Vladev G, Sirakov A, Matanov S, Sirakova K, Ninov K, Sirakov S
From the Radiology Department (G.V., A.S., S.M., S.S.), UH St Ivan Rilski, Sofia, Bulgaria.
Radiology Department (K.S., G.V., A.S., S.S.), Medical University of Sofia, Bulgaria.
AJNR Am J Neuroradiol. 2025 Apr 2;46(4):712-719. doi: 10.3174/ajnr.A8564.
Flow-diverter stents are a potent and efficient tool in the instrumentarium of neurointerventional radiologists for the treatment of intracranial aneurysms. With their implementation, some adverse effects and complications such as hemorrhagic and ischemic ones, have been seen as a potential downfall of the method. In-stent stenosis is one such complication, which until now has not received enormous attention due to its seemingly benign characteristic. In our study we propose a different point of view on this matter and aim to establish a potential mechanism for its development: a subacute postprocedural stent deformation, due to segmental vessel constriction as a reaction to the implant.
We enrolled 48 patients between the ages of 31 and 71 (8 men) with aneurysms on the distal portions of the ICA, all of whom were treated with the p64 flow-diverter stent, to assess the incidence of this phenomenon, as well as establish a correlation between it and subsequent clinical symptoms. A protocol for short-term follow-up, consisting only of a high-dose fluoroscopy image of the implant (conducted on the 14th postprocedural day) was implemented to assess the state of the implant before endothelization was to be expected.
Stent deformities were seen in 58% of cases. One patient with an observed stent deformity presented with several episodes of acute contralateral 1-sided weakness of the limbs. Seventy-one percent of those patients presented with a mild/moderate unilateral headache postprocedurally. A correlation between the deformity and a subsequent narrowing of the parent vessel diameter was established on follow-ups. Notable in-stent stenosis was reported in 35% of all cases.
Cases with subacute stent deformities are presented in a nonnegligible percent of flow-diversion therapies with the p64 stent. A statistically significant association between the observed deformation and subsequent in-stent stenosis was observed on follow-up.
血流导向支架是神经介入放射科医生治疗颅内动脉瘤的一种强大而有效的工具。随着其应用，一些不良反应和并发症，如出血性和缺血性并发症，被视为该方法的潜在缺陷。支架内狭窄就是这样一种并发症，由于其看似良性的特征，迄今为止尚未受到广泛关注。在我们的研究中，我们对此事提出了不同的观点，旨在建立其发展的潜在机制：术后亚急性支架变形，这是由于血管节段性收缩作为对植入物的反应所致。
我们纳入了48例年龄在31至71岁之间（8例男性）、颈内动脉远端有动脉瘤的患者，所有患者均接受p64血流导向支架治疗，以评估这种现象的发生率，并确定其与随后临床症状之间的相关性。实施了一个短期随访方案，仅包括植入物的高剂量荧光透视图像（在术后第14天进行），以评估预期内皮化之前植入物的状态。
58%的病例出现支架变形。一名观察到支架变形的患者出现了几次对侧肢体急性单侧无力发作。71%的患者术后出现轻度/中度单侧头痛。随访中发现变形与母血管直径随后变窄之间存在相关性。所有病例中有35%报告了明显的支架内狭窄。
在使用p64支架进行血流导向治疗的病例中，亚急性支架变形的情况占比不可忽视。随访中观察到所观察到的变形与随后的支架内狭窄之间存在统计学上的显著关联。
