| Objective: To investigate the short-mid-term outcomes of intracranial aneurysms with PED flow diversion.Methods: A total of 55 patients with 62 aneurysms were retrospectively reviewed in this research,whose clinical data were evaluated and then classified according to the modified Rankin scale(mRS).Aneurysms whose maximal diameter ranging from 1.5 to 26.0 1(6.1±5.7)mm including 10(16.1%)large or giant aneurysms,1(1.6%)basilar aneurysm,9(14.5%)vertebral aneurysms with 1(1.6%)of which were demonstrated at the extracranial vertebral,were treated with flow diversions.The outcomes of the aneurysms were evaluated in term of Raymond-Roy classification and the extent of intimal hyperplasia.Statistical methods were used to analyze the related factors of anterior ischemic complications,outcomes of the aneurysms and the extent of intimal hyperplasia.Results:(1)55 PEDs were all successfully implanted into 55 patients,making the treatment success rate up to 100%.32 patients with whose 37 aneurysms were treated simply with PED alone.21 patients with whose 23 aneurysms were treated by PEDs with the addition of coil embolization.2 patient with whose 2 aneurysms were first coiled,and then implanted with PEDs in their second phase of treatment.(2)39 patients with whose 46 aneurysms accomplished their imaging-follow-up.39(39/46,84.5%)aneurysms achieved complete occlusion,including 4 occurred intimal hyperplasia.There was significant difference in Raymond-Roy classification and the extent of intimal hyperplasia between saccular and nonsaccular aneurysms as well as anterior and posterior aneurysms.There was no statistic difference in RaymondRoy classification and the extent of intimal hyperplasia between groups of various follow-up times.(3)Periprocedural complications were observed in 10(18.2%)patients,including 5 patients with major complications(mRS≥2).Death was consequently observed in 2 patients,one of which died of acute subarachnoid hemorrhage,and the other died of intraparenchymal hemorrhage.Late complications were observed in 2(2/53,3.8%)patients,one of whom consequently died of acute subarachnoid hemorrhage.There was no statistic discrepancy in the occurrence of anterior ischemic complications between different blood pressure levels,whether branches were covered by flow diversions.(4)6 patients with large aneurysms,2 patients with giant aneurysms were contained in this research.The average maximal diameter is 20.16 mm.Periprocedural death was met in 1(12.5%)patient,along with 1 patient with mild periprocedural complication.Late post-procedural death was observed in 1(1/7,14.2%)patient.With an average followup time of 5.6 months,complete occlusion(RRC Ⅰ)was achieved in 4(4/5,80.0%)patients along with near-complete occlusion(RRC Ⅱ)in 1(1/5,20.0%)patient.(5)None Periprocedural complication or Late post-procedural was observed in 9 patients with intracranial vertebral aneurysms.All posterior inferior cerebral arteries maintained patent in 4 patients whose PICAs were covered by flow diversions.(6)1 patient whose aneurysm was demonstrated in V3 segment of extracranial vertebral artery observed moderate in-PED stenosis 3 months after procedure with no clinical symptom.The patency was confirmed during at the 12 months follow-up.Conclusion: These results suggest that PED flow diversion performs a high rate of complete occlusion,low morbidity rate,and low fatality rate.Aneurysms located at the posterior circulation and the nonsaccular shape may be factors of Raymond-Roy classification and the extent of intimal hyperplasia.A safer treatment still needs to be found,as flow diversion with the addition of coil showed a high mortality rate in large/giant aneurysms.The use of flow diversion in extracranial vertebral aneurysm needs comprehensive consideration. |
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