The SAMMPRIS Trial showed that medical treatment of intracranial stenosis is safer than intracranial angioplasty and stenting (IAS). One of the reasons for the worse outcome with IAS was the occurrence of ipsilateral cerebral hemorrhage, which may be associated with an intracranial exchange maneuver. Newly developed mini intracranial stents may enhance the safety of IAS by obviating the need for this maneuver. We retrospectively evaluated 7 intracranial stenoses (6 patients, 5 men, mean age 57) which were treated with an Atlas stent. In 5 cases there was a high-grade atherosclerotic stenosis which did not optimally respond to medical treatment, one patient had radiotherapy induced stenosis and in one patient there was a chronic arterial dissection with a distal aneurysm. All lesions were located in the petrocavernous segment of the internal carotid artery. All of the procedures were performed electively under dual antiplatelet therapy and general anesthesia. After performing angioplasty of the stenosis with an over-the-wire balloon (e.g. Gateway balloon), the Atlas stent was delivered directly through the lumen of the angioplasty balloon, without a need for an intracranial exchange maneuver.The procedure was successful in all patients. There was no mortality or permanent morbidity related to the procedures. At a mean follow-up of 9.8 months (range 1–18 months ), there was one case of asymptomatic occlusion and otherwise no evidence of restenosis. None of the patients suffered a recurrent ipsilateral stroke.Although further studies are needed for demonstrate safety and efficacy of self-expandable mini stents in IAS, our results indicate that a single step angioplasty/stenting is feasible with these devices. We suggest the optimization of the currently available over-the-wire balloons for this technique.Disclosures F. Cay: None. Y. Senturk: None. A. Peker: None. E. Arsava: None. M. Topcuoglu: None. A. Arat: None.
PurposeImmediate hemodynamic compromise of a side branch jailed by a flow diverter is an infrequently encountered phenomenon in bifurcation aneurysms which is attributed by some authors to the “Coanda effect”. We aimed to check the relevance of this phenomenon with aneurysm occlusion rate on follow-up in bifurcation aneurysms treated by flow diversion.MethodsAll intracranial aneurysms treated with flow diverters in a single center were retrospectively reviewed. 30 patients treated by flow diverters which jail a major intracranial side branch originating from the aneurysm were identified. 7 patients among these demonstrated hemodynamic compromise of the jailed side branch intraprocedurally, immdeately after FD deployment (Group 1). 23 patients did not demonstrate any immediate side branch stagnation or occlusion (group 2). Patients in group 1 were treated by induced hypertension and augmentation of antiplatelet therapy in the perioperative period. Mann-Whitney U test was used to compare the diameters of the side branch, the parent artery and flow diverter as well as the angle between the parent artery/side branch between these 2 groups. Chi-square analysis was performed to compare the rate of occlusion of aneurysms at 6 months and at final follow-up.ResultsNone of the patients in group 1 developed any permanent neurologic deficits. There were no significant differences between parent artery diameters, side branch diameters, flow diverter diameters and side branch angles between the two groups. Occlusion rate was similar in both groups at 6 months. However at the final follow-up there was a significantly higher rate of aneurysm occlusion in group 1 versus group 2 (p=0.03).ConclusionIntraprocedural, pressure-related compromise of a jailed side branch originating from an intracranial aneurysm treated by flow diversion does not necessarily indicate a bad outcome, on the contrary it may predict occlusion of the aneurysm on long term follow-up.Disclosures: Y. Senturk: None. F. Cay: None. A. Peker: None. O. Ocal: None. A. Arat: None.
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