载瘤动脉近远端直径差异度对颅内动脉瘤血流导向装置术后支架内狭窄的预测价值

黄驰; 王雪涛; 张丹瑜; 张周娴; 黄伟佳; 彭超; 郭宗铎; 梁淑茵; 冯欣; 张炘; 李西锋; 刘爱华; 段传志; 苏世星

doi:10.3969/j.issn.1006-5725.2026.11.001

实用医学杂志 >

2026 , Vol. 42 >Issue 11: 1889 - 1898

DOI: https://doi.org/10.3969/j.issn.1006-5725.2026.11.001

心脑血管疾病专栏

载瘤动脉近远端直径差异度对颅内动脉瘤血流导向装置术后支架内狭窄的预测价值

黄驰 ,
王雪涛 ,
张丹瑜 ,
张周娴 ,
黄伟佳 ,
彭超 ,
郭宗铎 ,
梁淑茵 ,
冯欣 ,
张炘 ,
李西锋 ,
刘爱华 ,
段传志 ,
苏世星

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^1.南方医科大学珠江医院神经外科中心脑血管病外科，国家临床重点专科，脑血管病诊断与治疗教育部工程研究中心，广东省普通高校脑功能修复与再生重点实验室，珠江医院脑科学与脑智能研究所，南方医科大学珠江医院脑血管病中心（广东广州 510282 ）
^2.中山市中医院神经外科（广东中山 528403）；南方医科大学3第一临床医学院
^4.第二临床医学院（广东广州 510000 ）
^5.南方医科大学第三附属医院神经外科（广东广州 510000 ）
^6.广东省人民医院神经外科（广东广州 510080 ）
^7.重庆医科大学附属第一医院神经外科（重庆 400016 ）
^8.首都医科大学附属北京天坛医院神经外科研究所介入神经放射科（北京 100070 ）

收稿日期: 2026-01-20

网络出版日期: 2026-06-15

基金资助

国家卫生健康委能力建设和继续教育中心课题(GWJJQ2023100101);广东省科技创新战略专项资金(pdjh2025bk052);南方医科大学校级大学生创新训练计划项目(202512121245)

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Arterial diameter difference in predicting in-stent stenosis for intracranial aneurysms after flow-diversion treatment

Chi HUANG ,
Xuetao WANG ,
Danyu ZHANG ,
Zhouxian ZHANG ,
Weijia HUANG ,
Chao PENG ,
Zongduo GUO ,
Shuyin LIANG ,
Xin FENG ,
Xin ZHANG ,
Xifeng LI ,
Aihua LIU ,
Chuanzhi DUAN ,
Shixing SU

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^1.Neurosurgery Center，Department of Cerebrovascular Surgery，the National Key Clinical Specialty，Engineering Research Center of Diagnostic and Therapeutic Technology and Devices for Cerebrovascular Diseases in Ministry of Education，Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration，Zhujiang Hospital Institute for Brain Science and Intelligence，Zhujiang Hospital，Southern Medical University，Guangzhou 510282，Guangdong，China
^2.Department of Neurosurgery，Zhongshan Hospital of Traditional Chinese Medicine，Zhongshan 528403，Guangdong，China
^3.The First School of Clinical Medicine，Southern Medical University，Guangzhou 510000，Guangdong，China
^4.The Second School of Clinical Medicine，Southern Medical University，Guangzhou 510000，Guangdong，China
^5.Department of Neurosurgery，the Third Affiliated Hospital of Southern Medical University，Guangzhou 510000，Guangdong，China
^6.Department of Neurosurgery，Guangdong Provincial People's Hospital，Guangzhou 510080，Guangdong，China
^7.Department of Neurosurgery，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，Chongqing，China
^8.Department of Interventional Neuroradiology，Beijing Neurosurgical Institute，Beijing Tiantan Hospital，Capital Medical University，Beijing 100070，Beijing，China

Received date: 2026-01-20

Online published: 2026-06-15

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摘要

目的探讨载瘤动脉近远端直径差异度与血流导向装置（flow-diverter devices，FD）术后支架内狭窄（in-stent stenosis，ISS）发生率之间的关联。方法本研究基于国内6家高级卒中中心前瞻性维护的数据库进行回顾性分析。纳入2020年1月至2024年1月期间接受Pipeline或Tubridge血流导向装置治疗的患者。采用渐进式协变量调整的多因素logistic回归模型及限制性立方样条（restricted cubic spline，RCS）曲线分析载瘤动脉近远端直径差异度（arterial diameter difference， ADD）与术后6个月造影随访中植入后ISS发生的关系；以显著狭窄作为替代结局进行敏感性分析；通过分层分析探讨ADD对ISS的影响在不同特征人群中是否存在差异。结果最终共有439例患者符合纳排标准，年龄（53.5 ± 10.5）岁。术后6个月随访显示，动脉瘤完全闭塞率和ISS发生率分别为81.8%和15.0%。多因素分析表明，ADD每增加一个单位，ISS发生风险增加约2倍（OR = 2.416，95%CI：1.528 ~ 3.821，P < 0.001）。敏感性分析显示的结果一致且亚组分析未发现不同人群之间存在显著差异。RCS曲线提示当ADD超过0.30时，ISS及显著狭窄的发生风险均显著上升。结论 ADD是FD术后发生ISS的独立危险因素，较高的ADD与FD术后ISS风险增加相关。

关键词： 颅内动脉瘤; 血流导向装置; 支架内狭窄; 血管内治疗; 危险因素

本文引用格式

黄驰 , 王雪涛 , 张丹瑜 , 张周娴 , 黄伟佳 , 彭超 , 郭宗铎 , 梁淑茵 , 冯欣 , 张炘 , 李西锋 , 刘爱华 , 段传志 , 苏世星 . 载瘤动脉近远端直径差异度对颅内动脉瘤血流导向装置术后支架内狭窄的预测价值[J]. 实用医学杂志, 2026 , 42(11) : 1889 -1898 . DOI: 10.3969/j.issn.1006-5725.2026.11.001

Abstract

Objective To investigate the association between arterial diameter discrepancy （ADD） and the incidence of in-stent stenosis （ISS） following flow diverter （FD） placement. Methods This retrospective analysis utilized data from a prospectively maintained multicenter registry across six advanced stroke centers in China. Patients who underwent FD treatment with the Pipeline Embolization Device （PED） or Tubridge Flow Diverter （TFD） between January 2020 and January 2024 were enrolled. Multivariable logistic regression models with progressive covariate adjustment and restricted cubic spline （RCS） analyses were used to evaluate the association between ADD and ISS at the 6-month angiographic follow-up. Sensitivity analyses assessed significant ISS as a secondary outcome. Subgroup analyses were performed to determine whether the association varied across patient characteristics. Results A total of 439 patients were included （53.5 ± 10.5） years. At the 6-month follow-up， the rates of complete aneurysm occlusion and ISS were 81.8% and 15.0%， respectively. Multivariable analysis revealed that each unit increase in ADD was associated with a 2.4-fold increase in the odds of ISS （OR = 2.42， 95% CI： 1.53 ~ 3.82， P < 0.001）. These findings remained robust in sensitivity analyses. Subgroup analyses showed no significant effect modification across patient characteristics. RCS analysis demonstrated a threshold effect， with the risk of both ISS and significant ISS increasing markedly when ADD exceeded 0.30. Conclusions Higher arterial diameter discrepancy is independently associated with an increased risk of ISS following FD placement. These findings may aid neurointerventionalists in preprocedural risk stratification and device selection， highlighting the potential clinical value of tapered FDs for treating vessels with significant diameter mismatches.

Key words： intracranial aneurysm; flow-diverter devices; in-stent stenosis; endovascular treatment; risk factors

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