A retrospective analysis of flow diverters therapy for large and giant unruptured intracranial aneurysms
血流导向装置治疗大型/巨大颅内未破裂动脉瘤的回顾性研究

摘要

目的 比较血流导向装置（Flow Diverters, FD）单独应用与联合弹簧圈填塞（Coil Embolization）治疗未破裂大型及巨大颅内动脉瘤的疗效与安全性，为临床治疗策略提供参考依据。方法 收集在深圳市第二人民医院2020年4月至2021年12月期间进行介入治疗的未破裂大型（10–24 mm）及巨大（≥25 mm）颅内动脉瘤患者资料。根据治疗方式分为两组：FD单独治疗组（FD组）与FD联合弹簧圈填塞治疗组（FD+Coil组）。收集患者的基础资料、动脉瘤形态、位置及手术时长相关参数，比较两组在影像学完全闭塞率、术中或术后5天内并发症的发生率、以及治疗后患者的预后情况。结果 共纳入30例患者，FD组19（63.3%）例，FD+Coil组11（36.7%）例。两组数据在基线临床资料特征方面及影像学相关参数方面差异无统计学意义（P>0.05）。围手术期及术后并发症的发生率FD+Coil组（27.3% ）略高于FD组（10.5%），但差异无统计学意义（P=0.327）。血流导向装置联合弹簧圈填塞（FD+Coil组）在即刻闭塞率方面显著优于血流导向装置（FD组）对比结果（81.8% vs 0%，P<0.001）。术中操作方面、在手术时长上二者有显著差异（Z=1.98,P=0.047）。在随访时间>6个月的中长期闭塞率方面二者无明显差异（P = 0.619）。在神经功能预后（P=0.537）、并发症发生率（p=0.327）等方面二者均无显著差异。结论 对于需要及时完全闭塞的动脉瘤应优先选择血流导向装置和弹簧圈联合治疗，中长期治疗效果二者并无明显差别。但联合治疗耗时更长、对于没有高需求马上闭塞的患者、耐受差或体质及全麻风险高的患者应首先考虑单独应用血流导向装置。

Abstract

Objective To compare the efficacy and safety of flow Diverters (FD) versus FD combined with coil embolization (FD+Coil) in the treatment of unruptured large and giant intracranial aneurysms, and to provide a reference for clinical.
Methods Data were collected from patients with unruptured large (10–24 mm) and giant (≥25 mm) intracranial aneurysms who underwent endovascular treatment at Shenzhen Second People’s Hospital between April 2020 and December 2021. Patients were divided into two groups based on the treatment strategy: FD group (FD) and FD combined with coil embolization group (FD+Coil). Baseline patient characteristics, aneurysm morphology and location, and procedure duration were recorded. The imaging-based complete occlusion rate, incidence of periprocedural or early (within 5 days) complications, and prognosis were compared between the two groups.
Results 30 patients were enrolled, with 19 (63.3%) in the FD group and 11 (36.7%) in the FD+Coil group. No statistically significant differences were observed between the groups in baseline characteristics or imaging parameters (P > 0.05). The incidence of periprocedural and early complications was slightly higher in the FD+Coil group (27.3%) than in the FD group (10.5%), but the difference was not statistically significant (P = 0.327). The FD+Coil group demonstrated a significantly higher immediate occlusion rate compared to the FD group (81.8% vs. 0%, P < 0.001). A significant difference in procedure duration was also observed (Z = 1.98, P = 0.047). no significant differences were found between the two groups in mid- to long-term occlusion rates at >6 months follow-up (P = 0.619), neurological outcomes (P = 0.537), or overall complication rates (P = 0.327).
Conclusion   FD combined with coil embolization should be preferred for aneurysms requiring immediate and complete occlusion. The mid- to long-term outcomes of the two treatment strategies are comparable. Given the longer procedure time and potential risks, FD may be more appropriate for patients who do not require urgent occlusion, or who have poor tolerance or high risk under general anesthesia.