Qi Peng, Tong Xin, Liang Xin, Xue Xiaopeng, Wu Zhongxue, Feng Xin, Zhang Meng, Jiang Zhiqun, Wang Daming, Liu Aihua
Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ther Adv Neurol Disord. 2023 Jun 8;16:17562864231176187. doi: 10.1177/17562864231176187. eCollection 2023.
The prevalence of intracranial aneurysms is approximately 3% worldwide. Posterior circulation (PC) aneurysms have a higher risk of treatment complications than anterior circulation aneurysms. Improving the survival rate and quality of life of patients with PC aneurysms remains one of the most important issues in the field.
Flow diverter (FD) treatment of PC aneurysms remains controversial. We aimed to investigate the effects of FD treatment and analyze differences among different application methods or aneurysm types in PC aneurysms.
This is a multicenter retrospective study.
Patients with PC aneurysms treated with the pipeline embolization device (PED) or Tubridge embolization device (TED) between 2015 and 2020 in five neurovascular centers were retrospectively enrolled. The primary outcomes were major perioperative complication, clinical outcome, and aneurysm occlusion rates. Univariable and multivariable logistic regression analyses were used to determine the risk factors of each outcome.
In total, 252 aneurysms were included. Major perioperative complication, favorable clinical outcome, and complete occlusion rates were 7.5%, 91.0%, and 79.1%, respectively. Compared with other types of aneurysms, dissecting aneurysms had the best clinical outcome and highest occlusion rate. Both clinical and angiographic outcomes were independently associated with the aneurysm location at the basilar artery. Aneurysm size was not associated with any outcome. TED had similar clinical and angiographic outcomes compared with PED but more perioperative major complications. Tandem treatment and coiling assistance may have poorer clinical outcomes but similar occlusion rates. Single- and multiple-stent treatments had similar outcomes.
FD treatment of PC aneurysms achieved favorable clinical outcomes and long-term aneurysm occlusion rates with acceptable perioperative complication rates, especially in dissecting and non-basilar artery aneurysms. There was no additional improvement in outcomes with coiling assistance, multi-stent application, or tandem treatment. Therefore, the use of PC aneurysms should be carefully considered.
颅内动脉瘤在全球的患病率约为3%。后循环（PC）动脉瘤的治疗并发症风险高于前循环动脉瘤。提高PC动脉瘤患者的生存率和生活质量仍然是该领域最重要的问题之一。
PC动脉瘤的血流导向（FD）治疗仍存在争议。我们旨在研究FD治疗的效果，并分析PC动脉瘤不同应用方法或动脉瘤类型之间的差异。
这是一项多中心回顾性研究。
回顾性纳入2015年至2020年期间在五个神经血管中心接受管道栓塞装置（PED）或密网支架栓塞装置（TED）治疗的PC动脉瘤患者。主要结局指标为围手术期主要并发症、临床结局和动脉瘤闭塞率。采用单因素和多因素逻辑回归分析确定各结局的危险因素。
共纳入252个动脉瘤。围手术期主要并发症、良好临床结局和完全闭塞率分别为7.5%、91.0%和79.1%。与其他类型的动脉瘤相比，夹层动脉瘤的临床结局最佳，闭塞率最高。临床和血管造影结局均与基底动脉处的动脉瘤位置独立相关。动脉瘤大小与任何结局均无关。与PED相比，TED的临床和血管造影结局相似，但围手术期主要并发症更多。串联治疗和弹簧圈辅助治疗的临床结局可能较差，但闭塞率相似。单支架和多支架治疗的结局相似。
PC动脉瘤的FD治疗取得了良好的临床结局和长期动脉瘤闭塞率，围手术期并发症发生率可接受，尤其是在夹层动脉瘤和非基底动脉动脉瘤中。弹簧圈辅助、多支架应用或串联治疗在结局方面没有额外改善。因此，PC动脉瘤的使用应谨慎考虑。
