Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents

Ros, Valerio Da; Caroff, Jildaz; Rouchaud, Aymeric; Mihalea, Cristian; Ikka, Léon; Moret, Jacques; Spelle, Laurent

doi:10.3174/ajnr.a5167

Cited by 15 publications

(4 citation statements)

References 34 publications

(41 reference statements)

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“…However, as this location is less accessible for clipping, FDD can be an option for complex or recurrent aneurysms, although ischemic and hemorrhagic complications are a concern. 26 In a multicentric series of 16 complex basilar tip aneurysms, complete/near complete occlusion was achieved in 68.8% of cases, with higher rates in case of adjunctive coiling. One thromboembolic event and one delayed SAH occurred.…”

Section: Bifurcation Aneurysmsmentioning

confidence: 96%

Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

et al. 2019

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Flow diverter devices have gained wide acceptance for the treatment of unruptured intracranial aneurysms. Most studies are based on the treatment of large aneurysms harboring on the carotid syphon. However, during the last years the “off-label” use of these stents has widely grown up even if not supported by randomized studies. This review examines the relevant literature concerning “off-label” indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurysms, small aneurysms, recurrent aneurysms, and direct carotid cavernous fistulas.

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Section: Bifurcation Aneurysmsmentioning

confidence: 96%

Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

et al. 2019

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“…The mean time to complete occlusion overall confirmed by the first imaging was 10.0 ± 1.1 months (range, 4. [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The mean time to complete occlusion confirmed by the first imaging was significantly longer in fusiform aneurysms than saccular aneurysms (12.1 ± 3.9 months vs. 7.1 ± 3.5 months; p = 0.036).…”

Section: Angiographic Outcomesmentioning

confidence: 99%

Endovascular Treatment of Large or Giant Basilar Artery Aneurysms Using the Pipeline Embolization Device: Complications and Outcomes

Chen

et al. 2022

Front. Neurol.

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BackgroundThis study aimed to investigate clinical and angiographic outcomes of Pipeline embolization device (PED) treatment of large or giant basilar artery (BA) aneurysms and examine associated factors.MethodsClinical and angiographic data of 29 patients (18 men, 11 women) with large or giant BA aneurysms were retrospectively examined. Mean age was 44.1 ± 21.2 years (range, 30–68). Mean aneurysm size was 22.2 ± 8.3 mm (range, 12.0–40.1).ResultsMean angiographic follow-up was 18.3 ± 3.4 months (range, 4.5–60). The rate of adequate aneurysmal occlusion (O'Kelly–Marotta grade C–D) was 87%. The overall complication rate was 44.8%; most complications (84.6%) occurred in the periprocedural period. Univariable comparison of patients who did and did not develop complications showed significant differences in aneurysm size (p < 0.01), intra-aneurysmal thrombus (p = 0.03), and mean number of PEDs used (p = 0.02). Aneurysm size (odds ratio, 1.4; p = 0.04) was an independent risk factor for periprocedural complications in multivariable analysis. Mean clinical follow-up was 23.5 ± 3.2 months (range, 0.1–65). Nine patients (31%) had a poor clinical outcome (modified Rankin scale score ≥3) at last follow-up, including 7 patients who died. Univariable comparisons between patients with favorable and unfavorable clinical outcomes showed that aneurysm size (p = 0.009) and intra-aneurysmal thrombus (p = 0.04) significantly differed between the groups. Multivariable analysis showed that aneurysm size (odds ratio, 1.1; p = 0.04) was an independent risk factor for poor clinical outcome.ConclusionPED treatment of large or giant BA aneurysms is effective and can achieve a satisfactory long-term occlusion rate. However, the treatment complications are not negligible. Aneurysm size is the strongest predictor of perioperative complications and poor clinical outcome.

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“…Although DAPT is recommended before SACE to prevent ischemic complications, Hudson reported that shunting with DAPT increased postoperative cerebral hemorrhage. [7] Given the existence of a case report of successful flow diverter use for the treatment of a basilar aneurysm, [2] we aimed to achieve permanent cure by placing a FRED for flow diverter or an LVIS stent in expectation of an FD effect with DAPT after the first coil embolization [Table 2]. SAPT was started before the first coil embolization, and DAPT before the second cerebral endovascular treatment was administered over 10 days after the shunt operation.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus

Yoshida¹,

Kamatani²,

Maruyama³

et al. 2023

Surgical Neurology International

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Background: There is no established adequate treatment for thrombosed aneurysm of the basilar artery with obstructive hydrocephalus. We conducted coil embolization and peritoneal shunting followed by placement of a stent expected to exert flow diversion (FD) effects to treat 2 patients with giant thrombosed aneurysms of the basilar artery with associated obstructive hydrocephalus, with good results. Methods: From April 2019 to March 2021, consecutive two cases of symptomatic hydrocephalus due to giant thrombosed aneurysms in the posterior cranial fossa at our hospital were treated. At first, coil embolization was performed to prevent aneurysm rupture. After coil embolization, ventriculoperitoneal shunting was performed. Finally, stent-assisted coil embolization was performed with flow re-direction endoluminal device (FRED) or low-profile visualized intraluminal support device (LVIS) stent. Results: Both patients were discharged after recovering well, with no postoperative hemorrhagic or ischemic complications. Conclusion: Staged surgery using a FRED for flow diverter or an LVIS stent expected to have FD effects may offer an effective treatment option.

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Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents

Abstract: Flow diversion is a feasible technique with an efficacy demonstrated at a midterm follow-up, especially in the case of basilar apex aneurysm recurrences after previous endovascular treatments. Concern about its safety profile still exists.

Cited by 15 publications

References 34 publications

Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

Endovascular Treatment of Large or Giant Basilar Artery Aneurysms Using the Pipeline Embolization Device: Complications and Outcomes

Treatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus

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