1Department of Neurosurgery, University of Illinois at Chicago, Illinois.
2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
J Neurosurg. 2024 Mar 8;141(2):310-315. doi: 10.3171/2023.12.JNS232221. Print 2024 Aug 1.
Treatment of intracranial aneurysms by flow diversion is safe and effective and is increasingly popular. However, the correct treatment paradigm for aneurysms incompletely treated by initial placement of a flow diverter has not been established, nor have the subsequent natural history and occlusion rates of such aneurysms. The authors sought to outline the natural history of such aneurysms, which to date have been considered partially treated.
The authors retrospectively reviewed consecutive cases from 6 high-volume neurointerventional services, including all cases in which the first follow-up imaging after placement of a flow diverter showed incomplete occlusion of the aneurysm, and for which subsequent clinical and/or radiological follow-up was available. All included patients were treated with the Pipeline Flex embolization device or the Pipeline Flex embolization device with Shield Technology. Subsequent radiographic and clinical outcome data were collected and analyzed using the Kaplan-Meier survival function.
A total of 263 patients with persistently patent aneurysms on first follow-up imaging after flow diversion were identified. Of these, 204 had clinical follow-up and 152 had additional imaging follow-up. Of this final cohort, 148 aneurysms were unruptured, and 4 were ruptured. The average aneurysm size by maximum dimension was 10.8 mm. The average recorded follow-up was 27.8 months in the cohort, with some patients followed for as long as 9 years from treatment. Over the course of 403 person-years of follow-up, no delayed aneurysm ruptures were recorded. Both with and without retreatment, aneurysms showed a trend toward progressive occlusion over time. Complications related to device placement were low.
Aneurysms that have been incompletely treated by flow diversion have a benign natural history with progression toward occlusion over time, with or without retreatment.
血流导向装置治疗颅内动脉瘤安全有效，应用日益广泛。然而，对于初始血流导向装置放置后未完全治疗的动脉瘤，尚未确定正确的治疗模式，也不清楚此类动脉瘤的后续自然史和闭塞率。作者旨在概述此类动脉瘤的自然史，迄今为止，这些动脉瘤被认为是部分治疗的。
作者回顾了来自 6 个高容量神经介入服务的连续病例，包括首次放置血流导向装置后影像学随访显示动脉瘤不完全闭塞的所有病例，以及有后续临床和/或影像学随访的病例。所有纳入的患者均采用 Pipeline Flex 栓塞装置或带有 Shield Technology 的 Pipeline Flex 栓塞装置进行治疗。使用 Kaplan-Meier 生存函数收集和分析所有纳入患者的后续影像学和临床转归数据。
共确定了 263 例首次随访时血流导向装置治疗后仍存在动脉瘤的患者。其中 204 例有临床随访，152 例有额外影像学随访。在最终队列中，148 个动脉瘤未破裂，4 个动脉瘤破裂。最大直径的平均动脉瘤大小为 10.8mm。队列的平均记录随访时间为 27.8 个月，部分患者从治疗开始最长随访时间达 9 年。在 403 人年的随访过程中，未记录到延迟性动脉瘤破裂。无论是否进行再治疗，动脉瘤均呈逐渐闭塞的趋势。与器械放置相关的并发症发生率较低。
血流导向装置治疗不完全的动脉瘤具有良性自然史，随着时间的推移逐渐闭塞，无论是否进行再治疗。
