Clinical Study Of Flow Diverter In The Treatment Of Posterior Circulation Aneurysms

Background and purposeIntracranial posterior circulation aneurysms account for about 3.8%-15%of intracranial aneurysms,and have higher risk of rupture,disability and mortality than anterior circulation aneurysms.The treatment methods of intracranial aneurysms are mainly divided into surgery and intravascular interventional therapy.For posterior circulation aneurysms,due to the complex local neurovascular anatomy,it is difficult to expose the aneurysms in traditional surgery,which lead a high incidence of postoperative complications.Intravascular interventional therapy has become the mainstream treatment method.In recent years,as a new intravascular stent,the flow diverter has higher metal coverage than the traditional stent.The metal coverage of FD is at the same level as the traditional stent assisted coil embolization at the tumor neck.Due to its low porosity,it can reconstruct the hemodynamics of the aneurysm carrying artery and reduce the pressure in the aneurysm capsule,At the same time,the high metal coverage can provide the attachment position for endothelial cells to endothelialization,so as to promote the healing of aneurysms.In the treatment of anterior circulation aneurysms,FD has achieved high aneurysm occlusion rate,low complication rate and aneurysm recurrence rate.For posterior circulation aneurysms,the traditional intravascular interventional therapy has some problems,such as the involvement of branches near the aneurysm and the non-dense embolization of the aneurysm,resulting in a high recurrence rate and high incidence of complications.And aneurysm embolization can’t relieve the mass effect of the aneurysm,which is particularly prominent on the premise that the limited space and important neural tissue in the posterior fossa.Therefore,the treatment of posterior circulation aneurysms with FD may make up for the shortcomings of traditional interventional methods,but there are few studies on the application of FD in posterior circulation aneurysms.Therefore,this study retrospectively analyzed the clinical data of patients with posterior circulation aneurysms treated with blood flow guidance device in our center,in order to explore the safety and effectiveness of FD in the treatment of posterior circulation aneurysms,and explore the relevant factors affecting the complete healing of aneurysms.Materials and MethodsThe patients with posterior circulation aneurysms treated with FD were retrospectively collected during January 2014 to October 2021 in the First Affiliated Hospital of Zhengzhou University.According to the location of aneurysms,the medical records were divided into vertebral artery group and basilar artery group.On the basis of this grouping and the number of FD used through surgery,the patients were divided into single stent group,multi stent group.Collect the clinical data of patients in the basilar artery multi stent group,and compare the differences in safety,effectiveness and clinical prognosis between each group and subgroups.In addition,the factors affecting the complete healing of aneurysms were analyzed by single factor and multi factor analysis.ResultsA total of 81 patients with posterior circulation aneurysms were included.The age is 20-77 years old.The incidence of ischemic events was 11.11%,the incidence of hemorrhagic events was 3.70%,the mortality was 4.94%,and the good prognosis was 92.59%.The median follow-up time was 7 months,and the complete healing rate was 67.53%.The incidence of ischemic events was 4.08%(single stent group vs multi stent group,5%vs0,P>0.05),the incidence of hemorrhagic events was 2.04%(single stent group vs multi stent group,2.05%vs0,P>0.05),the mortality was 2.04%(single stent group vs multi stent group,2.50%vs0,P>0.05),and the good prognosis was 97.96%(single stent group vs multi stent group,97.50%VS 100%,P>0.05),The complete healing rate was 66.67%(single stent group vs multiple stent group,66.67%vs 66.67%,P>0.05).The incidence of ischemic events was 21.88%(single stent group vs multi stent group,12%vs 57.14%,P<0.05),the incidence of hemorrhagic events was 6.25%(single stent group vs multi stent group,4%vs 14.29%,P>0.05),the mortality was 9.38%(single stent group vs multi stent group,0 vs 42.86%,P<0.05),and the good prognosis was 84.38%(single stent group vs multi stent group,100%vs 28.57%,P<0.05),The complete healing rate was 68.97%(single stent group vs multi stent group,72%vs 50%,P>0.05).Univariate analysis showed that combined coil(P=0.015)was a predictor of complete aneurysm healing.Multivariate analysis showed that combined coil(P=0.018)was a predictor of complete aneurysm healing.Conclusions1.The incidence of perioperative ischemic complications in basilar artery group was higher than that in vertebral artery group.In the treatment of basilar artery aneurysms with flow diverter,the application of multiple flow diverter will increase the incidence of ischemic complications,mortality and poor prognosis.2.Flow diverter combined with spring coil could promote the complete healing of posterior circulation aneurysms.3.The use of flow diverter in the treatment of posterior circulation aneurysms has a high complete healing rate and a certain incidence of complications.