用于治疗未破裂大脑前动脉远端动脉瘤的血流导向支架：CRETA注册研究分析
Flow-diverting stents for the treatment of unruptured distal anterior cerebral artery aneurysms: analysis of the CRETA Registry.
作者信息
Scarcia Luca, Clarençon Frédéric, Dmytriw Adam A, Shotar Eimad, Premat Kevin, Jabbour Pascal, Tjoumakaris Stavropoula I, Gooch Reid, Psychogios Marios-Nikos, Ntoulias Nikolaos, Sporns Peter B, Puri Ajit S, Singh Jasmeet, Kuhn Anna Luisa, Hassan Ameer E, Algin Oktay, Möhlenbruch Markus A, Hohenstatt Sophia, Russo Riccardo, Bergui Mauro, Goren Oded, Kole Matthew J, Bankole Nourou Dine Adeniran, Bibi Richard, Boulouis Gregoire, Morimoto Takeshi, Sakakibara Fumihiro, Pop Raoul, Juravle Ciprian, Ho Joanna Wk, Ferrario Angel, Pujol Lereis Virginia, Cooper Jared, Gandhi Chirag D, Salsano Giancarlo, Castellan Lucio, Camilli Arianna, Consoli Arturo, Sgreccia Alessandro, Raz Eytan, Chung Charlotte, Burel Julien, Papagiannaki Chrysanthi, Rasheed Umair, Baqir Hassan Khawaja Muhammad, Hong Tao, Ji Zhe, Rautio Riitta, Sinislao Matias, Ruggiero Maria, Lafe Elvis, Da Ros Valerio, Bellini Luigi, Gabrieli Joseph D, Cester Giacomo, Levitt Michael R, Carroll Kate T, Abecassis Zack A, Caragliano Antonio Armando, Vinci Sergio L, Bellanger Guillaume, Cognard Christophe, Marnat Gaultier, Saleille Lisa, Limbucci Nicola, Capasso Francesco, Piano Mariangela, Rollo Claudia, Guedon Alexis, Arpaia Francesco, Romi Andrea, Di Caterino Fortunato, Biondi Alessandra, Kalsoum Erwah, Mykola Vyval, Guenego Adrien, Patel Aman B, Pereira Vitor M, Pedicelli Alessandro, Alexandre Andrea Maria
机构信息
Neuroradiology, Henri Mondor Hospital, Creteil, France.
Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, 47, Bd de l'Hôpital, 75013, Paris, France.
出版信息
J Neurointerv Surg. 2025 Jan 27. doi: 10.1136/jnis-2024-022315.
BACKGROUND
Data about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow diversion in unruptured DACA aneurysm treatment.
METHODS
Databases from 39 centers were retrospectively reviewed for unruptured DACA aneurysms treated with flow-diverting stents. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed.
RESULTS
A total of 168 patients with 168 unruptured DACA aneurysms were treated between January 2018 and December 2022. One hundred and twenty-five were women (74.4%) and the median age was 61 (IQR 52-67) years. The most common morphology was saccular (91.7%), with branch involvement in 61.9% of cases. Median parent vessel diameter was 1.9 mm (IQR 1.7-2.2) and stents were successfully deployed in 99.4% of cases. In 96.4% a single stent was implanted, while 3.6% of cases required two stents. Median imaging follow-up was 16.5 (IQR 7-24) months. At last follow-up the rate of occlusion (O'Kelly-Marotta scale C or D) was 82.1%. Symptomatic thromboembolic or hemorrhagic complications occurred in 5.3% of patients and the mortality rate was 0.6%. The rate of retreatment was 1.2%.
CONCLUSIONS
Flow-diverting stents are a reasonably safe and effective treatment option for unruptured DACA aneurysms.
背景
关于血流导向治疗大脑前动脉远端动脉瘤（DACA）的安全性和有效性的数据有限。我们进行了最大规模的多中心分析，以评估血流导向治疗未破裂DACA动脉瘤的疗效。
方法
对39个中心的数据库进行回顾性分析，纳入接受血流导向支架治疗的未破裂DACA动脉瘤患者。评估患者的人口统计学特征、临床表现、影像学特征、手术并发症及治疗结果。
结果
2018年1月至2022年12月期间，共治疗了168例未破裂DACA动脉瘤患者。其中125例为女性（74.4%），中位年龄为61岁（四分位间距52 - 67岁）。最常见的形态为囊状（91.7%），61.9%的病例累及分支。载瘤动脉的中位直径为1.9毫米（四分位间距1.7 - 2.2毫米），99.4%的病例成功植入支架。96.4%的患者植入了单个支架，3.6%的患者需要植入两个支架。影像学随访的中位时间为16.5个月（四分位间距7 - 24个月）。在最后一次随访时，闭塞率（O'Kelly-Marotta分级C或D）为82.1%。5.3%的患者出现了有症状的血栓栓塞或出血性并发症，死亡率为0.6%。再次治疗率为1.2%。
结论
血流导向支架是治疗未破裂DACA动脉瘤的一种相对安全有效的方法。
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