The Retrospective Analysis Of Domestic Flow Diverter Tubridge In The Treatment Of Intracranial Aneurysms

Objective: To explore the efficacy and safety of domestic flow diverter Tubridge in the treatment of intracranial aneurysms in our center,and summarize the treatment experience.Secondly,four-dimensional flow MRI(4D flow MRI)was used to preliminary explore the hemodynamic changes before and after Tubridge implantation.Methods: From November 2018 to July 2021,collected the basic information,imaging data,and adverse events during the perioperative period of all patients who received domestic flow diverter Tubridge in the Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University.The follow-up date was up to January 2022.The 4D flow MRI was used to collect hemodynamic data of some patients with intracranial aneurysms treated with Tubridge.Imaging follow-up was conducted at 3,6,12,and 24 months after surgery.The occlusion of aneurysms was evaluated by O’Kelly Marotta(OKM)grading.Telephone follow-up was conducted at 3,6,12,24,and 36 months after surgery.The prognosis of patients was evaluated by the modified Rankin Scale(m RS).The influencing factors of intracranial aneurysm occlusion were analyzed by relevant statistical analysis methods.including 16 males(32.7%)and 33 females(67.3%),aged from 18 to 78 years,with an average age of 56.7 ± 9.4 years.There were 46 internal carotid artery aneurysms(80.7%),3 middle cerebral artery aneurysms(5.3%),and 8 vertebral artery aneurysms(14.0%).There were 27 small or medium-sized aneurysms(47.4%),29 large aneurysms(50.9%),and 1giant aneurysm(1.7%).A total of 53 Tubridge were implanted in 49 patients,including 4 patients with 2 Tubridge and the rest with 1Tubridge.21 patients(42.9%)were treated with Tubridge alone,and the other 28 patients(57.1%)were treated with Tubridge + coil.Nine patients had perioperative adverse events,of which 3 patients(6.1%)had ischemic complications,2 patients had contralateral limb dysfunction,and 1 patient had transient syncope.Another patient(2.0%)had a femoral artery pseudoaneurysm.Before and after surgery,the 4D flow MRI examination was performed on 5 patients who used Tubridge + coil.It was found that the flow velocity,wall shear stress(WSS)and streamline were significantly lower.38 patients(44 aneurysms)completed imaging follow-up.Among them,29 patients(35 aneurysms)were followed up by Digital subtraction angiography(DSA).The median follow-up time was12 months.30 aneurysms(85.7%,30/35)were completely occluded,and5 aneurysms(14.3%,5/35)were not completely occluded.And 5 patients(13.2%,5/38)had different degrees of stenosis of the parent artery without obvious symptoms.41 patients were followed up by telephone,and the mean follow-up time was 19.4 ± 8.4 months.The symptoms ofResults: A total of 49 patients(57 aneurysms)were included,the patients were significantly improved(P < 0.001),and the two patients with postoperative limb dysfunction were significantly improved.Univariate analysis showed that the follow-up time(P = 0.005)was the factor affecting the complete occlusion of aneurysms.It is suggested that there is a certain relationship between the follow-up time and the degree of intracranial aneurysm.Conclusion: 1.The follow-up results of digital subtraction angiography in this study showed that the complete occlusion rate of domestic flow diverter Tubridge in the treatment of intracranial aneurysms was 85.7%,and the incidence of postoperative stroke-related complications was 6.1%,and the curative effect is significant.Tubridge or Tubridge + coil may be a safe and effective method for the treatment of intracranial aneurysms.2.The follow-up results of this study show that the follow-up time may be one of the factors affecting the complete occlusion of intracranial aneurysms,suggesting that the follow-up time of invasive angiography should be properly grasped.3.This study suggests that 4D flow MRI can judge qualitatively the hemodynamic changes of domestic flow diverter Tubridge and evaluate its efficacy.However,future research should design prospective,multicenter randomized control and long-term follow-up to further verify the effect of 4D flow MRI in Tubridge.