The Use of Flow Diverter in Ruptured, Dissecting Intracranial Aneurysms of the Posterior Circulation
| Autor: | Markus A Möhlenbruch, Pantelis Stavrinou, Anastasios Mpotsaris, Christoph Kabbasch, Volker Maus, Utako Birgit Barnikol, Jan Borggrefe, Thomas Liebig, Franziska Dorn, Nuran Abdullayev |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Vertebral artery Posterior cerebral artery Aneurysm Ruptured 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Modified Rankin Scale medicine.artery medicine Basilar artery Humans cardiovascular diseases Aged Retrospective Studies business.industry Endovascular Procedures Intracranial Aneurysm Middle Aged medicine.disease Surgery Anterior inferior cerebellar artery Posterior inferior cerebellar artery Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 111 |
| ISSN: | 1878-8769 |
| Popis: | Objective Acute dissecting aneurysms of the posterior circulation are a rare cause of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion and stent-assisted coiling, but appear to be associated with an increased risk of ischemic stroke. Vessel reconstruction with flow diverters is an alternative treatment option; however, its safety and efficacy in the acute stage remains unclear. Methods This is a multicentric retrospective analysis of 15 consecutive acutely ruptured dissecting posterior circulation aneurysms treated with flow diverters. The primary end point was favorable aneurysm occlusion, defined as OKM C1-3 and D (O'Kelly Marotta scale). Secondary end points were procedure-related complications and clinical outcome. Results Nine of 15 aneurysms (60%) arose from the intradural portion of the vertebral artery, 3 were located on the posterior inferior cerebellar artery and 1 each on the anterior inferior cerebellar artery, posterior cerebral artery, and basilar artery. Flow diverter placement was technically successful in 14 of 15 cases (93%). After endovascular treatment, none of the ruptured aneurysms rebled. Median clinical follow-up was 217 days and median angiographic follow-up was 203 days. Favorable occlusion was observed in 7 of 14 aneurysms (50%) directly after flow diverter placement; of those, 5 were completely occluded (36%). Seven patients (47%) with poor-grade subarachnoid hemorrhage died in the acute phase. Favorable clinical outcome (modified Rankin scale ≤2) was observed in 4 of 15 patients (27%) and a moderate outcome (modified Rankin scale 3/4) was observed in 5 of 15 patients (33%). All aneurysms showed complete occlusion at follow-up. Conclusions Flow diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent rebleeding. Larger cohort studies are required to validate these results. |
| Databáze: | OpenAIRE |
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