Jia Zhikun, Yin Jiahe, Wang Xuetao, Quan Tao, Luo Bin, Huang Mengshi, Li Zhixi, Jin Xin, Li Xifeng, Liu Yanchao, Duan Chuanzhi, Zhang Xin
Department of Cerebrovascular Surgery, Neurosurgery Center, Guangzhou, China; The National Key Clinical Specialty, Guangzhou, China; Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangzhou, China; Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China; The Neurosurgery Institute of Guangdong Province, Neurovascular Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, China.
World Neurosurg. 2025 Jul;199:124072. doi: 10.1016/j.wneu.2025.124072. Epub 2025 May 12.
In-stent stenosis (ISS) remains a significant adverse event following flow diverter (FD) placement for intracranial aneurysms. This study investigated whether admission fibrinogen (FIB) levels could predict ISS occurrence.
We conducted a multicenter retrospective cohort study of 394 consecutive patients who underwent FD treatment for intracranial aneurysms across 4 comprehensive stroke centers between March 2016 and October 2024. The primary predictor was admission FIB level, and the primary endpoint was angiographically confirmed ISS during 12.63 ± 9.29 months of follow-up. Multiple variables were collected, including patient demographics, aneurysm characteristics, procedural details, and vascular risk factors. The association between FIB levels and ISS was analyzed using Cox logistic regression and threshold effect analysis with 2-piecewise linear regression models.
Among the cohort, 90 patients (22.84%) were diagnosed with ISS, all of whom exhibited asymptomatic stenosis with a stenosis rate of ≥ 25%. Threshold effect analysis identified a nonlinear relationship between FIB levels and ISS risk, with an inflection point at 2.71 g/L. Below this threshold, each unit increase in FIB was associated with a significantly lower risk of ISS (adjusted hazard ratio: 0.27; 95% confidence interval: 0.10-0.69; P = 0.006).
Low admission FIB (< 2.71 g/L) independently predicts ISS risk after FD treatment. With each additional unit of FIB level, there was a 73% reduction in the risk of ISS after FD treatment at follow-up. These results may help identify patients at higher risk for ISS who might benefit from more intensive.
颅内动脉瘤血流导向装置（FD）置入术后，支架内狭窄（ISS）仍是一项重大不良事件。本研究调查了入院时纤维蛋白原（FIB）水平是否可预测ISS的发生。
我们对2016年3月至2024年10月期间在4个综合卒中中心接受颅内动脉瘤FD治疗的394例连续患者进行了一项多中心回顾性队列研究。主要预测指标为入院时FIB水平，主要终点为随访12.63±9.29个月期间经血管造影证实的ISS。收集了多个变量，包括患者人口统计学资料、动脉瘤特征、手术细节和血管危险因素。使用Cox逻辑回归和两段式线性回归模型进行阈值效应分析，以分析FIB水平与ISS之间的关联。
在该队列中，90例患者（22.84%）被诊断为ISS，所有患者均表现为无症状狭窄，狭窄率≥25%。阈值效应分析确定FIB水平与ISS风险之间存在非线性关系，拐点为2.71 g/L。低于该阈值时，FIB每增加一个单位，ISS风险显著降低（调整后风险比：0.27；95%置信区间：0.10-0.69；P=0.006）。
入院时低FIB水平（<2.71 g/L）可独立预测FD治疗后ISS风险。随访时，FIB水平每增加一个单位，FD治疗后ISS风险降低73%。这些结果可能有助于识别ISS风险较高的患者，这些患者可能从更强化的治疗中获益。
