Objective: To study the feasibility of domestic flow diverter(TFD) for the treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms. Methods: This is a retrospective case series study.The study retrospectively evaluated consecutive 54 patients with unruptured intracranial small- and medium-sized wide-neck aneurysms treated with TFD in the Department of Cerebrovascular Disease,the Second Affiliated Hospital of Kunming Medical University between October 2019 and January 2024. There were 11 males and 43 females, and the age of patients was (54.9±9.6) years (range:36 to 74 years). There were 63 aneurysms in 54 patients,6 of which were tandem multiple small aneurysms. One case had saccular aneurysms of bilateral internal carotid artery. The maximum diameter of aneurysm was (4.1±0.8) mm (range: 1.5 to 10.0 mm).The ratio of the maximum diameter of the aneurysm to the neck width diameter was 1.3±0.4 (range:0.4 to 2.4). The surgical and follow-up data were collected. The aneurysm embolization rate at the immediate operation and follow-up,and the complications were analyzed. The degree of aneurysm embolization was evaluated using the O'Kelly-Marotta (OKM) grading system,with OKM grade D as complete occlusion and grade C and above (C1,C2,C3 and D) as successful occlusion. Clinical outcomes of all patients were evaluated by modified Rankin scale(mRS). Results: For 63 aneurysms, 48 aneurysms were treated with TFD alone,and 15 aneurysms were treated with a combination of TFD and coiling. The immediate postoperative successful occlusion rate was 14.3% (9/63) and the complete occlusion rate was 3.2% (2/63). Follow-up results were obtained for all of the patients. The follow-up time (M(IQR)) was 124 (182) days (range: 85 to 754 days). The time to aneurysm successful occlusion was 140.5 (151.5) days (range: 85 to 308 days). At final follow-up,the successful aneurysm occlusion rate was 68.3% (43/63) and the complete occlusion rate was 58.7% (37/63). The complete occlusion rate of the TFD group was 50.0% (24/48) and the TFD+coiling group was 13/15. All patients had no aneurysm rupture,ischemic complications and no recurrence of the aneurysm needed to retreatment during the intraoperative and follow-up period. A total of 3 mild haemorrhagic complications which were related to dual-antiplatelet agents. Twelve patients had asymptomatic mild-moderate stent stenosis. TFD covered 66 branch vessels totally. Only 6 branches were affected by the time of the last follow-up and none of the patients had relevant ischaemic symptoms. All of 54 patients were evaluated as mRS score<2 points at the last follow-up. Conclusion: Using TFD to treat internal carotid artery unruptured small and medium-sized wide-neck aneurysms can simplify the surgical procedure with low complication rate, which is a clinically optional treatment approach.
目的： 探讨国产血流导向装置治疗颈内动脉未破裂中小型宽颈动脉瘤的可行性。 方法： 本研究为回顾性病例系列研究。回顾性分析2019年10月至2024年1月昆明医科大学第二附属医院脑血管病科连续收治的54例使用国产血流导向装置治疗的颈内动脉未破裂中小型宽颈动脉瘤患者的病历资料。男性11例，女性43例，年龄（54.9±9.6）岁（范围：36~74 岁）。54例患者共有63个动脉瘤，其中6例为串联多发小动脉瘤，1例为双侧颈内动脉囊状动脉瘤，动脉瘤最大径为（4.1±0.8）mm（范围：1.5~10.0 mm）；瘤体最大径与瘤颈宽径的比值为1.3±0.4（范围：0.4~2.4）。收集并分析患者手术情况，术后即刻及随访时的动脉瘤栓塞率，围手术期及随访期并发症情况等。采用O′Kelly-Marotta（OKM）分级系统评估动脉瘤栓塞程度，以动脉瘤OKM分级D级为完全闭塞，以C级或D级为成功闭塞；采用改良Rankin量表（mRS）评估临床功能结局。 结果： 54例患者的63个动脉瘤中，48个采用单纯植入血流导向装置治疗，15个采用血流导向装置联合弹簧圈栓塞治疗。术后即刻成功闭塞率为14.3%（9/63），完全闭塞率为3.2%（2/63）。所有患者获得随访，随访时间［M（IQR）］124（182）d（范围：85~754 d）。数字减影血管造影提示动脉瘤成功闭塞时间为140.5（151.5）d（范围：85~308 d）。末次随访时，动脉瘤成功闭塞率为68.3%（43/63），完全闭塞率为58.7%（37/63）。单纯植入血流导向装置动脉瘤的完全闭塞率为50.0%（24/48），血流导向装置联合弹簧圈栓塞治疗动脉瘤的完全闭塞率为13/15。所有患者未发生动脉瘤破裂、缺血相关并发症、动脉瘤复发再治疗等。3例患者发生与双联抗血小板药物相关轻微出血并发症；12例出现无症状性支架内轻-中度狭窄；血流导向装置累计覆盖分支血管66支，至末次随访时，共6支分支血管受累，均无临床症状。54例患者末次随访时mRS评分均<2分。 结论： 使用国产血流导向装置治疗颈内动脉未破裂宽颈中小型动脉瘤，能够简化手术过程，并发症发生率低，是临床可选的治疗方法。.