Filho José Alberto Almeida, Oberman Dan Zimelewicz, Freitas Diogo Gonçalves, Costa Rodrigo Azeredo, Brandão Thiago Dantas S, Junior Orlando Teixeira Maia
Department of Endovascular Neurosurgery, Hospital Santa Teresa, Petropolis, Brazil.
Department of Neurosurgery, Air Force Galeão Hospital, Rio de Janeiro, Brazil.
Surg Neurol Int. 2023 May 5;14:160. doi: 10.25259/SNI_97_2023. eCollection 2023.
The silk + flow-diverter stent is increasingly used to treat complex intracranial aneurysms including wide-neck and fusiform aneurysms. Balloon angioplasty has been used to better appose the flow diverter (FD) to the vessel wall and, thus, improve aneurysm occlusion rates and decrease periprocedural complications. Sparse data are available concerning the results of this technique. We report our experience with silk + FD associated with balloon angioplasty for the treatment of intracranial aneurysms.
A retrospective study was conducted on all patients treated by the silk + FD. Clinical charts, procedural data, and angiographic results were reviewed and compared between those treated with balloon angioplasty. A multivariate analysis was conducted to identify predictors of complications, occlusion, and outcome.
Between July 2014 and May 2016, we identified 209 patients with 223 intracranial aneurysms. There were 176 (84.2%) women and 33 (15.8%) men. The most common stent size used was 4.5 mm in 101 patients (46.1%), followed by 4 mm in 57 patients (26%). Univariate analysis observed that stent diameter was significantly related to aneurysm occlusion ( < 0.05). Patients with more than 1 aneurysm treated with silk + stent have a 9.07 times greater chance of having complications in the procedure than patients with only 01 aneurysm (OR = 9.07; = 0.0008). Patients who had angioplasty without the use of a balloon have a 13.69-times-higher risk of complications (OR = 13.69; = 0.0003). Older age, larger aneurysms, and the use of more than 1 FD device were predictors of recanalization.
Endovascular treatment of intracranial aneurysms with the silk + FD associated with balloon angioplasty is a safe and effective therapeutic option. Balloon angioplasty in combination with FD lowers the risk of complications. Higher complication rates and worse outcomes are associated with older age and large aneurysms.
丝质+血流导向支架越来越多地用于治疗包括宽颈和梭形动脉瘤在内的复杂颅内动脉瘤。球囊血管成形术已被用于更好地使血流导向装置（FD）贴合血管壁，从而提高动脉瘤闭塞率并减少围手术期并发症。关于该技术结果的数据稀少。我们报告了我们使用丝质+FD联合球囊血管成形术治疗颅内动脉瘤的经验。
对所有接受丝质+FD治疗的患者进行回顾性研究。回顾并比较了接受球囊血管成形术患者的临床病历、手术数据和血管造影结果。进行多变量分析以确定并发症、闭塞和预后的预测因素。
2014年7月至2016年5月期间，我们确定了209例患有223个颅内动脉瘤的患者。其中女性17六例（84.2%），男性33例（15.8%）。最常用的支架尺寸为4.5毫米，共101例患者（46.1%），其次是4毫米，共57例患者（26%）。单变量分析发现支架直径与动脉瘤闭塞显著相关（<0.05）。接受丝质+支架治疗的多个动脉瘤患者在手术中发生并发症的几率比仅患有1个动脉瘤的患者高9.07倍（OR=9.07；=0.0008）。未使用球囊进行血管成形术的患者发生并发症的风险高13.69倍（OR=13.69；=0.0003）。年龄较大、动脉瘤较大以及使用超过1个FD装置是再通的预测因素。
丝质+FD联合球囊血管成形术对颅内动脉瘤进行血管内治疗是一种安全有效的治疗选择。球囊血管成形术与FD联合可降低并发症风险。较高的并发症发生率和较差的预后与年龄较大和动脉瘤较大有关。
