Ozaki Saya, Imamura Hirotoshi, Niwa Akihiro, Tsutsui Taishi, Yamada Naoto, Ikedo Taichi, Hamano Eika, Yamada Kiyofumi, Mori Hisae, Iihara Koji, Kataoka Hiroharu
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
J Neuroendovasc Ther. 2024;18(9):231-239. doi: 10.5797/jnet.oa.2024-0025. Epub 2024 Aug 10.
Flow diverters (FDs), first introduced in Japan in 2015, were initially limited to wide-necked large cerebral aneurysms, which pose a high treatment risk. However, based on the results of the PREMIER study, the indications have expanded since 2020, and the number of treatment cases is increasing in Japan. At our hospital, FD placement with adjunctive coil embolization has been actively performed for medium-sized cerebral aneurysms, as indicated in the PREMIER study; herein, we report the outcomes of this treatment.
Of the 25 patients with 28 aneurysms who underwent FD placement at our institution between April 2022 and June 2023, 15 with 17 wide-necked unruptured cerebral aneurysms with a maximum diameter of <12 mm in the internal carotid artery (ICA) or vertebral artery (VA) were included. Postoperative complications were investigated in each case, and the aneurysm occlusion status was assessed using ultrashort echo time (UTE)-MRA at 3 months postoperatively and angiography at 6 months postoperatively. Fifteen patients who underwent coiling or stent-assisted coiling (SAC) for the same criteria during the same period were compared. Baseline characteristics and treatment results were compared between FD and coiling/SAC cases.
Four males and 11 females with a mean age of 61.7 ± 12.8 years were included, and the median follow-up period was 9 months (6-18 months). There were 14 aneurysms of the ICA and 3 of the VA, and the mean maximum aneurysm diameter was 7.9 ± 1.7 mm. All patients were treated using the Pipeline Flex with Shield Technology (Medtronic, Minneapolis, MN, USA), and 14 aneurysms (82.4%) were treated with adjunctive coil embolization. There were no symptomatic strokes in the perioperative period; only one patient receiving corticosteroid therapy for thyroid eye disease had asymptomatic ICA occlusion at 3 months. Fifteen aneurysms (88.2%) were not visible on UTE-MRA at 3 months postoperatively, and angiography at 6 months showed complete occlusion in 16 (94.1%) aneurysms. The coiling/SAC group had a smaller neck size and higher volume embolization ratio than the FD group; however, complete occlusion was higher in the FD group.
FD placement with adjunctive coil embolization for medium-sized cerebral aneurysms is expected to result in good occlusion rates in the early postoperative period.
血流导向装置（FDs）于2015年首次在日本引入，最初仅限于治疗风险高的宽颈大型脑动脉瘤。然而，根据PREMIER研究结果，自2020年以来其适应证有所扩大，在日本治疗病例数不断增加。在我们医院，正如PREMIER研究所表明的，已积极对中型脑动脉瘤进行FD置入联合弹簧圈栓塞治疗；在此，我们报告该治疗的结果。
在2022年4月至2023年6月期间于我院接受FD置入的25例患者（共28个动脉瘤）中，纳入15例患有17个宽颈未破裂脑动脉瘤的患者，这些动脉瘤位于颈内动脉（ICA）或椎动脉（VA），最大直径<12mm。调查每例患者的术后并发症，并在术后3个月使用超短回波时间（UTE）-MRA以及在术后6个月使用血管造影评估动脉瘤闭塞情况。将同期15例因相同标准接受单纯弹簧圈栓塞或支架辅助弹簧圈栓塞（SAC）的患者作为对照。比较FD组与单纯弹簧圈栓塞/SAC组的基线特征和治疗结果。
纳入4例男性和11例女性，平均年龄61.7±12.8岁，中位随访期为9个月（6 - 18个月）。有14个动脉瘤位于ICA，3个位于VA，平均最大动脉瘤直径为7.9±1.7mm。所有患者均使用带Shield技术的Pipeline Flex（美敦力公司，明尼阿波利斯，明尼苏达州，美国）进行治疗，14个动脉瘤（82.4%）接受了联合弹簧圈栓塞。围手术期无有症状性卒中发生；仅1例因甲状腺眼病接受皮质类固醇治疗的患者在术后3个月出现无症状性ICA闭塞。术后3个月UTE-MRA显示15个动脉瘤（88.2%）不显影，术后6个月血管造影显示16个动脉瘤（94.1%）完全闭塞。单纯弹簧圈栓塞/SAC组的瘤颈尺寸较小且栓塞体积比更高；然而，FD组的完全闭塞率更高。
中型脑动脉瘤FD置入联合弹簧圈栓塞有望在术后早期获得良好的闭塞率。
