Purpose

Some aneurysms remain patent after treatment with flow diverters (FD) due to residual blood flow in the aneurysm. Several studies have proposed that branches and residual flow are associated with delayed aneurysm occlusion. We propose that aneurysm isolation (i.e., the complete disconnection of the aneurysm from surrounding vessels) might be a possible factor facilitating aneurysm occlusion. This study aimed to determine if aneurysm isolation was a factor associated with aneurysm occlusion after FD treatment.

Methods

We reviewed 80 internal carotid artery (ICA) aneurysms treated with FDs between October 2014 and April 2021. Aneurysm isolation was assessed in high-resolution cone-beam computed tomograms at the end of each treatment. Aneurysms with incorporated branches and those with connections to other branches due to stent malapposition were deemed to be nonisolated. Other factors, such as patient age, sex, anticoagulant use, aneurysm size, adjunct coil use, and the presence of incorporated branches, were considered. The degree of aneurysm occlusion (complete or incomplete) was assessed by follow-up angiograms 12 months after treatment.

Results

Complete occlusion was achieved in 57 of 80 aneurysms (71%). Completely occluded aneurysms had a significantly higher ratio of isolation compared to incompletely occluded aneurysms (91.2% vs. 69.6%, P = 0.032). Multivariate logistic regression analysis showed that aneurysm isolation was the sole significant predictor of complete aneurysm occlusion (odds ratio, OR 19.38; 95% confidence interval, CI 2.280–164.657; P = 0.007).

Conclusion

Aneurysm isolation is a significant factor contributing to complete occlusion after FD treatment.

中文翻译：

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动脉瘤隔离与分流器治疗后动脉瘤完全闭塞相关

目的

由于动脉瘤中残留血流，一些动脉瘤在使用分流器 (FD) 治疗后仍然处于明显状态。多项研究提出，分支和残余血流与延迟性动脉瘤闭塞有关。我们认为动脉瘤隔离（即动脉瘤与周围血管完全断开）可能是促进动脉瘤闭塞的一个可能因素。本研究旨在确定动脉瘤隔离是否是 FD 治疗后动脉瘤闭塞的相关因素。

方法

我们回顾了 2014 年 10 月至 2021 年 4 月期间使用 FD 治疗的 80 例颈内动脉 (ICA) 动脉瘤。在每次治疗结束时，通过高分辨率锥形束计算机断层扫描评估动脉瘤的隔离情况。具有合并分支的动脉瘤和由于支架贴壁不良而与其他分支相连的动脉瘤被认为是非孤立的。还考虑了其​​他因素，例如患者年龄、性别、抗凝剂的使用、动脉瘤大小、辅助弹簧圈的使用以及合并分支的存在。治疗后 12 个月通过随访血管造影评估动脉瘤闭塞程度（完全或不完全）。

结果

80 个动脉瘤中有 57 个（71%）实现了完全闭塞。与不完全闭塞的动脉瘤相比，完全闭塞的动脉瘤的隔离率显着更高（91.2% vs. 69.6%，P  = 0.032）。多变量逻辑回归分析显示，动脉瘤隔离是动脉瘤完全闭塞的唯一显着预测因子（比值比，OR 19.38；95% 置信区间，CI 2.280–164.657；P  = 0.007）。

结论

动脉瘤隔离是 FD 治疗后导致完全闭塞的重要因素。