Li Yuanzhi, Fan Feng, Chen Zhen, Liu Chao, Zhang Hang, Fu Yu, Guan Sheng
Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, China.
Neurosurg Rev. 2025 May 1;48(1):398. doi: 10.1007/s10143-025-03560-8.
To compare the clinical and imaging efficacy of flow diversion-assisted coiling (FD-assisted coiling) and coiling followed by staged-flow diversion (staged-FD) in the treatment of very large and giant intracranial aneurysms of the internal carotid artery. Between April 2015 and June 2024, 60 patients with very large and giant (≥ 20 mm in diameter) saccular intracranial aneurysms of the internal carotid artery were retrospectively analyzed at a single institution. Patients were classified into two groups: the FD-assisted coiling group (n = 45) and the staged-FD group (n = 15). Immediate occlusion rates, perioperative complication rates, and clinical and imaging follow-up results were compared between the two groups. Aneurysm occlusion was determined using the O'Kelly-Marotta (OKM) grading system. The rate of complete or subtotal immediate postoperative occlusion was significantly higher in the staged-FD group compared to the FD-assisted coiling group [60% (9/15) vs. 26.7% (12/45), p = 0.019]. The complication rate was significantly lower in the staged-FD group compared to the FD-assisted coiling group[0% (0/15) vs. 31.1% (14/45), p = 0.034]. On postoperative day 190 (172.3, 204.3), 45 patients in both groups underwent mid-term DSA. In the FD-assisted coiling group, 54.8% (17/31) had OKM D. In the staged-FD group, 63.6% (7/11) had OKM D. The median time interval between the first-stage coiled embolization and the second-stage FD placement was 40 (15,69) days. For very large and giant saccular intracranial aneurysms of the internal carotid artery, coiling followed by staged-FD achieves higher rates of complete or subtotal embolization in the immediate postoperative period and has a lower complication rate compared to single-stage FD-assisted coiling.
比较血流导向辅助弹簧圈栓塞术（FD辅助弹簧圈栓塞术）和先弹簧圈栓塞再分期血流导向术（分期FD）治疗颈内动脉大型和巨大型颅内动脉瘤的临床及影像学疗效。2015年4月至2024年6月，在一家机构对60例颈内动脉大型和巨大型（直径≥20mm）囊状颅内动脉瘤患者进行回顾性分析。患者分为两组：FD辅助弹簧圈栓塞组（n = 45）和分期FD组（n = 15）。比较两组的即刻闭塞率、围手术期并发症发生率以及临床和影像学随访结果。采用O'Kelly-Marotta（OKM）分级系统确定动脉瘤闭塞情况。分期FD组术后即刻完全或次全闭塞率显著高于FD辅助弹簧圈栓塞组[60%（9/15）对26.7%（12/45），p = 0.019]。分期FD组并发症发生率显著低于FD辅助弹簧圈栓塞组[0%（0/15）对31.1%（14/45），p = 0.034]。术后第190天（172.3，204.3），两组45例患者接受中期数字减影血管造影（DSA）。在FD辅助弹簧圈栓塞组，54.8%（17/31）达到OKM D级。在分期FD组，63.6%（7/11）达到OKM D级。第一阶段弹簧圈栓塞与第二阶段FD置入之间的中位时间间隔为40（15，69）天。对于颈内动脉大型和巨大型囊状颅内动脉瘤，与单阶段FD辅助弹簧圈栓塞相比，先弹簧圈栓塞再分期FD在术后即刻实现完全或次全栓塞的比率更高，且并发症发生率更低。
