Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
J Neurointerv Surg. 2024 Aug 14;16(9):921-927. doi: 10.1136/jnis-2023-020582.
Flow diversion (FD: flow diversion, flow diverter) is an endovascular treatment for many intracranial aneurysm types; however, limited reports have explored the use of FDs in bifurcation aneurysm management. We analyzed the safety and efficacy of FD for the management of intracranial bifurcation aneurysms.
A systematic review identified original research articles that used FD for treating intracranial bifurcation aneurysms. Articles with >4 patients that reported outcomes on the use of FDs for the management of bifurcation aneurysms along the anterior communicating artery (AComA), internal carotid artery terminus (ICAt), basilar apex (BA), or middle cerebral artery bifurcation (MCAb) were included. Meta-analysis was performed using a random effects model.
19 studies were included with 522 patients harboring 534 bifurcation aneurysms (mean size 9 mm, 78% unruptured). Complete aneurysmal occlusion rate was 68% (95% CI 58.7% to 76.1%, I=67%) at mean angiographic follow-up of 16 months. Subgroup analysis of FD as a standalone treatment estimated a complete occlusion rate of 69% (95% CI 50% to 83%, I=38%). The total complication rate was 22% (95% CI 16.7% to 28.6%, I=51%), largely due to an ischemic complication rate of 16% (95% CI 10.8% to 21.9%, I=55%). The etiologies of ischemic complications were largely due to jailed artery hypoperfusion (47%) and in-stent thrombosis (38%). 7% of patients suffered permanent symptomatic complications (95% CI 4.5% to 9.8%, I=6%).
FD treatment of bifurcation aneurysms has a modest efficacy and relatively unfavorable safety profile. Proceduralists may consider reserving FD as a treatment option if no other surgical or endovascular therapy is deemed feasible.
血流导向装置（FD：血流导向、血流改道）是许多颅内动脉瘤类型的血管内治疗方法；然而，有限的报道探讨了 FD 在分叉部动脉瘤治疗中的应用。我们分析了 FD 治疗颅内分叉部动脉瘤的安全性和有效性。
系统回顾确定了使用 FD 治疗颅内分叉部动脉瘤的原始研究文章。纳入了>4 例患者的文章，这些文章报告了使用 FD 治疗前交通动脉（AComA）、颈内动脉末端（ICAt）、基底尖（BA）或大脑中动脉分叉（MCAb）分叉部动脉瘤的结果。使用随机效应模型进行荟萃分析。
纳入了 19 项研究，共 522 例患者，共 534 个分叉部动脉瘤（平均大小为 9mm，78%未破裂）。在平均 16 个月的血管造影随访中，完全闭塞率为 68%（95%CI 58.7%至 76.1%，I=67%）。作为单独治疗的 FD 的亚组分析估计完全闭塞率为 69%（95%CI 50%至 83%，I=38%）。总的并发症发生率为 22%（95%CI 16.7%至 28.6%，I=51%），主要是由于缺血性并发症发生率为 16%（95%CI 10.8%至 21.9%，I=55%）。缺血性并发症的病因主要是由于被夹闭的动脉低灌注（47%）和支架内血栓形成（38%）。7%的患者发生永久性症状性并发症（95%CI 4.5%至 9.8%，I=6%）。
FD 治疗分叉部动脉瘤的疗效适中，安全性较差。如果认为没有其他手术或血管内治疗方法可行，介入医生可能会考虑将 FD 作为一种治疗选择。
