Li Li, Xu Gang-Qin, Gao Hui-Li, Gao Bu-Lang, Zhang Kun, Wang Zi-Liang, Li Tian-Xiao
Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China.
Front Neurol. 2022 Aug 23;13:919866. doi: 10.3389/fneur.2022.919866. eCollection 2022.
To investigate the effect and safety of flow diverters in the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery in comparison with stent-assisted coiling or stenting alone.
Patients with unruptured dissecting intracranial aneurysms of the vertebral artery treated with the flow diverter, stent-assisted coiling, or stenting alone were retrospectively enrolled. The clinical data were analyzed and compared.
Twenty-five patients were enrolled in the flow diversion group and 42 patients in the stenting group. Twenty-six flow diverters were deployed in the flow diversion group. Immediate angiography revealed contrast agent retention within the aneurysm cavity in all patients. In the stenting group, 48 stents were deployed, and immediate angiographic outcome showed O'Kelly-Marotta (OKM) grade D in 18 (42.9%) aneurysms, grade C in 16 (38.1%), and grade B in 8 (19.0%). Periprocedural ischemic complications of thrombosis occurred in two (4.8%) patients and were treated with thrombolysis. In the flow diversion group, 19 (76%) patients underwent angiographic follow-up 3-46 (median 24) months after the procedure, with the OKM grade D in 11 (57.9%) patients, C in two (10.5%), and B in six (31.6%). The aneurysm recurrence rate was zero, and all diverters remained patent. Asymptomatic instent stenosis occurred in two (10.5%) patients. In seven of the ten patients with mild or moderate parent artery stenosis before the procedure who experienced angiographic follow-up, the stenosis was improved in five (71.4%) patients. In the stenting group, angiographic follow-up was carried out in 33 (78.6%) patients 6-58 months (median 34) after the procedure, with OKM grade D in 22 (66.7%) patients, grade C in five (15.2%), grade B in three (9.1%), and aneurysm recurrence (grade B, with increased contrast agent into the aneurysm cavity) in three (9.1%). Five (16.7%) patients experienced asymptomatic instent stenosis, and six of the 12 patients (50%) with parent artery stenosis were improved.
Flow diverters with or without selective adjunctive coiling for the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery may be safe and effective with good occlusion effects not inferior to those of stent-assisted coiling and stenting alone even though the long-term effect still warrants confirmation.
比较血流导向装置与单纯支架辅助弹簧圈栓塞术或单纯支架置入术治疗未破裂椎动脉夹层颅内动脉瘤的疗效及安全性。
回顾性纳入接受血流导向装置、支架辅助弹簧圈栓塞术或单纯支架置入术治疗的未破裂椎动脉夹层颅内动脉瘤患者。对临床资料进行分析和比较。
血流导向组纳入25例患者，支架置入组纳入42例患者。血流导向组共置入26枚血流导向装置。即刻血管造影显示所有患者动脉瘤腔内均有造影剂滞留。支架置入组共置入48枚支架，即刻血管造影结果显示，18例（42.9%）动脉瘤为O'Kelly-Marotta（OKM）D级，16例（38.1%）为C级，8例（19.0%）为B级。围手术期血栓形成导致的缺血性并发症发生在2例（4.8%）患者中，经溶栓治疗。血流导向组中，19例（76%）患者在术后3 - 46个月（中位时间24个月）接受血管造影随访，其中11例（57.9%）患者为OKM D级，2例（10.5%）为C级，6例（31.6%）为B级。动脉瘤复发率为零，所有血流导向装置均保持通畅。2例（10.5%）患者出现无症状支架内狭窄。术前有轻至中度载瘤动脉狭窄的10例患者中，7例接受血管造影随访，其中5例（71.4%）患者狭窄情况改善。支架置入组中，33例（78.6%）患者在术后6 - 58个月（中位时间34个月）接受血管造影随访，其中22例（66.7%）患者为OKM D级，5例（15.2%）为C级，3例（9.1%）为B级，3例（9.1%）动脉瘤复发（B级，动脉瘤腔内造影剂增多）。5例（16.7%）患者出现无症状支架内狭窄，12例载瘤动脉狭窄患者中有6例（50%）情况改善。
血流导向装置联合或不联合选择性辅助弹簧圈栓塞术治疗未破裂椎动脉夹层颅内动脉瘤可能是安全有效的，闭塞效果良好，不劣于单纯支架辅助弹簧圈栓塞术和单纯支架置入术，尽管长期疗效仍有待证实。
