Abstract：
BACKGROUND: Advances in the use of flow diversion (FD) now extend to bifurcation aneurysms; herein, we compare thromboembolic events in patients with internal carotid artery (ICA) aneurysms treated with and without exclusion of the anterior cerebral artery (ACA).
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.
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.
摘要：
背景：流量转移（FD）的使用进展现在扩展到分叉动脉瘤；在本文中，我们比较了使用和不使用ACA治疗的ICA动脉瘤患者的血栓栓塞事件.
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.
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.
