Background:We compared the treatment of small unruptured intracranial aneurysms(UIAs)with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil pack...Background:We compared the treatment of small unruptured intracranial aneurysms(UIAs)with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment.Methods:Fifty-one UIAs in 51 patients treated with pipeline embolization device(PED)were included in this study and defined as the PED group.We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent,which were defined as the LVIS group.Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS.Clinical analysis was also performed between these two groups after the match.Results:There was no difference in procedural complications between the two groups(P=0.558).At the first angiographic follow-up,the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group(98.0%vs.82.4%,P=0.027).However,during the further angiographic follow-up,the complete occlusion rate in the PED group achieved 100%,which was higher than that in the LVIS group(98.0%).Compared with the LVIS group after treatment,cases in the PED group showed a higher value of velocity in the aneurysm(0.03±0.09 vs.0.01±0.01,P=0.037)and WSS on the aneurysm(2.32±5.40 vs.0.33±0.47,P=0.011).Consequently,the reduction ratios of these two parameters also showed statistical differences.These parameters in the LVIS group showed much higher reduction ratios.However,the reduction ratio of the velocity on the neck plane was comparable between two groups.Conclusions:Both LVIS and PED were safe and effective for the treatment of small UIAs.However,LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED.The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.展开更多
目的总结血管内栓塞治疗颅内微小动脉瘤的效果与技术经验。方法回顾分析经血管内栓塞治疗25例(计29枚)颅内微小动脉瘤(瘤体最大长径:2～3 mm 15枚、1.6～1.9 mm 14枚),其中单纯弹簧圈栓塞10枚,球囊辅助栓塞10枚,支架辅助栓塞7枚,单纯支...目的总结血管内栓塞治疗颅内微小动脉瘤的效果与技术经验。方法回顾分析经血管内栓塞治疗25例(计29枚)颅内微小动脉瘤(瘤体最大长径:2～3 mm 15枚、1.6～1.9 mm 14枚),其中单纯弹簧圈栓塞10枚,球囊辅助栓塞10枚,支架辅助栓塞7枚,单纯支架覆盖瘤颈2枚。结果29枚动脉瘤术后即刻致密栓塞13枚,占44.8%。出院时按改良GOS评分评估预后,25例患者中恢复正常18例、良好2例、一般2例、差1例、死亡2例。23例患者随访6个月～4年,无再出血病例;19例(21枚动脉瘤)复查造影,其中2例(2枚)复发(给予补充致密栓塞),2例(2枚)行单纯支架覆盖瘤颈的患者见动脉瘤已闭塞。结论血管内治疗微小动脉瘤安全有效,微导管头端合理塑形与技术操作规范是治疗成功的关键。展开更多
基金This work was supported by the National Natural Science Foundation of China(grant numbers: 81801156, 81801158 and 82072036)Beijing Hospitals Authority Youth Programme(code: QML20190503)
文摘Background:We compared the treatment of small unruptured intracranial aneurysms(UIAs)with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment.Methods:Fifty-one UIAs in 51 patients treated with pipeline embolization device(PED)were included in this study and defined as the PED group.We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent,which were defined as the LVIS group.Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS.Clinical analysis was also performed between these two groups after the match.Results:There was no difference in procedural complications between the two groups(P=0.558).At the first angiographic follow-up,the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group(98.0%vs.82.4%,P=0.027).However,during the further angiographic follow-up,the complete occlusion rate in the PED group achieved 100%,which was higher than that in the LVIS group(98.0%).Compared with the LVIS group after treatment,cases in the PED group showed a higher value of velocity in the aneurysm(0.03±0.09 vs.0.01±0.01,P=0.037)and WSS on the aneurysm(2.32±5.40 vs.0.33±0.47,P=0.011).Consequently,the reduction ratios of these two parameters also showed statistical differences.These parameters in the LVIS group showed much higher reduction ratios.However,the reduction ratio of the velocity on the neck plane was comparable between two groups.Conclusions:Both LVIS and PED were safe and effective for the treatment of small UIAs.However,LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED.The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.
文摘目的总结血管内栓塞治疗颅内微小动脉瘤的效果与技术经验。方法回顾分析经血管内栓塞治疗25例(计29枚)颅内微小动脉瘤(瘤体最大长径:2～3 mm 15枚、1.6～1.9 mm 14枚),其中单纯弹簧圈栓塞10枚,球囊辅助栓塞10枚,支架辅助栓塞7枚,单纯支架覆盖瘤颈2枚。结果29枚动脉瘤术后即刻致密栓塞13枚,占44.8%。出院时按改良GOS评分评估预后,25例患者中恢复正常18例、良好2例、一般2例、差1例、死亡2例。23例患者随访6个月～4年,无再出血病例;19例(21枚动脉瘤)复查造影,其中2例(2枚)复发(给予补充致密栓塞),2例(2枚)行单纯支架覆盖瘤颈的患者见动脉瘤已闭塞。结论血管内治疗微小动脉瘤安全有效,微导管头端合理塑形与技术操作规范是治疗成功的关键。
