Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
School of Biomedical Engineering, Capital Medical University, Beijing, China.
J Neurointerv Surg. 2023 Dec;15(12):1187-1193. doi: 10.1136/jnis-2022-019680. Epub 2023 Jan 23.
Flow diverters have revolutionized the treatment of intracranial aneurysms. However, the delayed complications associated with flow diverter use are unknown.
To evaluate the incidence, severity, clinical outcomes, risk factors, and dynamic changes associated with in-stent stenosis (ISS) after treatment with a Pipeline embolization device (PED).
Patients who underwent PED treatment between 2015 and 2020 were enrolled. The angiographic, clinical, and follow-up data of 459 patients were independently reviewed by four neuroradiologists to identify ISS. Binary logistic regression was conducted to determine ISS risk factors, and an ISS-time curve was established to demonstrate dynamic changes in ISS after PED implantation.
Of the 459 treated patients, 69 (15.0%) developed ISS. At follow-up, nine patients (2.0%) with ISS demonstrated reversal, while 18 (3.9%) developed parental artery occlusion. A total of 380 patients (82.8%) achieved complete aneurysm occlusion (O'Kelly-Marotta grade D). Patients with posterior-circulation aneurysm (OR=2.895, 95% CI (1.732 to 4.838; P<0.001) or balloon angioplasty (OR=1.992, 95% CI 1.162 to 3.414; P=0.037) were more likely to develop ISS. Patients aged >54 years (OR=0.464, 95% CI 0.274 to 0.785; P=0.006) or with a body mass index of >28 kg/m (OR=0.427, 95% CI 0.184 to 0.991; P=0.026) had a lower ISS risk. Intimal hyperplasia initiated by PED placement peaked within 1 year after the procedure, rarely progressed after 12 months, and tended to reverse within 24 months.
ISS is a common, benign, and self-limiting complication of PED implantation in the Chinese population.
血流导向装置的出现彻底改变了颅内动脉瘤的治疗方式。然而，目前对于血流导向装置使用后相关的迟发性并发症还知之甚少。
评估Pipeline 栓塞装置（PED）治疗后支架内狭窄（ISS）的发生率、严重程度、临床转归、危险因素和动态变化。
纳入 2015 年至 2020 年接受 PED 治疗的患者。4 位神经放射科医生独立回顾了 459 例患者的血管造影、临床和随访资料，以确定 ISS。采用二项逻辑回归分析确定 ISS 的危险因素，并建立 ISS 时间曲线以显示 PED 植入后 ISS 的动态变化。
459 例治疗患者中，69 例（15.0%）发生 ISS。在随访时，9 例（2.0%）ISS 患者出现逆转，而 18 例（3.9%）发生载瘤动脉闭塞。380 例（82.8%）患者完全实现了动脉瘤闭塞（O'Kelly-Marotta 分级 D）。后循环动脉瘤（OR=2.895，95%CI（1.732 至 4.838；P<0.001）或球囊血管成形术（OR=1.992，95%CI 1.162 至 3.414；P=0.037）的患者更易发生 ISS。年龄>54 岁（OR=0.464，95%CI 0.274 至 0.785；P=0.006）或 BMI>28kg/m（OR=0.427，95%CI 0.184 至 0.991；P=0.026）的患者 ISS 风险较低。PED 放置后引发的内膜增生在术后 1 年内达到高峰，12 个月后很少进展，并在 24 个月内趋于逆转。
在中国人群中，PED 植入后 ISS 是一种常见的、良性的、自限性并发症。
