| Background and Purpose:Flow diverter(FD)has gained widespread acceptance in treating intracranial aneurysms.However,during the follow-up period,there still some aneurysms remained incomplete occluded.Our study aims to explore the risk factors that influence the complete occlusion of intracranial aneurysms after treatment with FD,and provide a theoretical basis for improving the complete occlusion rate of intracranial aneurysms.Methods:Between February 2015 to October 2020,patients who were treated with FD at Zhengzhou University People’s Hospital were retrospectively enrolled in our study.Patient and aneurysm baseline characteristics,procedure characteristics,packing density,inflow angle of aneurysm before and after procedure were collected.At 6-month imaging follow-up,the O’Kelly-Marotta(OKM)grading scale was used to evaluate the occlusion of aneurysm.The differences of the indexes between the aneurysm complete occlusion group and the in-complete occlusion group were compared.Multivariate logistic regression was used to analyze the related factors that influence the complete occlusion of aneurysms,and the Receiver Operating characteristic Curve(ROC curve)was used to analyze the predictive ability of related factors for complete occlusion of aneurysm.Results:A total of 354 patients harboring 451 aneurysms were enrolled,and the successful procedure rate was 100%.The post-procedure complication rated was 5.9%(21/354),with the modified Rankin scale(m RS)score ≤ 2 of 98.1%.A total of 226 patients with286 aneurysms underwent the imaging follow-up at the 6th month after procedure,of which 73.8%(211/286)of aneurysms showed complete occlusion(Grade D of OKM grading scale),7.7%(22/286)showed aneurysm neck remnant(Grade C of OKM grading scale),and 18.5%(53/286)showed incomplete occlusion(Grade B of OKM grading scale).Of the 286 aneurysms which have underwent the imaging follow-up,72 aneurysms have obtained the adjunctive coiling,with the median packing density of11.0%(7.1%,15.6%),and the complete occlusion rate was 83.3%(60/72).In the whole cohort,the multivariate logistic regression analysis showed adjunctive coiling,blood flow detained to venous phase were significant predictors of aneurysm occlusion,with the OR of 3.71[95% Confidence Interval(95% CI): 1.50 ～9.18,P=0.005],2.10(95% CI: 1.15 ～ 3.82,P = 0.015),respectively.Age ≥ 60,incorporation of a branch vessel,and aneurysm maximal diameter ≥ 15 mm were associated with incomplete occlusion,with the OR of 0.39(95% CI: 0.21～0.72,P =0.002),0.17(95% CI: 0.06 ～ 0.43,P < 0.001),0.27(95% CI: 0.11 ～ 0.69,P = 0.007),respectively.In the saccular aneurysm cohort,the mean inflow angle was decreased from 108.67° ± 24.32° to 101.02° ± 22.72°(P = 0.002)before and after procedure.The multivariate logistic regression analysis showed the reduction of the inflow angle was a significant predictor of aneurysm occlusion(OR = 1.09,95% CI: 1.04 ～ 1.15,P =0.001).Further ROC curve analysis showed that the reduction of the inflow angle before and after procedure,and the coil packing density have certain predictive values for the complete occlusion of the aneurysm.The area under ROC curve and the cut-off value was 0.819,0.774,and 6.65°,6.60%,respectively,with the sensitivity and specificity of60.7%,86.7% and 90.7%,58.3%,respectively.Conclusion:The treatment of FD combined coiling and blood flow detained to venous phase after FD implant were associated with complete aneurysmal occlusion,while age ≥ 60,incorporation of a branch vessel,and aneurysm maximal diameter ≥ 15 mm were associated with incomplete occlusion.The implantation of FD could change the inflow angle of the saccular aneurysms,and the degree of the reduction of the inflow angle was related to the complete occlusion of the aneurysm during the 6-month follow-up. |
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