AJNR. American journal of neuroradiology · 2026
Application of High-Resolution Conebeam CT for Evaluation of Endothelialization after Flow Diverter Implantation for Unruptured Intracranial Aneurysms.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Shi Shuailong, Zhang Zhike, Long Shuhai, Ma Ji, Lu Peijie, Ran Yuncai, Xie Shanshan, Yang Jie, Wang Ye, Li Tengfei
Аннотация
BACKGROUND AND PURPOSE: Although high-resolution conebeam CT (HR-CBCT) is used for immediate evaluation of stent apposition, studies using this technique to evaluate flow diverter (FD) endothelialization during follow-up are limited. The study aims to investigate the potential of HR-CBCT in assessing FD endothelialization and identify factors influencing poor endothelialization.
MATERIALS AND METHODS: The clinical and imaging data of patients with unruptured intracranial aneurysms (UIAs) treated by FDs from March 2019 to October 2023 were retrospectively analyzed. HR-CBCT was used for immediate evaluation of stent apposition, and FD endothelialization at 3, 6, and 12 months postimplantation was evaluated by using HR-CBCT and digital subtraction angiography. Multivariate logistic regression analysis was used to identify factors associated with poor endothelialization.
RESULTS: Among 402 FDs implanted for 446 aneurysms in 378 patients, 41 showed incomplete stent apposition (ISA) in postimplantation HR-CBCT scans. The aneurysm-occlusion rate at 12 months postimplantation was 84.8% (378/446), with 8.7% (35/402) of the FDs exhibiting in-stent stenosis (ISS). At 12 months postimplantation, 343 (85.1%) FDs showed good endothelialization, while 59 (14.9%) exhibited poor endothelialization. Multivariate logistic regression analysis identified age ≥60 years (OR = 2.209; 95% CI, 1.053-4.635; P = .04), a large aneurysm lumen inflow angle (OR = 1.102; 95% CI, 1.071-1.135; P < .001), parent artery excessive tortuosity (OR = 9.402; 95% CI, 1.141-77.479; P = .04), and ISA (OR = 10.967; 95% CI, 4.290-28.035; P < .001) as independent risk factors for poor endothelialization.
CONCLUSIONS: HR-CBCT can accurately evaluate FD endothelialization and ISS of UIAs after FD implantation. Age ≥60 years, a large aneurysm lumen inflow angle, parent artery excessive tortuosity, and ISA are independent risk factors for poor endothelialization.
MATERIALS AND METHODS: The clinical and imaging data of patients with unruptured intracranial aneurysms (UIAs) treated by FDs from March 2019 to October 2023 were retrospectively analyzed. HR-CBCT was used for immediate evaluation of stent apposition, and FD endothelialization at 3, 6, and 12 months postimplantation was evaluated by using HR-CBCT and digital subtraction angiography. Multivariate logistic regression analysis was used to identify factors associated with poor endothelialization.
RESULTS: Among 402 FDs implanted for 446 aneurysms in 378 patients, 41 showed incomplete stent apposition (ISA) in postimplantation HR-CBCT scans. The aneurysm-occlusion rate at 12 months postimplantation was 84.8% (378/446), with 8.7% (35/402) of the FDs exhibiting in-stent stenosis (ISS). At 12 months postimplantation, 343 (85.1%) FDs showed good endothelialization, while 59 (14.9%) exhibited poor endothelialization. Multivariate logistic regression analysis identified age ≥60 years (OR = 2.209; 95% CI, 1.053-4.635; P = .04), a large aneurysm lumen inflow angle (OR = 1.102; 95% CI, 1.071-1.135; P < .001), parent artery excessive tortuosity (OR = 9.402; 95% CI, 1.141-77.479; P = .04), and ISA (OR = 10.967; 95% CI, 4.290-28.035; P < .001) as independent risk factors for poor endothelialization.
CONCLUSIONS: HR-CBCT can accurately evaluate FD endothelialization and ISS of UIAs after FD implantation. Age ≥60 years, a large aneurysm lumen inflow angle, parent artery excessive tortuosity, and ISA are independent risk factors for poor endothelialization.