Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent-assisted coiling
Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent-assisted coiling
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DOI：
10.3171/2019.9.jns191733
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发表时间：
2021-01-01
影响因子：
4.1
通讯作者：
Chapot, Rene
中科院分区：
文献类型：
--
作者：
Aydin, Kubilay;Stracke, Christian Paul;Chapot, Rene
目的：复杂分叉部动脉瘤的血管内治疗仍然是一个外科挑战。双支架辅助弹簧圈栓塞技术，例如X和Y构型支架，可用于宽颈复杂颅内分叉部动脉瘤的血管内治疗。然而，X-和Y-支架中交叉点处的管腔内支柱不适于内皮化，这可能导致血栓栓塞并发症。T构型支架植入术是一种相对较新的双支架弹簧圈栓塞技术。T型支架植入术与X型或Y型支架植入术的不同之处在于没有重叠或交叉的支架段。最近报告了T型支架辅助弹簧圈栓塞术的有希望的短期结果。然而，长期效果尚未得到证实。本回顾性研究探讨了长期的血管造影和临床结果的患者与宽颈复杂的颅内分叉动脉瘤治疗T支架辅助coiling.METHODS进行了回顾性分析，以确定患者与宽颈复杂的颅内分叉动脉瘤治疗T支架辅助coiling在4个机构。评估了技术成功以及初始和随访临床和血管造影结局。根据Raymond分类评估动脉瘤充盈状态。对围手术期和迟发性并发症进行了审查。采用改良兰金量表（mRS）评价患者的神经功能状态。结果102例患者（54例女性）共102个动脉瘤，平均年龄57.9 ± 13.0岁。所有患者均成功行T型支架植入术。术后即刻血管造影显示83.3%的患者完全闭塞。围手术期并发症发生率为13.7%，导致永久性发病率为1.9%，死亡率为1%。80例患者（78.4%）在血管内手术后6个月或之后至少进行了一次随访DSA检查。血管造影随访的平均持续时间为30.0 ± 16.3个月。末次随访检查显示90.0%的患者完全闭塞。在随访期间，仅1例患者（1.3%）需要再次治疗。在4例患者（3.9%）中观察到迟发性血栓栓塞并发症，无永久性发病。所有患者末次临床随访时的mRS评分均在0 ~ 2分之间。结论短期血管造影结果显示T型支架辅助弹簧圈栓塞术是治疗宽颈复杂分叉部动脉瘤的一种可行且有效的血管内方法。长期血管造影随访结果表明，T型支架辅助弹簧圈栓塞术为宽颈复杂分叉部动脉瘤提供了持久的治疗方法，临床结局良好，证明了T型支架辅助弹簧圈栓塞术的长期安全性。
OBJECTIVE The endovascular treatment of complex bifurcation aneurysms possessing a neck that incorporates multiple side branches remains a surgical challenge. Double-stent-assisted coiling techniques, such as those with stents in an X and Y configuration, enable the endovascular treatment of wide-necked complex intracranial bifurcation aneurysms. However, the intraluminal struts at the intersection point in X- and Y-stents are not amenable to endothelialization, which may lead to thromboembolic complications. Stenting in the T configuration is a relatively new double-stent coiling technique. T-stenting differs from X- or Y-stenting in that there are no overlapping or intersecting stent segments. Promising short-term results of T-stent-assisted coiling were recently reported. However, the long-term results have not yet been demonstrated. This retrospective study investigated the long-term angiographic and clinical results in patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent-assisted coiling.METHODS A retrospective review was performed to identify patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent-assisted coiling at 4 institutions. The technical success and the initial and follow-up clinical and angiographic outcomes were assessed. Aneurysm filling status was assessed according to the Raymond classification. Periprocedural and delayed complications were reviewed. The neurological status of the patients was evaluated using the modified Rankin Scale (mRS).RESULTS One hundred two aneurysms in 102 patients (54 females), whose mean age was 57.9 +/- 13.0 years, were included in the study. T-stenting was performed successfully in all patients. Immediate postprocedural angiography revealed complete occlusion in 83.3% of patients. Periprocedural complications developed in 13.7%, resulting in permanent morbidity in 1.9% and death in 1%. Eighty patients (78.4%) had at least one follow-up DSA examination performed at 6 months or later following the endovascular procedure. The mean duration of angiographic follow-up was 30.0 +/- 16.3 months. The last follow-up examinations showed complete occlusion in 90.0% of patients. During the follow-up period, only 1 patient (1.3%) required retreatment. Delayed thromboembolic complications were observed in 4 patients (3.9%) without permanent morbidity. The mRS scores of all patients at the last clinical follow-up were between 0 and 2.CONCLUSIONS The short-term angiographic findings showed that T-stent-assisted coiling is a feasible and effective endovascular method to treat wide-necked complex bifurcation aneurysms. The long-term angiographic follow-up results suggest that T-stent-assisted coiling provides a durable treatment for wide-necked complex bifurcation aneurysms with favorable clinical outcomes, demonstrating the long-term safety of T-stent-assisted coiling.