Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience

Guerrero, Waldo R; Ortega‐Gutiérrez, Santiago; Hayakawa, Minako; Derdeyn, Colin P.; Rossen, James D.; Hasan, David; Samaniego, Edgar A

doi:10.1016/j.wneu.2017.09.125

Cited by 37 publications

(25 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were no thromboembolic complications seen in this series. More recently, our group published a series of 7 patients treated for ruptured vertebrobasilar dissecting aneurysms [20]. In our series, there were no intraoperative complications directly related to the PED placement and no patient re-bled.…”

Section: Discussionmentioning

confidence: 72%

Safety and Efficacy of the Pipeline Embolization Device Use in the Outside Circle of Willis Located Intracranial Aneurysms: A Single-Center Experience

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: The use of Pipeline Embolization Device (PED) is approved by the US Food and Drug Administration (FDA) to treat aneurysms located between the petrous and superior hypophyseal segments of the internal carotid artery. The purpose of this study is to evaluate the feasibility and efficacy of treating aneurysms outside the FDA approved anatomical locations. Furthermore, we analyze the safety of our antiplatelet protocol. Methods: Data on all patients treated with PED at our center from March 2015 to December 2017 were reviewed. Only patients with aneurysms treated with PED as off label use were included. Procedural complications and long-term functional outcome measured by modified Rankin Scale (mRS) were recorded. Tirofiban maintenance infusion was administered intravenously after PED deployment. None of the patients had platelet function testing. Results: A total of 36 patients harboring 36 aneurysms were included in the study. Mean age was 58.2 years ±14.6. Nineteen were women (52.8%) and most aneurysms were unruptured (80.6%). There were no intraoperative complications. Five patients experienced postoperative complications – 4 ischemic strokes and one groin hematoma. None led to any significant disability at follow-up. Thirty-one patients (86.1%) achieved an mRS of 0–2 at follow-up. A Raymond-Roy classification of 1 was achieved in 78.9% of patients. Conclusion: The use of PED to treat aneurysms located outside the circle of Willis is feasible and effective. Our novel antiplatelet protocol did not require platelet function assay testing and did not lead to a higher rate of thrombo-embolic events compared to what has been previously reported.

show abstract

Section: Discussionmentioning

confidence: 72%

Safety and Efficacy of the Pipeline Embolization Device Use in the Outside Circle of Willis Located Intracranial Aneurysms: A Single-Center Experience

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…So far, 12 case series of ruptured dissecting aneurysms or ruptured blood blister-like aneurysms treated in acute phase with flow diverter have been reported. [13][14][15][16][17][18][19][20][21][22][23][24] In these reports, 115 ruptured site (68 internal carotid artery, six middle cerebral artery, one anterior cerebral artery, 26 vertebral artery, six basilar artery, two posterior cerebral artery, three anterior inferior cerebellar artery, three posterior inferior cerebellar artery) were treated; 101 were treated with only flow diverter, 14 with flow diverter and coil. In these 115 cases, no rebleeding from ruptured site and 10 symptomatic thrombotic events were observed after procedure.…”

Section: Discussionmentioning

confidence: 99%

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Sonobe

Yoshida

Niizuma

et al. 2020

NMC Case Report Journal

View full text Add to dashboard Cite

The diagnosis and treatment of patients with ruptured basilar artery dissection (rBAD) are often difficult. We present a case of rBAD diagnosed with magnetic resonance vessel wall imaging (MR-VWI) and treated with coil embolization with overlapping low-profile visualized intraluminal support (LVIS) stents. The case is of a 49-year-old woman with subarachnoid hemorrhage. digital subtraction angiography (DSA) showed irregularity in an anterior wall of the middle portion of the basilar artery, indicating the presence of a false lumen. MR-VWI showed local enhancement in an arterial wall, which was consistent with the wall irregularity observed in DSA. Overlapping stents (two LVIS stents) was performed in the basilar artery and coils were placed in the false lumen. The false lumen was completely thrombosed, and anterograde blood flow of the basilar artery was preserved. Dual antiplatelet therapy was administered, and the patient underwent an uneventful postoperative course. DSA performed 6 months later showed a white-collar sign. MR-VWI has attracted attention as a useful modality for detecting a ruptured lesion in patients with subarachnoid hemorrhage. This is the first report, to the best of our knowledge, describing the practical use of MR-VWI for rBAD. MR-VWI is suggested to improve diagnostic accuracy for rBAD. There are no established treatments for rBAD; reconstructive endovascular treatments comprising stent placement and coil embolization of a false lumen are promising. The LVIS stent has a braided design and high metal coverage ratio and is considered to be reasonable for use in rBAD. Coil embolization of a false lumen with overlapping LVIS stents may be effective for rBAD.

show abstract

“…Full texts of 55 articles were reviewed for eligibility. Finally, 13 articles 13,14,[17][18][19][20][21][22][23][24][25][26]31 meeting inclusion criteria were selected for data archival and analysis. Individual patient data was retrieved from each of the 13 studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…12 Despite these concerns, a number of retrospective case series have presented their experience with flow diversion to treat ruptured aneurysms with "challenging" morphologies. [13][14][15][16][17][18][19][20][21][22][23] These case series have justified the use of flow diversion as a salvage treatment for ruptured aneurysms with "challenging" morphologies, which are difficult to treat by traditional neurosurgical or endovascular modalities. 23,24 Once a decision is made to treat a ruptured aneurysm with flow diversion, there is considerable debate on the ideal timing of flow diverter placement.…”

Section: Introductionmentioning

confidence: 99%

“…diversion (less than 2 days from SAH ictus), 19,21,25 while others advocate for delayed treatment (2-14 days from SAH ictus). 18,26 The stated reasons for timing of flow diversion are anecdotal; for example, some prefer early flow diversion because it may facilitate faster patient rehabilitation, while others prefer delayed flow diversion because it may minimize hemorrhagic complications from dual antiplatelet therapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early Versus Delayed Flow Diversion for Ruptured Intracranial Aneurysms: A Meta-Analysis

et al. 2019

View full text Add to dashboard Cite

Objective: The use and timing of flow diversion for aneurysmal subarachnoid hemorrhage (SAH) is controversial. The objective of this study is to perform a meta-analysis and systematic review to compare overall complication rate between early versus delayed flow diversion for ruptured aneurysms. Methods: Literature search for all eligible articles was performed using PubMed, Cochrane and Web of Science databases. The primary outcome was the overall complication rate (any complication in the perioperative period), and secondary outcomes were (1) hemorrhage and (2) stroke/death (all hemorrhagic/ischemic strokes and/or death). Results: Thirteen articles including 142 patients met inclusion criteria. Eighty-nine (62.7%) patients underwent early deployment of flow diverters (i.e., 2 days or less). The odds ratio for overall complication rate with early versus delayed flow diversion was 0.95 (95% CI=0.36-2.49, p=0.42). The odds ratio for the secondary outcome of hemorrhagic complication for early vs. delayed flow diversion was 1.44 (95% CI 0.45-4.52, p=0.87) and of stroke/death was 1.67 (95%CI 0.5-4.9, p=0.69). The odds ratio of early vs. delayed flow diversion for blister/dissecting/fusiform aneurysms was 0.82 (95% CI 0.29-2.30) and for saccular/giant aneurysms was 2.23 (95% CI 0.17-29.4). At last follow-up, 71.6% of patients had good performance status (mRS score 0-2), and the rate of angiographic aneurysm occlusion was 90.2%. Conclusion: This meta-analysis did not show a difference in overall complication rate between early vs. delayed flow diversion for ruptured aneurysms. Early flow diversion for ruptured blister/fusiform/dissecting aneurysms carries a lower risk of aneurysm rerupture and overall complications as compared to that for ruptured saccular/giant aneurysms.

show abstract

Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience

Cited by 37 publications

References 19 publications

Safety and Efficacy of the Pipeline Embolization Device Use in the Outside Circle of Willis Located Intracranial Aneurysms: A Single-Center Experience

Safety and Efficacy of the Pipeline Embolization Device Use in the Outside Circle of Willis Located Intracranial Aneurysms: A Single-Center Experience

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Early Versus Delayed Flow Diversion for Ruptured Intracranial Aneurysms: A Meta-Analysis

Contact Info

Product

Resources

About