Piano Mariangela, Trombatore Pietro, Lozupone Emilio, Pero Guglielmo, Cervo Amedeo, Macera Antonio, Quilici Luca, Peschillo Simone, Valvassori Luca, Boccardi Edoardo
Department of Neuroradiology, Niguarda Hospital, 20162 Milano, Italy.
Department of Neuroradiology, Ospedale San Gerardo, 20900 Monza, Italy.
Brain Sci. 2022 Nov 10;12(11):1524. doi: 10.3390/brainsci12111524.
In this study, the authors evaluated the efficacy and the safety of flow diverter devices (FDD) in anterior communicating artery (ACoA) region aneurysms, focusing on anatomical factors that could affect the outcome, such as the location of the aneurysm along the ACoA (centered on ACoA or decentered on the A1-A2 junction) and the anatomy of the ACoA region.
Clinical, procedural and follow-up data were analyzed. Aneurysms were classified according to the location along the ACoA (centered or decentered on the A1-A2 junction) and on the basis of the anatomical configuration of the ACoA region. Safety was assessed by recording intraprocedural, periprocedural and delayed complications to determine the morbidity and mortality rates. The functional outcome was evaluated with the modified Rankin scale (mRS) prior to and after the endovascular procedure. To assess the efficacy, midterm and long-term clinical, angiographic and cross-sectional imaging follow-ups were recorded. Subgroup analysis according to the different ACoA regional anatomical configurations and the ACoA aneurysm locations were performed.
33 patients (17 males; 16 females) with ACoA region aneurysms were treated with FDDs. 27 aneurysms were located at the A1-A2 junction (82%) while the remaining six aneurysms were centered on the ACoA. No mortality was recorded. The overall morbidity rate was 6% (2/33 procedures). Major complications occurred in 33% (2/6) of ACoA aneurysms and in the 0% of A1-A2 junction aneurysms. Mid-term and long-term neuroimaging follow-ups showed the occlusion of the aneurysm in 28/33 cases (85%). Complete occlusion rates were 93% in the A1-A2 junction aneurysms and 50% in ACoA aneurysms.
The FDD is a safe and effective tool that can be used in the treatment of selected cases of ACoA region aneurysms. The location of the aneurysm along the ACoA and the regional anatomy of the ACoA complex could affect the efficacy and safety.
在本研究中，作者评估了血流导向装置（FDD）治疗前交通动脉（ACoA）区域动脉瘤的疗效和安全性，重点关注可能影响治疗结果的解剖学因素，如动脉瘤在ACoA上的位置（以ACoA为中心或偏离A1 - A2交界处）以及ACoA区域的解剖结构。
分析临床、手术及随访数据。根据动脉瘤在ACoA上的位置（以A1 - A2交界处为中心或偏离）以及ACoA区域的解剖结构对动脉瘤进行分类。通过记录术中、围手术期及延迟并发症来评估安全性，以确定发病率和死亡率。在血管内治疗前后，用改良Rankin量表（mRS）评估功能预后。为评估疗效，记录中期和长期的临床、血管造影及横断面成像随访情况。根据不同的ACoA区域解剖结构和ACoA动脉瘤位置进行亚组分析。
33例（17例男性；16例女性）ACoA区域动脉瘤患者接受了FDD治疗。27例动脉瘤位于A1 - A2交界处（82%），其余6例动脉瘤以ACoA为中心。无死亡病例记录。总体发病率为6%（33例手术中有2例）。主要并发症在6例ACoA动脉瘤中发生率为33%（2/6），在A1 - A2交界处动脉瘤中发生率为0%。中期和长期神经影像学随访显示，33例中有28例（85%）动脉瘤闭塞。A1 - A2交界处动脉瘤的完全闭塞率为93%，ACoA动脉瘤的完全闭塞率为50%。
FDD是一种安全有效的工具，可用于治疗部分ACoA区域动脉瘤病例。动脉瘤在ACoA上的位置以及ACoA复合体的区域解剖结构可能会影响疗效和安全性。
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