Background:We compared the treatment of small unruptured intracranial aneurysms(UIAs)with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil pack...Background:We compared the treatment of small unruptured intracranial aneurysms(UIAs)with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment.Methods:Fifty-one UIAs in 51 patients treated with pipeline embolization device(PED)were included in this study and defined as the PED group.We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent,which were defined as the LVIS group.Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS.Clinical analysis was also performed between these two groups after the match.Results:There was no difference in procedural complications between the two groups(P=0.558).At the first angiographic follow-up,the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group(98.0%vs.82.4%,P=0.027).However,during the further angiographic follow-up,the complete occlusion rate in the PED group achieved 100%,which was higher than that in the LVIS group(98.0%).Compared with the LVIS group after treatment,cases in the PED group showed a higher value of velocity in the aneurysm(0.03±0.09 vs.0.01±0.01,P=0.037)and WSS on the aneurysm(2.32±5.40 vs.0.33±0.47,P=0.011).Consequently,the reduction ratios of these two parameters also showed statistical differences.These parameters in the LVIS group showed much higher reduction ratios.However,the reduction ratio of the velocity on the neck plane was comparable between two groups.Conclusions:Both LVIS and PED were safe and effective for the treatment of small UIAs.However,LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED.The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.展开更多
Background:Giant serpentine aneurysms(GSA)originate from saccular or spindle aneurysm,dissimilar from dissected aneurysm,that are defined as partially thrombosed giant aneurysms with tortuous internal vascular channel...Background:Giant serpentine aneurysms(GSA)originate from saccular or spindle aneurysm,dissimilar from dissected aneurysm,that are defined as partially thrombosed giant aneurysms with tortuous internal vascular channel.The clinical and neuroradiologic characteristics are clarified and the mechanism of formation and the efficacy of double stent implantation in GSA are discussed.Case presentation:An 18-year-old man presented himself with a GSA arising from the internal cerebral artery(ICA).In addition,a mandibular aneurysm(MA)arose from the external cerebral artery(ECA).Success was achieved in treating GSA through endovascular treatment with double stents implanted in the parent artery,which were LEO stent and Tubridge flow diverter.After 1 year of follow-up,three-dimensional reconstruction of blood vessels revealed the disappearance of the serpentine access of GSA,which was found to be replaced with a roughly normal vascular structure.Conclusions:Double stent implantation has provided a feasible treatment option for giant serpentine internal carotid aneurysms and eliminated the possibility of causing collateral circulation occlusion.Therefore,it represents a simple and suitable treatment method for anatomical structure and operation.展开更多
基金This work was supported by the National Natural Science Foundation of China(grant numbers: 81801156, 81801158 and 82072036)Beijing Hospitals Authority Youth Programme(code: QML20190503)
文摘Background:We compared the treatment of small unruptured intracranial aneurysms(UIAs)with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment.Methods:Fifty-one UIAs in 51 patients treated with pipeline embolization device(PED)were included in this study and defined as the PED group.We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent,which were defined as the LVIS group.Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS.Clinical analysis was also performed between these two groups after the match.Results:There was no difference in procedural complications between the two groups(P=0.558).At the first angiographic follow-up,the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group(98.0%vs.82.4%,P=0.027).However,during the further angiographic follow-up,the complete occlusion rate in the PED group achieved 100%,which was higher than that in the LVIS group(98.0%).Compared with the LVIS group after treatment,cases in the PED group showed a higher value of velocity in the aneurysm(0.03±0.09 vs.0.01±0.01,P=0.037)and WSS on the aneurysm(2.32±5.40 vs.0.33±0.47,P=0.011).Consequently,the reduction ratios of these two parameters also showed statistical differences.These parameters in the LVIS group showed much higher reduction ratios.However,the reduction ratio of the velocity on the neck plane was comparable between two groups.Conclusions:Both LVIS and PED were safe and effective for the treatment of small UIAs.However,LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED.The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.
文摘Background:Giant serpentine aneurysms(GSA)originate from saccular or spindle aneurysm,dissimilar from dissected aneurysm,that are defined as partially thrombosed giant aneurysms with tortuous internal vascular channel.The clinical and neuroradiologic characteristics are clarified and the mechanism of formation and the efficacy of double stent implantation in GSA are discussed.Case presentation:An 18-year-old man presented himself with a GSA arising from the internal cerebral artery(ICA).In addition,a mandibular aneurysm(MA)arose from the external cerebral artery(ECA).Success was achieved in treating GSA through endovascular treatment with double stents implanted in the parent artery,which were LEO stent and Tubridge flow diverter.After 1 year of follow-up,three-dimensional reconstruction of blood vessels revealed the disappearance of the serpentine access of GSA,which was found to be replaced with a roughly normal vascular structure.Conclusions:Double stent implantation has provided a feasible treatment option for giant serpentine internal carotid aneurysms and eliminated the possibility of causing collateral circulation occlusion.Therefore,it represents a simple and suitable treatment method for anatomical structure and operation.
