Preliminary experience of application of flow diverter devices in the treatment of intracranial aneurysms complicated with moderate to severe stenosis of adjacent arteries
Objective To investigate the safety and efficacy of flow diverter(FD)devices in the treatment of intracranial aneurysms complicated with moderate to severe stenosis of adjacent arteries.Methods A retrospective analysis was conducted on the clinical data of 40 patients(with 42 aneurysms)with cerebral aneurysms complicated with moderate to severe stenosis of adjacent arteries at the Department of Neurointerventional Radiology,the First Affiliated Hospital of Zhengzhou University from July 2019 to November 2023.All patients underwent FD placement and percutaneous transluminal angioplasty with balloon dilation was performed on the stenotic adjacent arteries.The immediate embolization of the aneurysms was assessed using the O'Kelly-Marotta(OKM)grading scale,and surgery-related complications were documented.Regular telephone follow-ups were conducted to evaluate the improvement of clinical symptoms using the modified Rankin Scale(mRS).Imaging follow-up was performed to assess aneurysm embolization using the OKM grading scale and to check for the presence of in-stent stenosis(ISS).Results A total of 42 aneurysms were treated with 41 FDs,with no procedure-related complications.The immediate OKM grading showed 8 aneurysms(19.0％)of Grade A,23(54.8％)of Grade B,8(19.0％)of Grade C,and 3(7.2％)of Grade D.Perioperative complications occurred in 4 patients(10.0％),including 1 death,1 case of cerebral hemorrhage,and 2 cases of cerebral infarction.Follow-up was conducted for 39 patients(97.5％)at 3 months after discharge.The patients who experienced perioperative complications of cerebral hemorrhage and cerebral infarction had an mRS score of 0.Two patients with previous cerebral infarction had an mRS score of 1,while the remaining 34 patients had an mRS score of 0.At the 6-month follow-up,32 patients(80.0％)were evaluated.The mRS score of 2 patients with previous cerebral infarction remained at 1,and the remaining 30 patients had an mRS score of 0.Radiological follow-up was completed for 32 patients(with 34 aneurysms)with the follow-up duration[M(Q1,Q3)]of 6(6,10)months.The OKM grading showed 3 aneurysms(8.8％)of Grade A,5(14.7％)of Grade B,4(11.8％)of Grade C,and 22(64.7％)of Grade D.Mild in-stent stenosis(ISS)was observed in 8 cases(25.0％),and severe ISS was noted in 8 cases(25.0％).Conclusions Preliminary observations indicate that using FD devices to treat intracranial aneurysms with moderate to severe stenosis of adjacent arteries is effective and has an acceptable safety profile.However,the incidence of ISS and ischemic complications during the follow-up period warrants further investigation.
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