Xie Dajiang, Yang Heng, Zhao Li, Ye Xin, Yang Shuxu, Gao Chao, Tian Yanlong, Ni Wei, Gu Yuxiang
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China.
Front Neurol. 2023 Jan 30;14:1054631. doi: 10.3389/fneur.2023.1054631. eCollection 2023.
Tubridge flow diverter is a widely used device aimed at reconstructing parent arteries and occluding complex aneurysms in China. The experience of Tubridge in treating small and medium aneurysms is still limited. In this study, we aimed to evaluate the safety and efficacy of the Tubridge flow diverter for the treatment of the two types of aneurysms.
We reviewed the clinical records of aneurysms treated with a Tubridge flow diverter between 2018 and 2021 in a national cerebrovascular disease center. Cases were divided into small and medium aneurysms according to aneurysm size. The therapeutic process, occlusion rate, and clinical outcome were compared.
In total, 57 patients and 77 aneurysms were identified. The patients were divided into two groups: small aneurysms (39 patients, 54 aneurysms) and medium aneurysms (18 patients, 23 aneurysms). There were 19 patients with tandem aneurysms (a total of 39 aneurysms) in the two groups, among which 15 patients (30 aneurysms) were in the small aneurysm group and four patients (nine aneurysms) were in the medium aneurysm group. The results show that the mean maximal diameter/neck in the small and medium aneurysms was 3.68/3.25 and 7.61/6.24 mm, respectively. In total, 57 Tubridge flow diverters were successfully implanted without unfolding failure, and there were six patients with new mild cerebral infarction in the small aneurysm group. The complete occlusion rate on the last angiographic follow-up was achieved in 88.46% of the small aneurysms group and 81.82% of the medium aneurysms group. The complete occlusion rate of patients with tandem aneurysms in the last angiographic follow-up was 86.67% (13/15) of the small aneurysms group and 50% (2/4) of the medium aneurysm group. Intracranial hemorrhage was nonencountered in the two groups.
Our preliminary experience suggests that the Tubridge flow diverter might be a safe and effective treatment for small and medium aneurysms along the internal carotid artery. Long stents may increase the risk of cerebral infarction. Adequate evidence is required to clarify the definite indications and complications in a multicenter randomized controlled trial with a long-term follow-up.
在中国，Tubridge血流导向装置是一种广泛用于重建载瘤动脉和闭塞复杂动脉瘤的器械。Tubridge治疗中小型动脉瘤的经验仍较为有限。在本研究中，我们旨在评估Tubridge血流导向装置治疗这两种类型动脉瘤的安全性和有效性。
我们回顾了2018年至2021年在一家国家级脑血管病中心接受Tubridge血流导向装置治疗的动脉瘤患者的临床记录。根据动脉瘤大小将病例分为小型和中型动脉瘤。比较治疗过程、闭塞率和临床结局。
共纳入57例患者和77个动脉瘤。患者分为两组：小型动脉瘤组（39例患者，54个动脉瘤）和中型动脉瘤组（18例患者，23个动脉瘤）。两组中有19例串联动脉瘤患者（共39个动脉瘤），其中小型动脉瘤组15例患者（30个动脉瘤），中型动脉瘤组4例患者（9个动脉瘤）。结果显示，小型和中型动脉瘤的平均最大直径/瘤颈分别为3.68/3.25和7.61/6.24mm。共成功植入57枚Tubridge血流导向装置，无展开失败情况，小型动脉瘤组有6例患者出现新发轻度脑梗死。小型动脉瘤组末次血管造影随访时的完全闭塞率为88.46%，中型动脉瘤组为81.82%。串联动脉瘤患者末次血管造影随访时的完全闭塞率，小型动脉瘤组为86.67%（13/15），中型动脉瘤组为50%（2/4）。两组均未发生颅内出血。
我们的初步经验表明，Tubridge血流导向装置可能是治疗颈内动脉中小型动脉瘤的一种安全有效的方法。长支架可能会增加脑梗死风险。需要充分的证据来明确多中心随机对照试验中长期随访的明确适应证和并发症。
