血流导向装置治疗大脑中动脉动脉瘤的安全性和有效性：单中心经验及随访数据。
Safety and efficacy of flow diverter stents in the treatment of middle cerebral artery aneurysms: a single-center experience and follow-up data.
机构信息
Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
Department of Radiology, Koç University Hospital, İstanbul, Turkey
出版信息
Diagn Interv Radiol. 2023 Mar 29;29(2):350-358. doi: 10.4274/dir.2022.211050. Epub 2023 Feb 1.
PURPOSE
This study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results.
METHODS
The treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches.
RESULTS
The mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. ( = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0-1.30) for occluded aneurysms, and 0.50 (0-1.40) for non-occluded aneurysms ( = 0.323). The median oversizing was 0.70 (0.45-1.10) in occluded integrated branches and 0.50 (0-1.40) in non-occluded branches ( = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents.
CONCLUSION
MCA aneurysms tend to be complex, with integrated branches and potentially wide necks. FD stents are safe and effective in the treatment of MCA aneurysms, and the patency of the side and jailed branches is preserved in most cases. Higher occlusion and lower in-stent stenosis rates are seen with longer F/U durations.
目的
本研究旨在评估血流导向装置（FD）治疗大脑中动脉（MCA）动脉瘤的安全性和有效性，并分享随访结果。
方法
回顾性分析了 76 例采用血流重定向腔内装置（FRED）、FRED Jr.和Pipeline 栓塞装置（PED）FD 支架治疗的 MCA 动脉瘤患者的治疗和随访结果。比较了 FD 之间的动脉瘤闭塞率，并通过随访评估了整合和被夹闭的分支。比较了支架的过度扩张在闭塞/未闭塞动脉瘤和整合分支之间的差异。
结果
平均随访时间为 32 ± 6.3 个月，平均动脉瘤直径为 4.45mm。61 例（80.3%）动脉瘤为宽颈；73 例（96.1%）为囊状；52 例（68.4%）位于 M1 段；36 例（45.6%）使用 FRED，23 例（29.1%）使用 FRED Jr.，19 例（24.1%）使用 PED 进行治疗。6、12、24、36 和 60 个月数字减影血管造影（DSA）的总体闭塞率分别为 43.8%、63.5%、73.3%、85.7%和 87.5%。最后一次随访的闭塞率分别为 FRED 67.6%、PED 66.7%和 FRED Jr. 60.6%（=0.863）。在治疗 63 例（82.8%）动脉瘤时，有 6 个（10%）整合分支被 FD 覆盖。最后一次随访时，6 个（10%）整合分支出现无任何症状的闭塞。闭塞动脉瘤的中位数过度扩张为 0.45（0-1.30），未闭塞动脉瘤为 0.50（0-1.40）（=0.323）。闭塞整合分支的中位数过度扩张为 0.70（0.45-1.10），未闭塞分支为 0.50（0-1.40）（=0.131）。在 6 个月的随访中，22 个（30.1%）支架出现支架内狭窄，而在 24 个月的随访中只有 2 个（4.7%）出现支架内狭窄。因此，由于支架内狭窄，没有患者出现任何神经功能缺损。有 2 个支架出现严重的支架内狭窄。
结论
MCA 动脉瘤往往较为复杂，伴有整合分支和潜在的宽颈。FD 支架治疗 MCA 动脉瘤安全有效，大多数情况下可保留侧支和被夹闭分支的通畅性。随着随访时间的延长，闭塞率更高，支架内狭窄率更低。
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