Anatomical Flow Diversion by Hybrid Strategy for Intractable Large Cerebral Aneurysms.

IF 2.8 3区医学 Q2 Medicine

Clinical Neuroradiology Pub Date : 2024-08-27 DOI:10.1007/s00062-024-01452-w

Wataro Tsuruta, Takayuki Hara, Satoshi Miyamoto, Jun Isozaki, Daiichiro Ishigami, Hisayuki Hosoo, Yoshiro Ito, Mikito Hayakawa, Aiki Marushima, Yuji Matsumaru

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Abstract

Background and importance: Flow diverters (FDs) provide curative endovascular treatment for wide-necked sidewall aneurysms. The efficacy of FDs for bifurcation or branching sidewall aneurysms is probably limited. We used anatomical flow diversion (AFD) for intractable large cerebral aneurysms. We report our experiences with AFD.

Methods: The concept of AFD is the transformation from the bifurcation or branching sidewall type to the nonbranching sidewall type. Linearization of the parent artery by stenting, intentional branch occlusion, and aneurysmal coil embolization were performed. Furthermore, bypass surgery is performed for patients intolerant to branch occlusions. We evaluated the clinical outcomes of intractable aneurysms treated with AFD.

Results: AFD was performed in seven unruptured large aneurysms. Aneurysmal locations were the top of the basilar artery (BA), BA-superior cerebellar artery (SCA), internal carotid artery (IC)-posterior communicating artery (PcomA), and IC terminal. The mean dome diameter was 17.0 ± 4.6 mm. Six patients underwent bypass surgery. The occluded branches were the PCA + SCA, PcomA, and anterior cerebral artery (ACA) A1. An FD was used in three patients and a neck bridge stent in four patients. No intraprocedural complications occurred. Two postprocedural ischemic complications occurred in one patient. Six (86%) patients demonstrated a modified Rankin Scale (mRS) 0 at the 3-month follow-up, and one with an ischemic complication showed an mRS 5. Complete occlusion of all aneurysms was maintained with a median follow-up duration of 60 months.

Conclusion: AFD is useful for intractable large cerebral aneurysms with high curability, although safety verification is required.

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通过混合策略对难治性大面积脑动脉瘤进行解剖学血流分流。

背景和重要性：血流分流器（FDs）可为宽颈侧壁动脉瘤提供根治性血管内治疗。对于分叉或分支侧壁动脉瘤，血流分流器的疗效可能有限。我们采用解剖型血流分流术（AFD）治疗难治性大面积脑动脉瘤。我们报告了我们使用 AFD 的经验：AFD的概念是从分叉或分支侧壁型向非分支侧壁型的转变。方法：AFD的概念是从分叉或分支侧壁型转变为非分支侧壁型，通过支架、有意的分支闭塞和动脉瘤线圈栓塞等方法对母动脉进行线性化处理。此外，还为不能耐受分支闭塞的患者实施了旁路手术。我们对使用动脉导管扩张术治疗难治性动脉瘤的临床效果进行了评估：对 7 个未破裂的大动脉瘤进行了动脉导管扩张术。动脉瘤位置为基底动脉（BA）顶部、BA-小脑上动脉（SCA）、颈内动脉（IC）-后交通动脉（PcomA）和 IC 末端。平均穹顶直径为 17.0 ± 4.6 毫米。六名患者接受了搭桥手术。闭塞的分支为 PCA + SCA、PcomA 和大脑前动脉 (ACA) A1。三名患者使用了 FD，四名患者使用了颈桥支架。术中未出现并发症。一名患者出现了两次术后缺血性并发症。6名患者（86%）在3个月的随访中显示改良Rankin量表（mRS）为0，1名出现缺血并发症的患者显示mRS为5。中位随访时间为 60 个月，所有动脉瘤均保持完全闭塞：结论：AFD 适用于难治性大面积脑动脉瘤，治愈率高，但安全性有待验证。

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来源期刊

Clinical Neuroradiology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.90

自引率

3.60%

发文量

期刊介绍： Clinical Neuroradiology provides current information, original contributions, and reviews in the field of neuroradiology. An interdisciplinary approach is accomplished by diagnostic and therapeutic contributions related to associated subjects. The international coverage and relevance of the journal is underlined by its being the official journal of the German, Swiss, and Austrian Societies of Neuroradiology.