From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana.
AJNR Am J Neuroradiol. 2022 Nov;43(11):1615-1620. doi: 10.3174/ajnr.A7679. Epub 2022 Oct 13.
Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes.
A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals.
A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms ( = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm ( = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 ( = .34).
This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
血流导向装置已逐渐成为治疗前循环颅内动脉瘤的标准治疗方法。尽管存在破裂风险和不理想的结果等最初担忧，但最近将血流导向装置用于治疗后循环动脉瘤的适应证外使用也有所增加。本研究旨在探讨使用血流导向装置治疗后循环动脉瘤的并发症发生率和治疗结果随时间的变化，并进一步评估可能解释这种变化和结果的机制和变量。
使用多个国际学术机构的标准化数据集进行回顾性研究，以确定 2011 年 1 月至 2020 年 1 月期间接受血流导向装置治疗的破裂和未破裂后循环动脉瘤患者。将这段时间分为 4 个区间。
研究期间共进行了 378 例手术。随着时间的推移，治疗椎动脉动脉瘤的趋势增加，而治疗大型椎基底动脉动脉瘤的趋势减少（=0.05）。此外，介入医生越来越倾向于每个动脉瘤使用更少重叠的血流导向装置（=0.07）。血栓栓塞并发症的发生率呈下降趋势，从 2011-13 年的 15.8%降至 2018-19 年的 8.9%（=0.34）。
这项多中心经验表明，治疗基底动脉瘤、小动脉瘤的趋势减少，单一血流导向装置的使用增加，导致血栓栓塞和出血并发症的发生率降低。
