Department of Neurosurgery, Huadong Hospital, Fudan University, China.
Department of Neurology, Huadong Hospital, Fudan University, China.
Curr Neurovasc Res. 2024;20(5):560-567. doi: 10.2174/0115672026271147231130111233.
Treatment of anterior cerebral artery (ACA) aneurysms is still not well established. The Leo stent with blood flow direction is a retrievable stent for intracranial aneurysms, whereas it needs to be studied clearly in patients with ACA aneurysms.
Consecutive patients with ACA aneurysms were retrospectively enrolled in three neurosurgical centers between January 2016 and October 2021. The data on demographics, aneurysm characteristics, symptom resolution, and postoperative course were collected and analyzed. The aneurysm occlusion status was appraised by Raymond-Ray Occlusion Class (RROC).
A total of 57 patients with ACA aneurysms were included in our study. Immediate postprocedural angiograms showed that 20 aneurysms (35.1%) were in complete occlusion (RROC 1), 26 aneurysms (45.6%) were in near-complete occlusion (RROC 2), 11 aneurysms (19.3%) were in incomplete occlusion (RROC 3). The angiographic follow-up found that the rate of complete occlusion increased to 57.9%, and near-completion and incomplete occlusion dropped to 29.8% and 12.3%, respectively. The angiographic result of the last follow-up improved significantly (Z=- 2.805, P=0.005). Univariate analysis indicated that distal location of aneurysms (Z=4.538, P=0.033) and ruptured aneurysms (χ2=.6120, P=0.032) were potential risk factors for intra-parent artery narrowing. Furthermore, multivariate logistic regression analysis found that A3 aneurysms (95% CI 1.427~32.744, P=0.016) are the key risk factor for intra-parent artery narrowing.
The Leo stent is safe and effective for aneurysms located in ACA circulations. The overall occlusion degree improved during follow-up. A distal, small artery was the risk factor for intra-parent artery narrowing.
前交通动脉（ACA）动脉瘤的治疗方法仍未得到很好的建立。Leo 血流导向支架是一种用于颅内动脉瘤的可回收支架，但在 ACA 动脉瘤患者中还需要进行更深入的研究。
回顾性纳入 2016 年 1 月至 2021 年 10 月期间三家神经外科中心的连续 ACA 动脉瘤患者。收集并分析患者的人口统计学、动脉瘤特征、症状缓解和术后过程的数据。采用 Raymond-Ray 闭塞分级（RROC）评估动脉瘤闭塞情况。
共纳入 57 例 ACA 动脉瘤患者。即刻血管造影显示，20 个动脉瘤（35.1%）完全闭塞（RROC 1），26 个动脉瘤（45.6%）接近完全闭塞（RROC 2），11 个动脉瘤（19.3%）不完全闭塞（RROC 3）。血管造影随访发现完全闭塞率增加到 57.9%，接近完全闭塞和不完全闭塞率分别降至 29.8%和 12.3%。最后一次随访的血管造影结果明显改善（Z=-2.805，P=0.005）。单因素分析表明，动脉瘤的远端位置（Z=4.538，P=0.033）和破裂的动脉瘤（χ2=6.120，P=0.032）是引起载瘤动脉狭窄的潜在危险因素。进一步的多因素逻辑回归分析发现，A3 段动脉瘤（95%CI 1.427~32.744，P=0.016）是引起载瘤动脉狭窄的关键危险因素。
Leo 血流导向支架治疗 ACA 循环中的动脉瘤是安全有效的。在随访过程中，总体闭塞程度有所提高。小动脉的远端位置是引起载瘤动脉狭窄的危险因素。
