Treatment of acute aneurysmal subarachnoid haemorrhage with primary flow diversion: 5-year single-centre experience.

Autor: O'Reilly ST; Neuroradiology Department, Royal Victoria Hospital, Belfast, UK. Electronic address: sean.oreilly@belfasttrust.hscni.net., Flynn PA; Neuroradiology Department, Royal Victoria Hospital, Belfast, UK., Simms HN; Neurosurgery Department, Royal Victoria Hospital, Belfast, UK., Abouharb A; Neurosurgery Department, Royal Victoria Hospital, Belfast, UK., Smyth G; Neuroradiology Department, Royal Victoria Hospital, Belfast, UK., Burns PA; Neuroradiology Department, Royal Victoria Hospital, Belfast, UK., Rennie I; Neuroradiology Department, Royal Victoria Hospital, Belfast, UK.
Jazyk: angličtina
Zdroj: Clinical radiology [Clin Radiol] 2021 Dec; Vol. 76 (12), pp. 941.e19-941.e24. Date of Electronic Publication: 2021 Sep 20.
DOI: 10.1016/j.crad.2021.08.006
Abstrakt: Aim: To evaluate the safety and efficacy of treatment of patients presenting with acute aneurysmal subarachnoid haemorrhage (SAH) with primary flow-diverting stents (FDS; with or without adjuncts), with comparison to the published literature.
Materials and Methods: A retrospective single-centre review was undertaken of prospectively obtained data on patients treated for SAH over a 60-month period. Of 354 patients treated for SAH during that time period, 24 patients with a total of 25 aneurysms were identified. Baseline patient demographics were recorded and clinical and imaging outcomes assessed.
Results: Eighty-eight per cent (22/25) of the aneurysms were completely occluded (Raymond-Roy 1) at mean 12-month follow-up. The minor complication rate was 12.5% (3/24) without permanent morbidity. Mortality rate was 4% (1/25) after one patient died following aneurysmal rebleed on day 7 post-procedure. Forty-two per cent (10/24) of patients had a high-pressure shunt placed prior to endovascular treatment, no haemorrhagic complications of neurosurgical intervention were observed.
Conclusion: The necessity of dual antiplatelet therapy (DAPT) therapy when deploying FDS will rightly continue to limit their use in the acutely ruptured setting to a case-by-case basis whereby other treatment options are deemed unsafe. Methods employed to minimise subsequent haemorrhagic risks from DAPT in these patients may be worthy of further investigation.
(Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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