Bao J, Cao Y, Zhang X, Jing R, Yang Y T, Chen F X, Hu J Y, Li Y F
Department of Cerebrovascular Disease, the Second Affiliated Hospital of Kunming Medical University,Kunming650101, China.
Zhonghua Wai Ke Za Zhi. 2024 Dec 1;62(12):1104-1112. doi: 10.3760/cma.j.cn112139-20240822-00392.
To study the feasibility of domestic flow diverter(TFD) for the treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms. This is a retrospective case series study.The study retrospectively evaluated consecutive 54 patients with unruptured intracranial small- and medium-sized wide-neck aneurysms treated with TFD in the Department of Cerebrovascular Disease,the Second Affiliated Hospital of Kunming Medical University between October 2019 and January 2024. There were 11 males and 43 females, and the age of patients was (54.9±9.6) years (range:36 to 74 years). There were 63 aneurysms in 54 patients,6 of which were tandem multiple small aneurysms. One case had saccular aneurysms of bilateral internal carotid artery. The maximum diameter of aneurysm was (4.1±0.8) mm (range: 1.5 to 10.0 mm).The ratio of the maximum diameter of the aneurysm to the neck width diameter was 1.3±0.4 (range:0.4 to 2.4). The surgical and follow-up data were collected. The aneurysm embolization rate at the immediate operation and follow-up,and the complications were analyzed. The degree of aneurysm embolization was evaluated using the O'Kelly-Marotta (OKM) grading system,with OKM grade D as complete occlusion and grade C and above (C1,C2,C3 and D) as successful occlusion. Clinical outcomes of all patients were evaluated by modified Rankin scale(mRS). For 63 aneurysms, 48 aneurysms were treated with TFD alone,and 15 aneurysms were treated with a combination of TFD and coiling. The immediate postoperative successful occlusion rate was 14.3% (9/63) and the complete occlusion rate was 3.2% (2/63). Follow-up results were obtained for all of the patients. The follow-up time ((IQR)) was 124 (182) days (range: 85 to 754 days). The time to aneurysm successful occlusion was 140.5 (151.5) days (range: 85 to 308 days). At final follow-up,the successful aneurysm occlusion rate was 68.3% (43/63) and the complete occlusion rate was 58.7% (37/63). The complete occlusion rate of the TFD group was 50.0% (24/48) and the TFD+coiling group was 13/15. All patients had no aneurysm rupture,ischemic complications and no recurrence of the aneurysm needed to retreatment during the intraoperative and follow-up period. A total of 3 mild haemorrhagic complications which were related to dual-antiplatelet agents. Twelve patients had asymptomatic mild-moderate stent stenosis. TFD covered 66 branch vessels totally. Only 6 branches were affected by the time of the last follow-up and none of the patients had relevant ischaemic symptoms. All of 54 patients were evaluated as mRS score<2 points at the last follow-up. Using TFD to treat internal carotid artery unruptured small and medium-sized wide-neck aneurysms can simplify the surgical procedure with low complication rate, which is a clinically optional treatment approach.
探讨国产血流导向装置（TFD）治疗未破裂颈内动脉中小型宽颈动脉瘤的可行性。这是一项回顾性病例系列研究。该研究回顾性评估了2019年10月至2024年1月期间在昆明医科大学第二附属医院脑血管病科接受TFD治疗的54例连续未破裂颅内中小型宽颈动脉瘤患者。其中男性11例，女性43例，患者年龄为（54.9±9.6）岁（范围：36至74岁）。54例患者共63个动脉瘤，其中6个为串联多发小动脉瘤。1例为双侧颈内动脉囊状动脉瘤。动脉瘤最大直径为（4.1±0.8）mm（范围：1.5至10.0mm）。动脉瘤最大直径与颈部宽度直径之比为1.3±0.4（范围：0.4至2.4）。收集手术及随访资料，分析即刻手术及随访时动脉瘤栓塞率及并发症情况。采用O'Kelly-Marotta（OKM）分级系统评估动脉瘤栓塞程度，OKM D级为完全闭塞，C级及以上（C1、C2、C3和D）为成功闭塞。所有患者的临床结局采用改良Rankin量表（mRS）评估。63个动脉瘤中，48个动脉瘤单纯采用TFD治疗，15个动脉瘤采用TFD与弹簧圈联合治疗。术后即刻成功闭塞率为14.3%（9/63），完全闭塞率为3.2%（2/63）。所有患者均获得随访结果。随访时间（四分位间距）为124（182）天（范围：85至754天）。动脉瘤成功闭塞时间为140.5（151.5）天（范围：85至308天）。末次随访时，动脉瘤成功闭塞率为68.3%（43/63），完全闭塞率为58.7%（37/63）。TFD组完全闭塞率为50.0%（24/48），TFD+弹簧圈组为13/15。所有患者在术中及随访期间均未发生动脉瘤破裂、缺血性并发症，无需再次治疗动脉瘤复发。共发生3例与双联抗血小板药物相关的轻度出血并发症。12例患者有无症状轻度至中度支架狭窄。TFD共覆盖66条分支血管。至末次随访时仅6条分支血管受累，所有患者均无相关缺血症状。54例患者末次随访时mRS评分均<2分。采用TFD治疗颈内动脉未破裂中小型宽颈动脉瘤可简化手术操作，并发症发生率低，是一种临床可选的治疗方法。
