You Wei, Lv Jian, Li Zifan, Chen Xiheng, Deng Dingwei, Tang Yudi, Li Youxiang, Sun Yong, Jiang Yuhua
Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Syracuse University, Syracuse, NY, United States.
Front Neurol. 2023 Apr 25;14:1140497. doi: 10.3389/fneur.2023.1140497. eCollection 2023.
Data on in-stent stenosis (ISS) following the flow diverter (FD) implantation method are scarce and inconsistent. In the present study, we sought to determine the incidence of ISS and identify the factors that predict its severity via the use of ordinal logistic regression.
A retrospective review of our center's electronic database was conducted to identify all patients with intracranial aneurysms (IAs) who received pipeline embolization device (PED) implantation between 2016 and 2020. Patient demographics, aneurysm characteristics, procedural information, and clinical and angiographic outcomes were reviewed. ISS was quantitatively assessed on angiographic follow-ups and graded as mild (<25%), moderate (25-50%), or severe (>50%). Ordinal logistic regression was conducted to determine the predictors of stenosis severity.
A total of 240 patients with 252 aneurysms treated in 252 procedures were enrolled in this study. ISS has been detected in 135 (53.6%) lesions, with a mean follow-up time of 6.53 ± 3.26 months. The ISS was mild in 66 (48.9%) cases, moderate in 52 (38.5%) cases, and severe in 17 (12.6%) cases. All patients were asymptomatic, except for two of them with severe stenosis who presented with symptoms of acute cerebral thrombosis. Ordinal logistic regression identified that younger age and a longer procedure duration were independent predictors of a higher likelihood of ISS.
ISS is a common angiographic finding after PED implantation for IAs and is presented as a largely benign course through long-term follow-up. Patients who were younger in age and had a longer procedure duration were found to be at a greater risk of developing ISS.
关于血流导向装置（FD）植入术后支架内狭窄（ISS）的数据稀缺且不一致。在本研究中，我们试图通过使用有序逻辑回归来确定ISS的发生率，并识别预测其严重程度的因素。
对本中心的电子数据库进行回顾性分析，以确定2016年至2020年间接受Pipeline栓塞装置（PED）植入的所有颅内动脉瘤（IA）患者。回顾患者的人口统计学资料、动脉瘤特征、手术信息以及临床和血管造影结果。在血管造影随访中对ISS进行定量评估，并分为轻度（<25%）、中度（25%-50%）或重度（>50%）。进行有序逻辑回归以确定狭窄严重程度的预测因素。
本研究共纳入252例接受252次手术治疗的240例患者。在135个（53.6%）病变中检测到ISS，平均随访时间为6.53±3.26个月。66例（48.9%）为轻度ISS，52例（38.5%）为中度ISS，17例（12.6%）为重度ISS。所有患者均无症状，除了2例重度狭窄患者出现急性脑血栓形成症状。有序逻辑回归确定年龄较小和手术时间较长是ISS可能性较高的独立预测因素。
ISS是IA患者接受PED植入术后常见的血管造影表现，通过长期随访显示其病程大多为良性。发现年龄较小和手术时间较长的患者发生ISS的风险更大。
