METHODS: Retrospective analysis of aneurysms in the terminal ICA treated with FD from 2013 to 2023 at a single-center study. Procedures were classified according to the coverage at the origin of the ACA and compared through bivariate-analysis. A review was also carried on PubMed, Web of Science, and EMBASE until April 2024, adhering to the PRISMA reporting guidelines.
RESULTS: Ninety-five patients harboring 113 aneurysms treated in 102 procedures were evaluated. Fifty-eight were treated covering the ACA origin. Dual antiplatelet regimens included aspirin-clopidogrel (50%), aspirin-ticagrelor (44.1%), and aspirin-prasugrel (4.9%). Thromboembolic events occurred in 6 patients (5.9%), all of which presented with large vessel occlusion of the ICA, but without reaching statistical difference in the 2 treated cohorts (P = 0.46). At a median clinical follow-up of 5.95 months, there were no differences in the functional outcomes in the 2 groups (P = 0.22). Contralateral angiographic runs post-treatment after covering the ACA origin demonstrated increase in the A1 (median: 0.45 mm; IQR = 0.4-1.2) and ICA diameter (median: 0.55 mm; IQR = 0.1-1.2). After pooling data from literature and our cohort, complete side branch occlusion after the coverage of ACA was seen in 25% of branches (95%CI = 0.16-0.36), and thromboembolic events were observed after 3% (95%CI = 0.01-0.04) of procedures.
CONCLUSIONS: Thromboembolic events can occur in distal ICA aneurysms treated with FD, but no significant association was seen with covering the ACA origin.
方法:回顾性分析2013年至2023年在单中心接受FD治疗的晚期ICA动脉瘤。程序根据ACA起源的覆盖范围进行分类,并通过双变量分析进行比较。还对PubMed进行了审查,WebofScience,和EMBASE,直到2024年4月,遵守PRISMA报告准则。
结果:评估了在102例手术中治疗的95例动脉瘤患者。58人接受了涵盖ACA起源的治疗。双重抗血小板方案包括阿司匹林-氯吡格雷(50%),阿司匹林替格瑞洛(44.1%),和阿司匹林-普拉格雷(4.9%)。6例患者发生血栓栓塞事件(5.9%),表现为ICA大血管闭塞,但在两个治疗队列中没有达到统计学差异(p=0.46)。在5.95个月的中位临床随访中,两组的功能结局无差异(p=0.22).覆盖ACA起源后的对侧血管造影显示A1(中位数:0.45mm;IQR=0.4-1.2)和ICA直径(中位数:0.55mm;IQR=0.1-1.2)增加。在汇集了文献和我们队列的数据后,ACA覆盖后的侧支完全闭塞在25%的分支中可见(95CI=0.16-0.36),3%(95CI=0.01-0.04)的手术后观察到血栓栓塞事件。
结论:在接受FD治疗的远端ICA动脉瘤中可发生血栓栓塞事件,但与涵盖ACA起源没有显著关联.