Application of High-Resolution Conebeam CT for Evaluation of Endothelialization after Flow Diverter Implantation for Unruptured Intracranial Aneurysms.

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.