The significance of stent sizing for parent vessel stenosis after flow diversion of MCA bifurcation aneurysms.

IF 1.7 4区医学 Q3 Medicine

Interventional Neuroradiology Pub Date : 2024-09-27 DOI:10.1177/15910199241285503

Svetozar Matanov, Georgi Vladev, Alexander Sirakov, Kristian Ninov, Marin Penkov, Hristo Tsonev, Kristina Sirakova, Vasil Karakostov, Stanimir Sirakov

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引用次数: 0

Abstract

Background: Wide-necked bifurcation aneurysms (WNBA) of the middle cerebral artery (MCA) present significant therapeutic challenges. Flow-diverter stents have been increasingly adopted for their management, though they may give rise to adverse outcomes such as in-stent stenosis (ISS). This study explores the association between stent oversizing and the incidence of ISS following flow-diverter stent placement in MCA bifurcation aneurysms.

Methods: A retrospective study included 34 patients who underwent flow-diverter stent placement for MCA bifurcation aneurysms between 2020 and 2023. Data on patient demographics, aneurysm morphology, and stent sizing were collected. ISS was evaluated through follow-up imaging at 6-month post-procedure. Stent oversizing was determined by calculating the difference between the stent diameter and the proximal and distal parent vessel diameters. Statistical analyses included Pearson correlation and chi-square tests, with significance established at p < 0.05.

Results: The studied group had a mean age of 57.8 years, with 81.6% female patients. The average aneurysm neck size was 3.6 mm, with a mean dome-to-neck ratio of 1.6. ISS was detected in 64.7% of cases proximally and 88.2% distally. A statistically significant negative correlation (r = -0.496, p = 0.003) was observed between stent oversizing and ISS, indicating that increased stent oversizing was associated with a higher incidence of ISS, particularly in the distal vessel segments.

Conclusion: The findings indicate that stent oversizing is significantly associated with the development of ISS in MCA bifurcation aneurysms treated with flow-diverter stents. Careful consideration of stent sizing, particularly minimizing oversizing in distal segments, may mitigate the risk of ISS and improve clinical outcomes. These results underscore the importance of meticulous stent selection and procedural planning in neurointerventional practice.

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中动脉分叉动脉瘤血流分流后，支架尺寸对母血管狭窄的意义。

背景：大脑中动脉（MCA）宽颈分叉动脉瘤（WNBA）给治疗带来了巨大挑战。越来越多的患者采用分流支架来治疗这些动脉瘤，但这种支架可能会导致支架内狭窄（ISS）等不良后果。本研究探讨了在 MCA 分叉动脉瘤中放置分流支架后，支架尺寸过大与 ISS 发生率之间的关系：这项回顾性研究纳入了2020年至2023年间因MCA分叉动脉瘤接受分流支架置入术的34例患者。研究收集了患者人口统计学、动脉瘤形态学和支架尺寸的数据。通过术后 6 个月的随访成像评估 ISS。支架过大通过计算支架直径与近端和远端母血管直径之间的差值来确定。统计分析包括皮尔逊相关性和卡方检验，以 p 为显著性：研究组的平均年龄为 57.8 岁，女性患者占 81.6%。动脉瘤颈平均大小为 3.6 毫米，平均穹颈比为 1.6。64.7%的病例在近端检测到 ISS，88.2%的病例在远端检测到 ISS。支架尺寸过大与ISS之间存在统计学意义上的负相关（r = -0.496，p = 0.003），表明支架尺寸过大与ISS发生率较高有关，尤其是在远端血管段：结论：研究结果表明，在使用分流支架治疗的 MCA 分叉动脉瘤中，支架尺寸过大与 ISS 的发生显著相关。慎重考虑支架尺寸，尤其是尽量减少远段支架尺寸过大，可降低发生 ISS 的风险并改善临床预后。这些结果强调了在神经介入治疗中精心选择支架和制定手术计划的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Interventional Neuroradiology 医学-核医学

CiteScore

2.80

自引率

11.80%

发文量

192

审稿时长

6-12 weeks

期刊介绍： Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...