Predictors of Intracranial Aneurysm Residual Filling After Treatment With Flow Diversion at Early Follow-up: A Multicenter Experience of 2277 Patients.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-09-19 DOI:10.1227/neu.0000000000003747

Joshua D Burks, Ahmed Abdelsalam, Evan M Luther, Kara M Christopher, Michael A Silva, Pascal Jabbour, Sami Al Kasab, Michael R Levitt, Sai Sanikommu, Adib A Abla, Peter Kan, Adam S Arthur, Joshua W Osbun, Min S Park, Nohra Chalouhi, Tiffany Eatz, Ahmad Sweid, Stacey Q Wolfe, Alejandro M Spiotta, Kyle M Fargen, Dileep R Yavagal, Eric C Peterson, Eva M Wu, Clemens M Schirmer, Eyad Almallouhi, Giuseppe Lanzino, Waleed Brinjikji, Mohammad H El-Ghanem, Robert M Starke

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引用次数: 0

Abstract

Background and objectives: Flow-diverting stents (FDSs) have improved treatment options for intracranial aneurysms. Although FDS have proven successful in treating aneurysms that would previously have required complex microsurgical or endovascular repairs, treatment failures remain a concern. In this multicenter study, we aim to analyze the predictors of residual aneurysmal filling at early angiographic follow-up.

Methods: A retrospective analysis of a prospectively maintained neuroendovascular database at 14 high-volume US centers was conducted for all patients who underwent FDS placement for intracranial aneurysms between 2011 and 2019. Aneurysms were graded on the O'Kelly-Marotta scale (OKM).

Results: A total of 2277 patients underwent FDS embolization for intracranial aneurysms during the study period. The patient's mean age was 55 (SD ± 13.5) years, and 82% were female. The median maximal aneurysm diameter was 6.7 mm (IQR 4.10-11 mm). Complete aneurysm obliteration (OKM grade 4) occurred in 1109 patients (68%), and 146 (9%) were OKM grade 3, 188 (12%) were OKM grade 2, and 174 (11%) were OKM grade 1. In the adjusted multivariate analysis, individuals in the 65-74 years and 75+ years age groups had significantly increased risk of residual aneurysm filling at 6-month follow-up compared with the 18-44 years age group (odds ratio [OR] 1.92 (95% CI: 1.33-2.78) and 2.92 (95% CI: 1.79-4.77), respectively). Aneurysms arising from the superior cerebellar artery, the basilar artery, and the carotid terminus were more likely to have a residual filling (OR 12.6, 95% CI: 1.39-14.7; OR 4.27, 95% CI: 1.39-14.7; OR 3.16, 95% CI: 1.24-8.06, respectively).

Conclusion: As the utilization of FDS for intracranial aneurysms becomes more widespread, the efficacy of aneurysm obliteration needs to be assessed. Our results indicate that several patient-dependent factors, such as age, aneurysm location, and size, predict the likelihood of residual aneurysm filling 6 months post-treatment.

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早期随访中颅内动脉瘤分流治疗后残留填充的预测因素：2277例患者的多中心经验。

背景和目的：血流分流支架（FDSs）改善了颅内动脉瘤的治疗选择。虽然FDS在治疗动脉瘤方面已经被证明是成功的，而以前需要复杂的显微手术或血管内修复，但治疗失败仍然是一个问题。在这项多中心研究中，我们的目的是分析早期血管造影随访中残余动脉瘤填充的预测因素。方法：回顾性分析2011年至2019年期间接受FDS植入颅内动脉瘤的所有患者在美国14个大容量中心前瞻性维护的神经血管内数据库。动脉瘤按O'Kelly-Marotta评分（OKM）分级。结果：在研究期间，共有2277例患者接受了FDS栓塞治疗颅内动脉瘤。患者平均年龄55 （SD±13.5）岁，女性占82%。中位最大动脉瘤直径6.7 mm （IQR 4.10-11 mm）。1109例（68%）患者发生完全动脉瘤闭塞（OKM 4级），其中OKM 3级146例（9%），OKM 2级188例（12%），OKM 1级174例（11%）。在调整后的多因素分析中，与18-44岁年龄组相比，65-74岁和75岁以上年龄组在6个月随访时残留动脉瘤填充的风险显著增加（比值比[OR]分别为1.92 （95% CI: 1.33-2.78）和2.92 (95% CI: 1.79-4.77)）。产生于小脑上动脉、基底动脉和颈动脉末梢的动脉瘤更容易有残余填充（OR 12.6, 95% CI: 1.39-14.7; OR 4.27, 95% CI: 1.39-14.7; OR 3.16, 95% CI: 1.24-8.06）。结论：随着FDS在颅内动脉瘤治疗中的应用越来越广泛，动脉瘤闭塞术的疗效有待评估。我们的研究结果表明，一些患者依赖的因素，如年龄、动脉瘤位置和大小，可以预测治疗后6个月残留动脉瘤填充的可能性。

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

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.