Purpose

Endovascular treatment of posterior communicating artery aneurysms with fetal-type posterior communicating artery originating from the aneurysm dome is often challenging because, with conventional techniques, dense packing of aneurysms for posterior communicating artery preservation is difficult; moreover, flow-diversion devices are reportedly less effective. Herein, we describe a novel method called the λ stenting technique that involves deploying stents into the internal carotid artery and posterior communicating artery.

Methods

Between January 2018 and September 2020, the λ stenting technique was performed to treat eight consecutive cases of aneurysms. All target aneurysms had a wide neck (dome/neck ratio < 2), a fetal-type posterior communicating artery with hypoplastic P1, and a posterior communicating artery originating from the aneurysm dome. The origin of the posterior communicating artery from the aneurysm, relative to the internal carotid artery, was steep (< 90°: V shape).

Results

The maximum aneurysm size was 8.0 ± 1.9 mm (6–12 mm). The average packing density (excluding one regrowth case) was 32.7 ± 4.2% (26.8–39.1%). Initial occlusion was complete occlusion in 6 (75.0%) patients and neck remnants in 2 (25.0%) patients. Follow-up angiography was performed at 18.4 ± 11.6 months (3–38 months). There were no perioperative complications or reinterventions required during the study period.

Conclusion

The λ stenting technique enabled dense coil packing and preservation of the posterior communicating artery. This technique enabled safe and stable coil embolization. Thus, it could become an alternative treatment option for this sub-type of intracranial aneurysms.

中文翻译：

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λ支架：一种新的后交通动脉瘤技术，胎儿型后交通动脉起源于动脉瘤圆顶

目的

对于源自动脉瘤穹窿的胎儿型后交通动脉的后交通动脉瘤的血管内治疗通常具有挑战性，因为使用传统技术，难以将动脉瘤致密填充以保存后交通动脉。此外，据报道分流装置效果较差。在这里，我们描述了一种称为 λ 支架技术的新方法，该技术涉及将支架部署到颈内动脉和后交通动脉中。

方法

2018 年 1 月至 2020 年 9 月，实施 λ 支架技术治疗连续 8 例动脉瘤。所有靶动脉瘤均具有宽颈（圆顶/颈比 < 2）、具有发育不全的 P1 的胎儿型后交通动脉和源自动脉瘤圆顶的后交通动脉。相对于颈内动脉，动脉瘤后交通动脉的起源是陡峭的（< 90°：V 形）。

结果

最大动脉瘤尺寸为 8.0 ± 1.9 mm (6–12 mm)。平均堆积密度（不包括一个再生案例）为 32.7 ± 4.2% (26.8–39.1%)。6 名 (75.0%) 患者的初始闭塞为完全闭塞，2 名 (25.0%) 患者为颈部残余物。随访血管造影在 18.4 ± 11.6 个月（3-38 个月）进行。在研究期间没有围手术期并发症或需要再次干预。

结论

λ 支架技术实现了后交通动脉的致密线圈包装和保存。这种技术能够实现安全稳定的线圈栓塞。因此，它可能成为这种颅内动脉瘤亚型的替代治疗选择。