Fujii Takashi, Teranishi Kohsuke, Mitome-Mishima Yumiko, Kitamura Takayuki, Wada Kojiro, Kondo Akihide, Oishi Hidenori
Department of Neuroendovascular Therapy, Juntendo University, Graduate School of Medicine, Tokyo, Japan.
Department of Neurosurgery, National Defense Medical College, Saitama, Japan.
Asian J Neurosurg. 2024 May 27;19(2):168-173. doi: 10.1055/s-0043-1778085. eCollection 2024 Jun.
With the expansion of indications of flow diverter (FD) for cerebral aneurysms, FD placement for posterior communicating artery (Pcom) aneurysms has been approved. However, it is controversial whether Pcom aneurysms should be treated with FD or not. In this study, we report the outcome of FD treatment for Pcom aneurysms in Japan. We retrospectively analyzed 36 patients with 38 aneurysms treated with FD placement for Pcom aneurysms between 2015 and 2021 in our hospital. We divided our cases into complete occlusion (CO) and non-CO groups. And we extracted contributing factors to CO using multivariate analysis. We also compared the complications rate among the three types of FDs. CO was obtained in 29 cases (79.3%), and complications were observed in 3 cases (7.9%). Multivariate analysis revealed that the type of Pcom branch from the aneurysmal dome was a significant factor contributing to CO (odds ratio: 0.0052, 95% confidence interval 0.000048-0.584, = 0.029). In terms of complications, complication rate was significantly higher in the Flow-Redirection Endoluminal Device (FRED) group ( = 0.0491). The outcome for Pcom aneurysms treated by FD was acceptable. When treating, we must pay attention to where Pcom originates. Achieving CO with FD is difficult for aneurysms where the Pcom branches from the dome. Furthermore, when treating Pcom aneurysms with FRED, it is necessary to be careful about thromboembolic complications.
随着血流导向装置（FD）治疗脑动脉瘤适应证的扩大，FD治疗后交通动脉（Pcom）动脉瘤已获批准。然而，Pcom动脉瘤是否应采用FD治疗仍存在争议。在本研究中，我们报告了日本采用FD治疗Pcom动脉瘤的结果。
我们回顾性分析了2015年至2021年在我院接受FD治疗Pcom动脉瘤的36例患者的38个动脉瘤。我们将病例分为完全闭塞（CO）组和非CO组。并通过多因素分析提取影响CO的因素。我们还比较了三种类型FD之间的并发症发生率。
29例（79.3%）实现了CO，3例（7.9%）观察到并发症。多因素分析显示，动脉瘤瘤顶发出的Pcom分支类型是影响CO的一个重要因素（比值比：0.0052，95%置信区间0.000048 - 0.584，P = 0.029）。在并发症方面，血流导向腔内装置（FRED）组的并发症发生率显著更高（P = 0.0491）。
FD治疗Pcom动脉瘤的结果是可以接受的。治疗时，我们必须注意Pcom的起源位置。对于瘤顶发出Pcom的动脉瘤，采用FD实现CO较为困难。此外，使用FRED治疗Pcom动脉瘤时，有必要注意血栓栓塞并发症。
