Salsano Giancarlo, Scarcia Luca, Clarençon Frédéric, Shotar Eimad, Russo Riccardo, Bergui Mauro, Raz Eytan, Chung Charlotte, Simonato Davide, Rautio Riitta, Sinisalo Matias, Caragliano Antonio Armando, Vinci Sergio Lucio, Piano Mariangela, Rollo Claudia, Castellan Lucio, Fuschi Maurizio, Pereira Vitor Mendes, Dmytriw Adam A, Alexandre Andrea M, Pedicelli Alessandro
UOC Neuroradiologia. IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Neuroradiology Unit, Henri Mondor Hospital, Creteil, France.
Interv Neuroradiol. 2025 Aug 4:15910199251348514. doi: 10.1177/15910199251348514.
BackgroundData on off-label use of flow diverter for ruptured distal anterior cerebral artery aneurysms (rDACAAs) are limited. The purpose of the present study is to evaluate the efficacy and safety of flow diversion for rDACAAs in a large multicenter cohort.MethodsA retrospective observational study on consecutive patients who were treated with flow diversion for rDACAAs at 8 centers in 4 countries was performed. Primary outcome was the occlusion rate of the target aneurysm at the last radiological follow-up. Secondary outcomes included good clinical outcome, retreatment, technical success, procedure-related complications, radiological outcome of the covered branches and mortality rate.ResultsA total of 21 patients with 21 rDACAAs were treated between January 2017 and December 2024. Thirteen patients were women (61.9%) and the median age was 54 years (IQR 46-66). The most common etiology was saccular (71.4%), followed by dissecting (23.8%) and mycotic (4.8%). In all patients a single stent was successful deployed. Median imaging follow-up was 9 (7-12) months. At last follow-up adequate occlusion was 95.2%. Symptomatic thromboembolic or hemorrhagic complications occurred in 9.5% of patients. Seventeen patients (81%) had good clinical outcome (mRS 0-2) with mortality rate of 9.5%. In-stent stenosis occurred in one case that was conservatively managed without major concerns.ConclusionsFlow diversion is feasible as a potential treatment strategy for acutely ruptured aneurysms arising from distal anterior cerebral artery. Flow diverter may represent a valid option whenever other treatments are considered challenging or high risk.
背景
关于血流导向装置用于破裂的大脑前动脉远端动脉瘤（rDACAAs）的非标签使用的数据有限。本研究的目的是在一个大型多中心队列中评估血流导向治疗rDACAAs的疗效和安全性。
方法
对在4个国家的8个中心接受血流导向治疗rDACAAs的连续患者进行了一项回顾性观察研究。主要结局是最后一次影像学随访时目标动脉瘤的闭塞率。次要结局包括良好的临床结局、再次治疗、技术成功、与手术相关的并发症、被覆盖分支的影像学结局和死亡率。
结果
在2017年1月至2024年12月期间，共治疗了21例患有21个rDACAAs的患者。13例为女性（61.9%），中位年龄为54岁（四分位间距46 - 66岁）。最常见的病因是囊状（71.4%），其次是夹层（23.8%）和霉菌性（4.8%）。所有患者均成功植入单个支架。中位影像学随访时间为9（7 - 12）个月。在最后一次随访时，充分闭塞率为95.2%。9.5%的患者发生了有症状的血栓栓塞或出血性并发症。17例患者（81%）有良好的临床结局（改良Rankin量表评分0 - 2分），死亡率为9.5%。1例发生支架内狭窄，经保守处理，无重大问题。
结论
血流导向作为大脑前动脉远端急性破裂动脉瘤的一种潜在治疗策略是可行的。每当其他治疗被认为具有挑战性或高风险时，血流导向装置可能是一个有效的选择。
