随访中发现动脉瘤恶化，导致颈残留（4 例，7.3%）或动脉瘤复发（3 例，5.5%）。1 例复发性动脉瘤采用弹簧圈再栓塞治疗（1.8%）。直接与手术相关的并发症发生率为 4.8%。7 例长期随访中发现无症状支架内狭窄（12.7%；发病率 n=0），其中 6 例采用 Y 型支架吻合法。
使用 Acandis Acclino 支架系统治疗各种颅内动脉瘤是安全有效的，具有较高的动脉瘤闭塞率，长期随访并发症发生率低。总体而言，支架内狭窄的发生率较低，但可能取决于治疗技术（单支架辅助弹簧圈技术与支架辅助弹簧圈技术的 Y 型吻合法）。
