Application of flow diversion devices in the interventional treatment of complex intracranial aneurysms
Zhao Yang1, Jin Weitao1, Zhao Yuanli1, Liu Aihua2
1Department of Neurosurgery, Peking University International Hospital, Beijing 102206, China; 2Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Abstract：Objective To preliminarily explore the application value of flow-diversion devices (FD) in the interventional treatment of complex intracranial aneurysms.Methods The clinical data of 89 patients who were admitted at our institution from March 2016 to May 2020 were collected and retrospectively analyzed. The subjects comprised 34 males and 55 females, aged 28-75 (average 53.08) years. All the patients were diagnosed with complex intracranial aneurysm by digital subtraction angiography (DSA) before surgery. Among all the patients, 45 patients had large or giant aneurysm, 4 patients had microaneurysm, 25 patients had dissecting aneurysm, 1 patient had fusiform aneurysm, and 14 patients had tandem multiple aneurysm. The patients received FD alone or in combination with coil embolization. Embolization rate and modified Rankin Scale (mRS) score were observed immediately after surgery and during follow-up.Results Among the 89 patients, 56 were treated with FD and 33 were treated with FD with coil embolization. All FDs were successfully inserted. DSA showed that the stent was in good position and blood flow in the tumor lumen was retained. Embolization degree was classified using the O'Kelly-Marotta (OKM) scale. Based on the OKM scale, 68 cases(63.0%) were grade A, 39 cases (36.1%) were grade B, and 1 case (0.9%) was grade C. Ten patients suffered from ischemic complications, one died from ischemic complication, and two had hemorrhagic complications. The mRS scores were 0 in 25 cases, 1 in 57 cases, 2 in 4 cases, 3 in 1 case, 5 in 1 case, and 6 in 1 case. Eighty patients were followed up for 7 days to 20 months with an average of 12.4 months. During the follow-up period, one patient with massive gastrointestinal hemorrhage died of secondary pulmonary infection, and one patient died of unknown cause, which was considered aneurysm rebleeding. The mRS scores in the last follow-up were 0 in 39 cases, 1 in 37 cases, 2 in 2 cases, and 6 in 2 cases. Forty-eight patients underwent imaging examination 6-12 months after surgery. The stents were in good position, without movement. No stenosis was observed inside the stent. Based on the OKM scale, 33 aneurysms were grade D, 7 aneurysms were grade C, and 8 aneurysms were grade B. No aneurysm recurred during follow-up.Conclusions FD is a safe and effective treatment for complex intracranial aneurysms with high cure rate and low complication rate.
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Zhao Yang, Jin Weitao, Zhao Yuanli, Liu Aihua. Application of flow diversion devices in the interventional treatment of complex intracranial aneurysms. Chinese Journal of Anatomy and Clinics, 2021, 26(3): 271-276.
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2021, Vol. 26 
