Duan Yu, Huang Guohui, Shen Jun, Xu Ziwei, Li Zhuyu, Li Jian, Dai Dongwei
Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China.
Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Front Neurol. 2025 Mar 27;16:1552610. doi: 10.3389/fneur.2025.1552610. eCollection 2025.
The Tubridge flow diverter (TFD) has become a widely used device for reconstructing parent vessels and sealing complicated aneurysms in China. However, its application to managing distal small to medium-sized dissecting aneurysms has not been extensively investigated. This study aimed to evaluate the safety and effectiveness of the TFD and the factors affecting healing in patients with dissecting aneurysms in the middle cerebral artery (MCA).
Patients with dissecting aneurysms in the MCA who were treated with the TFD from 2019 to 2023 were included. According to the O'Kelly-Marotta (OKM) scale, OKM grade A was defined as dense embolism, while OKM grades B to D were defined as non-dense embolism in this study. Clinical information, the degree of aneurysm occlusion, and clinical outcomes were retrospectively analyzed.
A total of 25 patients with 25 MCA dissecting aneurysms were identified. The average age was 52.4 years (age range 20-76), with 5 patients (20%) experiencing subarachnoid hemorrhage. In total, 12 aneurysms were located in the M1 segment, 11 involved the M2 bifurcation, and two were in the M3 segment or above. The median aneurysm length was 17.3 mm (range 4.2-27), and the average width was 5.4 mm (range 2.3-7.6). A total of 12 cases had one or more branches in the MCA. Furthermore, four cases (16%) showed asymptomatic in-stent stenosis, and five cases (20%) had main branch injuries during the angiographic follow-up. A total of three patients experienced acute ischemic events, and one had not fully recovered during the follow-up. There were no deaths related to procedure complications. According to the single-factor analysis, the patients in the non-dense embolism group during the follow-up had more strong branches before the operation (χ = 9.001, = ).
The TFD is a safe and effective flow diverter for distal dissecting MCA aneurysms. The aneurysms with strong branches were associated with a higher rate of non-dense embolism during the follow-up.
在中国，Tubridge血流导向装置（TFD）已成为一种广泛用于重建母血管和封闭复杂动脉瘤的器械。然而，其在处理远端中小尺寸夹层动脉瘤方面的应用尚未得到广泛研究。本研究旨在评估TFD治疗大脑中动脉（MCA）夹层动脉瘤患者的安全性和有效性以及影响愈合的因素。
纳入2019年至2023年期间接受TFD治疗的MCA夹层动脉瘤患者。在本研究中，根据奥凯利 - 马罗塔（OKM）分级，OKM A级定义为致密栓塞，而OKM B至D级定义为非致密栓塞。对临床信息、动脉瘤闭塞程度和临床结果进行回顾性分析。
共确定25例患有25个MCA夹层动脉瘤的患者。平均年龄为52.4岁（年龄范围20 - 76岁），5例（20%）发生蛛网膜下腔出血。总共12个动脉瘤位于M1段，11个累及M2分叉，2个位于M3段或更高部位。动脉瘤中位长度为17.3毫米（范围4.2 - 27），平均宽度为5.4毫米（范围2.3 - 7.6）。总共12例患者的MCA有一个或多个分支。此外，4例（16%）在血管造影随访期间出现无症状支架内狭窄，5例（20%）在血管造影随访期间发生主要分支损伤。共有3例患者发生急性缺血事件，1例在随访期间未完全恢复。无与手术并发症相关的死亡病例。根据单因素分析，随访期间非致密栓塞组患者术前有更多粗大分支（χ² = 9.001，P = ）。
TFD是治疗远端MCA夹层动脉瘤的一种安全有效的血流导向装置。有粗大分支的动脉瘤在随访期间非致密栓塞率较高。
