高分辨率锥形束计算机断层扫描在未破裂颅内动脉瘤血流导向装置植入术后内皮化评估中的应用

Application of high-resolution cone-beam computed tomography for evaluation of endothelialization after flow diverter implantation for unruptured intracranial aneurysms.

作者信息

Shi Shuailong, Zhang Zhike, Long Shuhai, Ma Ji, Lu Peijie, Ran Yuncai, Xie Shanshan, Yang Jie, Wang Ye, Li Tengfei

机构信息

From the Department of Interventional Radiology (Shuailong Shi, Shuhai Long, Ji Ma, Peijie Lu, Jie Yang, Ye Wang, Tengfei Li), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; The School of Life Science and Technology (Zhike Zhang), Xi'an Jiaotong University, Xi'an, China; and Department of Magnetic Resonance (Yuncai Ran, Shanshan Xie), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

出版信息

AJNR Am J Neuroradiol. 2025 Sep 9. doi: 10.3174/ajnr.A8997.

DOI:10.3174/ajnr.A8997

PMID:40925683

Abstract

BACKGROUND AND PURPOSE

Although high-resolution cone-beam computed tomography (HR-CBCT) is used for immediate evaluation of stent apposition, studies using this technique to evaluate flow diverter (FD) endothelialization during follow-up are limited. The study aims to investigate the potential of HR-CBCT in assessing FD endothelialization and identify factors influencing poor endothelialization.

MATERIALS AND METHODS

The clinical and imaging data of patients with unruptured intracranial aneurysms (UIAs) treated by FDs from March 2019 to October 2023 were retrospectively analyzed. HR-CBCT was used for immediate evaluation of stent apposition, and FD endothelialization at 3-, 6-, and 12-months post-implantation was evaluated using HR-CBCT and digital subtraction angiography. Multivariate logistic regression analysis was used to identify factors associated with poor endothelialization.

RESULTS

Among 402 FDs implanted for 446 aneurysms in 378 patients, 41 showed incomplete stent apposition (ISA) in post-implantation HR-CBCT scans. The aneurysm-occlusion rate at 12 months post-implantation was 84.8% (378/446), with 8.7% (35/402) of the FDs exhibiting in-stent stenosis (ISS). At 12 months post-implantation, 343 (85.1%) FDs showed good endothelialization, while 59(14.9%) exhibited poor endothelialization. Multivariate logistic regression analysis identified age ≥ 60 years (OR=2.209;95% CI:1.053-4.635;P=0.04), a large aneurysm lumen inflow angle (OR=1.102;95% CI:1.071-1.135;P<0.001), parent artery excessive tortuosity (OR=9.402;95% CI:1.141-77.479;P=0.04), and ISA (OR=10.967;95% CI:4.290-28.035;P<0.001) as independent risk factors for poor endothelialization.

CONCLUSIONS

HR-CBCT can accurately evaluate FD endothelialization and ISS of UIAs after FD implantation. Age ≥ 60 years, a large aneurysm lumen inflow angle, parent artery excessive tortuosity, and ISA are independent risk factors for poor endothelialization.

ABBREVIATIONS

HR-CBCT = high-resolution cone-beam computed tomography; FD = flow diverter; UIAs = unruptured intracranial aneurysms; ISA = incomplete stent apposition; ISS = in-stent stenosis.

摘要

背景与目的

尽管高分辨率锥形束计算机断层扫描（HR-CBCT）用于即刻评估支架贴壁情况，但利用该技术在随访期间评估血流导向装置（FD）内皮化的研究有限。本研究旨在探讨HR-CBCT在评估FD内皮化方面的潜力，并确定影响内皮化不良的因素。

材料与方法

回顾性分析2019年3月至2023年10月接受FD治疗的未破裂颅内动脉瘤（UIA）患者的临床和影像资料。HR-CBCT用于即刻评估支架贴壁情况，并在植入后3个月、6个月和12个月使用HR-CBCT和数字减影血管造影评估FD内皮化情况。采用多因素逻辑回归分析确定与内皮化不良相关的因素。

结果

在378例患者中为446个动脉瘤植入了402个FD，其中41个在植入后HR-CBCT扫描中显示支架贴壁不完全（ISA）。植入后12个月的动脉瘤闭塞率为84.8%（378/446），8.7%（35/402）的FD出现支架内狭窄（ISS）。植入后12个月时，343个（85.1%）FD显示内皮化良好，而59个（14.9%）内皮化不良。多因素逻辑回归分析确定年龄≥60岁（OR=2.209；95%CI：1.053-4.635；P=0.04）、动脉瘤腔流入角大（OR=1.102；95%CI：1.071-1.135；P<0.001）、载瘤动脉过度迂曲（OR=9.402；95%CI：1.141-77.479；P=0.04）和ISA（OR=10.967；95%CI：4.290-28.035；P<0.001）是内皮化不良的独立危险因素。