| Background: Intracranial aneurysm(IA)is a relatively common clinical intracranial vascular disease.A stable aneurysm presents a static development with relatively low risk of growth and rupture,and may remain unruptured for life.However,an unstable unruptured aneurysm is like an untimely bomb that may rupture at any time,and the mortality rate of patients is extremely high,so the treatment of IA is of great concern to experts and scholars worldwide.For this reason,physicians from all over the world have been trying to find the best treatment for this disease in order to reduce the pain and financial burden caused by the disease.Today,after more than 20 years of development,the treatment of IA has gradually transitioned from craniotomy to minimally invasive endovascular treatment(including spring-ring tamponade,stent-assisted,flow-directed devices,etc.),and studies from various centers have shown that endovascular surgical treatment can effectively reduce postoperative complications and the recurrence rate of aneurysms.The most frequently used treatment for wide-necked and relatively widenecked intracranial aneurysms is various types of stent-assisted embolization,among which the braided stent represented by LEO was marketed earlier in China,and the laser engraved Atlas stent was approved for marketing in China in recent years and has been used in clinical practice for a relatively short period of time.Purpose: The purpose of this study is to apply statistical methods to analyze the clinical efficacy and prognosis of Neuroform Atlas and LEO stent-assisted occlusion of intracranial aneurysms,to summarize the experience of our physicians in treating these patients,to analyze the characteristics of the two types of stents in clinical practice,to accumulate experience for clinical surgeons in the selection of intraoperative stents,to improve the cure rate of patients,and to provide clinical data for reducing related complications.Methods: Retrospective analysis of 70 patients who visited Xianyang Hospital of Yan’an University in the last 5 years from December 2017 to December 2022 and had intracranial wide carotid aneurysms filled with Neuroform Atlas or LEO stents assisted by spring coils at the Interventional Catheterization Center of Cerebrovascular Hospital and met the inclusion criteria were divided into Atlas stent group(n=40)and LEO stent group(n=30)according to the choice of stent at the time of assisted filling.The baseline data of the patients were firstly analyzed and compared,and secondly,the immediate postoperative embolization,procedure-related complications,postoperative recovery(using the discharge mRS and 90-day mRS score scale as evaluation indexes),and length of hospital stay were compared between the two groups,and all data were statistically analyzed using SPSS 26.0 software.Results: The immediate postoperative angiography was performed to assess the aneurysm embolization.The postoperative grade Ⅰ embolization rate reached 62.5% in the Atlas stent group and 36.7% in the LEO stent group,and the difference in the degree of postoperative grade Ⅰ embolization was statistically significant when comparing the two groups of patients,P=0.032(P<0.05).The postoperative grade Ⅱ embolization rate was 30.0% in the Atlas stent group,and the postoperative grade Ⅲ embolization rate was 33.3%in the LEO stent group,P=0.142(P>0.05)when comparing the two groups,which means that the difference in the degree of postoperative grade Ⅱ embolization between the two groups was not statistically significant.There was no statistically significant difference in the degree of postoperative grade Ⅲ embolism between the patients.Comparing the mRS scores of the two groups at admission(Z=-0.548,P=0.584),there was no statistically significant difference in the overall condition of the two groups at admission.mRS scores at admission and discharge between patients in the Atlas stent group(P<0.001)and patients in the LEO stent group(P=0.022),the Pvalues for both groups were less than 0.05,indicating that the use of both stents was effective in the treatment of patients.In addition,the difference in good prognosis(mRS≤2)at 90 days after discharge was not statistically significant between the two groups(97.6% in the Atlas group vs.86.6% in the LEO group,P=0.104),and the rate of good prognosis was higher in both groups.In conclusion,it was shown that the treatment of intracranial wide carotid aneurysms with these two stents was effective and relatively safe.Comparison of length of hospitalization: The difference in the number of days of hospitalization between the two groups was not statistically significant(Z=-0.270,P=0.787).Comparison of procedure-related complications: the difference in intraoperative bleeding between the two groups of stented patients was not statistically significant(2.5%in the Atlas group vs.6.7% in the LEO group X~2=0.065,P=0.798);the difference in the occurrence of acute intraoperative in-stent thrombosis between the two groups was not statistically significant(0.0% in the Atlas group vs.3.3% in the LEO group X~2=0.021,P=0.884);the occurrence of postoperative ischemic stroke was lower in the Atlas group than in the LEO group in both groups,P<0.05,a statistically significant difference(2.5%in the Atlas group vs.16.7% in the LEO groupX~2=4.390,P=0.036);the overall complications related to surgery in both groups The overall complications related to surgery occurred less in the Atlas group than in the LEO group,P < 0.05,and the difference between the two groups was statistically significant(5.0% in the Atlas group vs 26.78% in the LEO group X~2=0.4.922,P = 0.027).Conclusion: Neuroform Atlas stents have a higher rate of aneurysm occlusion than LEO stents in the adjuvant treatment of intracranial wide carotid aneurysms;Postoperative ischemic stroke events were higher in the LEO stent group than in the Neuroform Atlas stent group,so aggressive antithrombotic therapy is needed with LEO stents to minimize embolic events.Similar clinical prognosis,90-day post-discharge mRS scores,and length of hospital stay before and after Neuroform Atlas and LEO stent-assisted treatment of intracranial wide carotid aneurysms;Overall,both Neuroform Atlas and LEO stents were safe and effective for the treatment of intracranial wide carotid aneurysms,but patients in the Neuroform Atlas group had lower surgical complications and higher rates of immediate postoperative aneurysm embolization,so the Neuroform Atlas stent was more recommended when faced with the choice between the two stents in clinical practice. |
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