Roy Joanna M, El Naamani Kareem, Momin Arbaz A, Ghanem Marc, Lan Matthews, Ahmed Meah T, Winiker Sarah, Teichner Eric M, Musmar Basel, Tjoumakaris Stavropoula I, Gooch Michael R, Ghosh Ritam, Zarzour Hekmat, Schmidt Richard F, Rosenwasser Robert H, Jabbour Pascal M
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2024 Nov;191:e473-e479. doi: 10.1016/j.wneu.2024.08.155. Epub 2024 Sep 4.
Few studies have reported the impact of telescoping flow diverters (FDs) in intracranial aneurysm treatment. Our study compared aneurysms treated using telescoping FDs to those treated with a single FD and identified predictors of telescoping.
This was a single-center retrospective review of a prospectively maintained database of aneurysms treated with FDs between 2011 and 2023. All patients who were treated with FDs for intracranial aneurysms were included in the study.
The study comprised 750 patients with 750 aneurysms treated using 871 FDs. The study cohort was divided into 85 patients requiring telescoping FDs and 655 who did not. Rates of hemorrhage (7.1% vs. 1.8%, P < 0.001), symptomatic stroke (5.9% vs. 2.6, P < 0.001), and asymptomatic stroke (1.2% vs. 0.8%, P < 0.001) were significantly higher in the telescoping cohorts. At final follow-up, the rate of nonocclusion (9.8% vs. 5.1%, P = 0.029) and the rate of complete occlusion (88.5% vs. 81.1%, P = 0.029) were significantly higher in the telescoping cohort. On multivariate analysis, fusiform morphology (odds ratio [OR]: 2.4, 95% confidence interval [CI] 1.0-5.0, P = 0.03), increasing aneurysm height (OR: 1.0, 95% CI 1.0-1.1, P= 0.034), and the use of the Pipeline Embolization Device FD (OR: 2.4, 95% CI 1.3-4.4, P = 0.005) were independent predictors of telescoping.
Aneurysms with fusiform morphology, increasing aneurysm height and those that underwent flow diversion using Pipeline Embolization Device had higher odds for telescoping. Significantly higher rates of angiographic occlusion with the use of telescoping FD add to the literature on its efficacy in treating aneurysms of varying morphology.
很少有研究报道套叠式血流导向装置（FD）在颅内动脉瘤治疗中的影响。我们的研究比较了使用套叠式FD治疗的动脉瘤与使用单一FD治疗的动脉瘤，并确定了套叠的预测因素。
这是一项对2011年至2023年间前瞻性维护的接受FD治疗的动脉瘤数据库进行的单中心回顾性研究。所有接受FD治疗颅内动脉瘤的患者均纳入本研究。
该研究包括750例患者的750个动脉瘤，共使用了871个FD。研究队列分为85例需要套叠式FD的患者和655例不需要的患者。套叠组的出血率（7.1%对1.8%，P<0.001）、症状性卒中发生率（5.9%对2.6，P<0.001）和无症状性卒中发生率（1.2%对0.8%，P<0.001）显著更高。在最后随访时，套叠组的未闭塞率（9.8%对5.1%，P=0.029）和完全闭塞率（88.5%对81.1%，P=0.029）显著更高。多因素分析显示，梭形形态（优势比[OR]：2.4，95%置信区间[CI]1.0 - 5.0，P = 0.03）、动脉瘤高度增加（OR：1.0, 95% CI 1.0 - 1.1, P = 0.034）以及使用Pipeline Embolization Device FD（OR：2.4, 95% CI 1.3 - 4.4, P = 0.005）是套叠的独立预测因素。
具有梭形形态、高度增加的动脉瘤以及使用Pipeline Embolization Device进行血流导向的动脉瘤发生套叠的几率更高。使用套叠式FD时血管造影闭塞率显著更高，这为其治疗不同形态动脉瘤的疗效增添了文献依据。
