Zhang Xuexian, Wang Ruidong, Ding Yuhan, Li Wei, Ren Hong, Zhang Jun
Department of Neurointervention, Jingmen People's Hospital, Jingmen, Hubei, China.
Interventional Department, Qujing Second People's Hospital, Qujing, Yunnan, China.
Front Neurol. 2023 Aug 16;14:1199390. doi: 10.3389/fneur.2023.1199390. eCollection 2023.
The management of middle cerebral artery (MCA) aneurysms remains a controversial topic, and MCA aneurysms have traditionally been treated primarily by surgical clipping. The Neuroform Atlas Stent™ (NAS, available from Stryker Neurovascular, Fremont, California) represents the latest generation of intracranial stents with improved stent delivery system capabilities.
This study aims to investigate the safety, feasibility and efficacy exhibited by NAS in treating unruptured aneurysms at the MCA bifurcation.
This was a two-center retrospective study involving 42 patients with unruptured wide-necked aneurysms (WNAs) of the MCA treated with the NAS from October 2020 to July 2022.
The stent was used to treat 42 cases of unruptured WNA at the MCA bifurcation. Endovascular treatment techniques had a 100% success rate. Immediate postoperative angiography found complete aneurysm occlusion in 34 patients (80.9%) (mRRC 1), neck remnant in 7 patients (16.7%) (mRRC 2), and residual aneurysm in 1 patient (2.4%) (mRRC 3). The thromboembolic complication rate was 2.4% (1/42). The follow-up period was 8.7 months on average (3-16 months). The last angiographic follow-up results revealed complete aneurysm occlusion in 39 patients (92.9%) (mRRC 1), neck remnant in 3 (7.1%) patients (mRRC 2), no aneurysm recanalization or recurrence, and no cases of stent intimal hyperplasia. During the latest clinical follow-up, all patients had an mRS score of 0.
Our study demonstrates that the NAS can be applied to treat unruptured WNAs at the MCA bifurcation with favorable safety, feasibility, and efficacy.
大脑中动脉（MCA）动脉瘤的治疗仍然是一个有争议的话题，传统上MCA动脉瘤主要通过手术夹闭进行治疗。Neuroform Atlas支架™（NAS，可从加利福尼亚州弗里蒙特的史赛克神经血管公司获得）代表了具有改进的支架输送系统能力的新一代颅内支架。
本研究旨在探讨NAS治疗MCA分叉处未破裂动脉瘤的安全性、可行性和有效性。
这是一项双中心回顾性研究，纳入了2020年10月至2022年7月期间42例使用NAS治疗的MCA未破裂宽颈动脉瘤（WNA）患者。
该支架用于治疗42例MCA分叉处未破裂WNA。血管内治疗技术成功率为100%。术后即刻血管造影发现34例患者（80.9%）动脉瘤完全闭塞（改良Raymond分级1级），7例患者（16.7%）瘤颈残留（改良Raymond分级2级），1例患者（2.4%）动脉瘤残留（改良Raymond分级3级）。血栓栓塞并发症发生率为2.4%（1/42）。平均随访期为8.7个月（3 - 16个月）。最后一次血管造影随访结果显示，39例患者（92.9%）动脉瘤完全闭塞（改良Raymond分级1级），3例患者（7.1%）瘤颈残留（改良Raymond分级2级），无动脉瘤再通或复发，无支架内膜增生病例。在最近一次临床随访中，所有患者改良Rankin量表（mRS）评分为0分。
我们的研究表明，NAS可用于治疗MCA分叉处未破裂WNA，具有良好的安全性、可行性和有效性。
