Comparison of Lattice Flow Diverter and Pipeline Embolization Device in Unruptured Intracranial Aneurysms: A Real-World, Propensity Score Matching Study.
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引用次数: 0
Abstract
Background and objectives: Flow diverters (FDs) have been increasingly used in treating unruptured intracranial aneurysms (UIAs). However, comparative studies between the novel lattice flow diverter (LFD) and other FDs are limited. Our study aimed to compare outcomes of LFD and the pipeline embolization device (PED) for UIAs using propensity score matching (PSM).
Methods: Patients with UIAs treated with LFD or PED between August 2023 and November 2024 were included. PSM was performed to adjust for age, sex, comorbidities, ischemic stroke history, smoking status, alcohol abuse, preoperative modified Rankin Scale scores, history of multiple aneurysms, aneurysm characteristics, adjunctive coiling, and angiographic follow-up duration. Perioperative complications and clinical and angiographic outcomes were compared after matching.
Results: A total of 99 patients treated by LFD and 187 patients treated by PED were included. Compared with the PED group, the LFD group had fewer females and more patients with a history of multiple aneurysms, wider aneurysm necks, shorter stent lengths, and lower rates of in-stent stenosis (ISS) (stenosis > 50%). After PSM, 55 matched pairs were analyzed. The LFD group demonstrated significantly lower ISS rates (1.8% vs 14.5%, P = .037), with no significant differences in perioperative complications, the complete occlusion rate at the median 216-day angiographic follow-up (87.3% vs 85.5%, P > .999), or favorable outcomes (96.4% vs 94.5%, P > .999) compared with the PED group.
Conclusion: The mechanical balloon-based LFD with surface modification showed a lower ISS rate and comparable perioperative outcomes, short-term occlusion rates, and clinical prognosis compared with PED. The advantages brought by the Innovation of LFD warrant further validation through long-term randomized controlled trials.
背景和目的：血流分流器（fd）越来越多地用于治疗未破裂颅内动脉瘤（UIAs）。然而，对新型点阵分流器与其他分流器的比较研究有限。我们的研究旨在使用倾向评分匹配（PSM）比较LFD和管道栓塞装置（PED）治疗UIAs的结果。方法：纳入2023年8月至2024年11月期间接受LFD或PED治疗的UIAs患者。采用PSM校正年龄、性别、合并症、缺血性卒中史、吸烟状况、酒精滥用、术前修正Rankin量表评分、多发性动脉瘤史、动脉瘤特征、辅助盘绕和血管造影随访时间。配对后比较围手术期并发症及临床和血管造影结果。结果：共纳入LFD组99例，PED组187例。与PED组相比，LFD组女性患者较少，多动脉瘤病史患者较多，动脉瘤颈较宽，支架长度较短，支架内狭窄（ISS）发生率较低（狭窄bb0 50%）。经PSM后，对55对配对进行分析。与PED组相比，LFD组的ISS发生率显著降低（1.8% vs 14.5%, P = 0.037），围手术期并发症、中位216天血管造影随访时的完全闭塞率（87.3% vs 85.5%, P = 0.999）或良好结局（96.4% vs 94.5%, P = 0.999）均无显著差异。结论：与PED相比，经表面修饰的机械式球囊LFD具有更低的ISS率和可比较的围手术期结局、短期闭塞率和临床预后。LFD创新带来的优势需要通过长期随机对照试验进一步验证。
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.
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