The use of flow diverter in ruptured, dissecting intracranial aneurysms of the posterior circulation
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 reconst...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2018
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| In: |
World neurosurgery
Year: 2018, Volume: 111, Pages: e424-e433 |
| ISSN: | 1878-8769 |
| DOI: | 10.1016/j.wneu.2017.12.095 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1016/j.wneu.2017.12.095 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S1878875017322118 
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| Author Notes: | Volker Maus, Anastasios Mpotsaris, Franziska Dorn, Markus Möhlenbruch, Jan Borggrefe, Pantelis Stavrinou, Nuran Abdullayev, Utako Birgit Barnikol, Thomas Liebig, Christoph Kabbasch |
| Summary: | 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. |
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| Item Description: | Available online 23 December 2017 Gesehen am 29.10.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1878-8769 |
| DOI: | 10.1016/j.wneu.2017.12.095 |