Vascular Geometry Changes After Stent-assisted Coiling Anterior Circulating Aneurysms

Background and Objective:Ruptured intracranial aneurysms(IAs)may cause high rate of morbidity and mortality.Stent-assisted coiling is widely used to treat wide neck intracranial aneurysms.Many studies have reported that intracranial stent can cause morphological changes of the parent artery,but the risk factors about these changes are unknown,and the effect of morphological changes on prognosis after stent-assisted coiling is uncertain.The purpose of this study was to investigate the factors related to vascular deformation and the relation between morphological changes of parent artery and stent-assisted coiling results.Methods:Stent-coiled aneurysms at an academic institution in China from October 2014 to March 2019 were retrospectively reviewed.Clinical data including: gender,age,and the size of the aneurysm,aneurysm location,stent type,whether the aneurysm ruptured and follow-up results,and imaging data were collected.The angle of stent-covered parental artery was measured before treatment and in follow-up.If the angle was changed more than 5 degree,it was defined as morphological change.The risk factors about the morphological change were analyzed.The relation between morphological changes and results about stent-assisted coiling was also studied.Results:201 patients were included in this study,mean age was 54.7±10.2 years,and male-female ratio was 58:143,of which 111 were ruptured IAs.Raymond I classification: was in 115,? was 66,? was 20.The follow-up results of Raymond classification: ? was in 180 patients,? was 11,? was 10.There were 118 cases were stable following treatment,71 need to be further embolization and 12 were in the recurrence group.There were 62 cases with parent artery morphological changes,with mean age of 52.4±8.3 years,and a male-female ratio was 25:37.The factors of gender,age,aneurysm location,stent type and aneurysm size were correlated with morphological change in univariate analysis(P<0.05),but ruptured IAs were notindependent risk factor of morphological change after stent implantation.The deformation rate of each aneurysm site was various(P=0.000),in which the middle cerebral artery and the anterior communicating artery inclined to deformation comparing to the posterior communicating segment of the internal carotid artery and the clinoid segment of the internal carotid artery.The deformation rate of various stent was different(P=0.000),in which Solitaire was more likely to be deformation than Lvis stent and the dense mesh stent.There was a significant difference in the deformation rate among different age groups(P=0.014).Patients under 60 years old were more likely to have parent artery deformation.The deformation rate of each aneurysm site were significantly different(P=0.019).There was a significant difference in the deformation rate between males and females(P=0.017).The parent artery is more likely to be deformed in men than in women.There was no significant difference in the deformation rate of ruptured aneurysm(P=0.704).Multivariate analysis showed that anterior communicating artery,middle cerebral artery,Lvis stent,dense mesh stent and ruptured aneurysm were correlated with morphological change(P<0.05).There was a significant difference between aneurysm prognosis and parent artery deformation(P=0.041).Conclusion:Anterior circulation aneurysm treated by stent-assisted coils is easily to cause the deformation of the parent artery,and the morphological change is significantly correlated with gender,age,aneurysm location,aneurysm size and stent type(P <0.05).The risk factors of deformation of parental artery include anterior communicating artery,middle cerebral artery,Lvis stent,dense mesh stent and ruptured aneurysm are risk factors for.The prognosis of aneurysms following interventional therapy was significantly correlated with parent artery deformation.