Huang Chi, Zhu Yajun, Feng Xin, Tong Xin, Wen Zhuohua, Lin Jiancheng, Huang Mengshi, Yuan Hao, Dai Lele, Chen Wenxin, Hu Yuqi, Bi Yiming, Deng Xueyan, Xie Zehui, Shang Gege, Luo Yingxue, Zhao Yitong, Peng Chao, Huang Changren, Su Shixing, Zhang Xin, Li Xifeng, Guo Zongduo, Liu Aihua, Duan Chuanzhi
Neurosurgery Center, Department of Cerebrovascular Surgery, Zhujiang Hospital, Southern Medical UniversityThe National Key Clinical SpecialtyEngineering Research Center of Diagnostic and Therapeutic Technology and Devices for Cerebrovascular Diseases, Ministry of Education; Guangdong Provincial Key Laboratory On Brain Function Repair and Regeneration; Zhujiang Hospital Institute for Brain Science and Intelligence, Guangzhou, China.
Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Neurosurg Rev. 2025 May 30;48(1):462. doi: 10.1007/s10143-025-03625-8.
The size of the Pipeline Embolization Device (PED) relative to the vessel is related to the therapeutic effect. However, the association between the stent-to-vessel matching status and treatment outcomes remains unclear. In this study, we aimed to evaluate this potential by measuring the dynamic changes in stent size during implantation. Participants who underwent PED implantation between September 2018 and September 2022 were reviewed. Coil-assisted embolization and multiple stents that could affect the measure accuracy were excluded. Three parameters were set to quantize the stent-matching degree: nominal match ratio (NMR), actual match ratio (AMR), and elongation ratio (ER). Study outcomes were incomplete occlusion and significant in-stent stenosis (ISS). The results were generated using multivariate logistic regression and restricted cubic spline (RCS) curves. A total of 388 patients were ultimately enrolled. Incomplete occlusion was observed in 22.4% and significant ISS in 5.2% at the last follow-up (11.63 ± 3.19 months). A larger distal AMR was significantly associated with incomplete occlusion (odds ratio [OR] = 12.733, 95% confidence interval [CI] = 3.678-44.082, p < 0.001) and significant ISS (OR = 43.469, 95% CI = 3.350-564.073, p = 0.004). The RCS curve indicated that the possibility of incomplete occlusion and significant ISS increased as the distal AMR exceeded 0.72 and 0.85, respectively. Neurointerventionalists should avoid pursuing over-expansion at the distal end when PED implantation. To match the vessel with significant lumen disparities and non-symmetrically tubular shapes, tapered FD and real-time software with automatic measure function were supposed to be developed in the future. TRIAL REGISTRATION: ClinicalTrials.gov (NCT06446778). Registered on May 22, 2024.
管道栓塞装置（PED）与血管的尺寸关系到治疗效果。然而，支架与血管的匹配状态和治疗结果之间的关联仍不明确。在本研究中，我们旨在通过测量植入过程中支架尺寸的动态变化来评估这种可能性。回顾了2018年9月至2022年9月期间接受PED植入的参与者。排除了可能影响测量准确性的弹簧圈辅助栓塞和多个支架。设置了三个参数来量化支架匹配程度：标称匹配率（NMR）、实际匹配率（AMR）和伸长率（ER）。研究结果为不完全闭塞和显著的支架内狭窄（ISS）。结果通过多变量逻辑回归和受限立方样条（RCS）曲线得出。最终共纳入388例患者。在最后一次随访（11.63±3.19个月）时，观察到22.4%的患者出现不完全闭塞，5.2%的患者出现显著的ISS。较大的远端AMR与不完全闭塞（比值比[OR]=12.733，95%置信区间[CI]=3.678-44.082，p<0.001）和显著的ISS（OR=43.469，95%CI=3.350-564.073，p=0.004）显著相关。RCS曲线表明，当远端AMR分别超过0.72和0.85时，不完全闭塞和显著ISS的可能性增加。神经介入医生在植入PED时应避免在远端追求过度扩张。为了匹配具有显著管腔差异和非对称管状形状的血管，未来应开发锥形FD和具有自动测量功能的实时软件。试验注册：ClinicalTrials.gov（NCT06446778）。于2024年5月22日注册。
