Flow Diversion for the Treatment of Basilar Apex Aneurysms
| Autor: | Kevin Phan, Salvatore Mangiafico, Nimer Adeeb, Ashish Kumar, Timo Krings, Paul M. Foreman, Hussain Shallwani, Nicola Limbucci, Leonardo Renieri, Adnan H. Siddiqui, Vitor Mendes Pereira, Thomas R. Marotta, Adam A Dmytriw, Caterina Michelozzi, Hakeem J Shakir, C Griessenauer, Elad I. Levy, Mark R. Harrigan, Christophe Cognard, Christopher S. Ogilvy, Yuchen Zhang, Charles C. Matouk, Ajith J. Thomas |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Databases Factual medicine.medical_treatment Posterior cerebral artery California 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences 0302 clinical medicine Aneurysm Blood vessel prosthesis Modified Rankin Scale medicine.artery Occlusion Humans Medicine cardiovascular diseases Embolization Aged Retrospective Studies business.industry Endovascular Procedures Intracranial Aneurysm Clipping (medicine) Middle Aged medicine.disease Embolization Therapeutic Blood Vessel Prosthesis Surgery Treatment Outcome cardiovascular system Female Neurology (clinical) business human activities 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 83:1298-1305 |
| ISSN: | 0148-396X |
| Popis: | Background Flow diversion for basilar apex aneurysms has rarely been reported. Objective To assess flow diversion for basilar apex aneurysms in a multicenter cohort. Methods Retrospective review of prospectively maintained databases at 8 academic institutions was performed from 2009 to 2016 to identify patients with basilar apex aneurysms treated with flow diversion. Clinical and radiographic data were analyzed. Results Sixteen consecutive patients (median age 54.5 yr) underwent 18 procedures to treat 16 basilar apex aneurysms with either the Pipeline Embolization Device (Medtronic Inc, Dublin, Ireland) or Flow Redirection Endoluminal Device (Microvention, Tustin, California). Five aneurysms (31.3%) were treated in the setting of subarachnoid hemorrhage. Seven aneurysms (43.8%) were treated with flow diversion alone, while 9 (56.2%) underwent flow diversion and adjunctive coiling. At a median follow-up of 6 mo, complete (100%) and near-complete (90%-99%) occlusion was noted in 11 (68.8%) aneurysms. Incomplete occlusion occurred more commonly in patients treated with flow diversion alone compared to those with adjunctive coiling. Patients with partial occlusion were significantly younger. Retreatment with an additional flow diverter and adjunctive coiling occurred in 2 aneurysms with wide necks. There was 1 mortality in a patient (6.3%) who experienced posterior cerebral artery and cerebellar strokes as well as subarachnoid hemorrhage after the placement of a flow diverter. Minor complications occurred in 2 patients (12.5%). Conclusion Flow diversion for the treatment of basilar apex aneurysms results in acceptable occlusion rates in highly selected cases. Both primary flow diversion and rescue after failed clipping or coiling resulted in a modified Rankin Scale score that was either equal or better than at presentation and the technology represents a viable alternative or adjunctive option. |
| Databáze: | OpenAIRE |
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