Department of Neuroradiology, Niguarda Hospital, Milano, Italy.
Department of Neuroradiology, Ospedale Vito Fazzi Hospital, Lecce, Italy.
J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106760. doi: 10.1016/j.jstrokecerebrovasdis.2022.106760. Epub 2022 Oct 3.
In this study, the authors retrospectively evaluated the effectiveness and the safety of non-surgical middle cerebral artery (MCA) aneurysms treated via the implantation of a flow diverter device (FDD).
Clinical, procedural and follow-up data were analyzed in order to evaluate the safety and effectiveness of the treatment with the FDD in complex MCA aneurysms. Safety was assessed recording (intra-procedural, peri-procedural and delayed) complications in order to determine the morbidity and mortality rates. Functional outcome was evaluated with modified Rankin Scale (mRS) prior and after the endovascular procedure. To assess the efficacy, midterm and long-term clinical, angiographic and cross-sectional imaging follow-ups were recorded.
47 patients (21 males; 26 females) with MCA aneurysms were treated with FDD. 7 were ruptured. 21 aneurysms were saccular, 19 dissecting, 3 fusiform, 2 blood blister-like and 2 were pseudo-aneurysms. 14 aneurysms were small, 23 large and 10 giant, with a mean size of 15.3 mm. 8 aneurysms were recurrent (Raymond-Roy class III): 2 patients had an aneurysmal sac recanalization after being treated with simple coiling and 6 after being treated with microsurgical clipping. In 4 cases (8.5%), more than one FDD was telescopically positioned in order to treat the aneurysm, for a total of 54 FDDs used. The overall mortality rate was 2.1% (1/47) and the overall morbidity rate was 8.6% (4/47). Midterm neuroimaging follow-ups showed the complete occlusion of the aneurysm in 63% cases, which became 91% at the end of the follow-up.
FDD is a safe and effective tool that can be used in the treatment of complex MCA aneurysms, where conventional neurosurgical treatments can be challenging or ineffective.
本研究回顾性评估了非手术治疗大脑中动脉（MCA）动脉瘤的效果和安全性，采用的方法是植入血流导向装置（FDD）。
分析临床、手术过程和随访数据，以评估 FDD 治疗复杂 MCA 动脉瘤的安全性和有效性。通过记录（术中、围手术期和延迟）并发症来评估安全性，以确定发病率和死亡率。采用改良 Rankin 量表（mRS）评估血管内治疗前后的功能结局。为了评估疗效，记录了中期和长期的临床、血管造影和横断面影像学随访结果。
47 例 MCA 动脉瘤患者（21 例男性；26 例女性）接受了 FDD 治疗。7 例为破裂性动脉瘤。21 例为囊状，19 例为夹层，3 例为梭形，2 例为血泡样，2 例为假性动脉瘤。14 例动脉瘤较小，23 例较大，10 例巨大，平均大小为 15.3mm。8 例为复发性动脉瘤（Raymond-Roy 分级 III 级）：2 例患者在单纯弹簧圈治疗后出现动脉瘤囊再通，6 例患者在显微手术夹闭后出现动脉瘤囊再通。为了治疗动脉瘤，4 例（8.5%）患者的 FDD 被进行了串联放置，共使用了 54 个 FDD。总的死亡率为 2.1%（1/47），总的发病率为 8.6%（4/47）。中期影像学随访显示，63%的动脉瘤完全闭塞，随访结束时达到 91%。
FDD 是一种安全有效的工具，可用于治疗复杂 MCA 动脉瘤，在这些情况下，传统的神经外科治疗可能具有挑战性或无效。
