Cavernous Carotid Aneurysms in the Era of Flow Diversion: A Need to Revisit Treatment Paradigms

Tanweer, Omar; Raz, Eytan; Brunswick, Andrew; Zumofen, Daniel; Shapiro, Maksim; Riina, Howard A.; Fouladvand, Mohammad; Becske, Tibor; Nelson, Peter Kim

doi:10.3174/ajnr.a4081

Cited by 42 publications

(33 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…15 Several investigators advocate ICA sparing therapy with flow diverters for ICA aneurysms, also in patients who can tolerate ICA occlusion. 22 However, recent meta-analyses that concern flow-diverter stents show that the combined morbidity and mortality rate is approximately 10%, regardless of the type of aneurysm. [23][24][25][26][27][28][29] Mortality was 4% in the study of Briganti et al 24 in 76 patients with cavernous aneurysms treated with flow diverters.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients

Bechan

Majoie

Sprengers

et al. 2015

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: At our institution, patients with large or giant ICA aneurysms are preferably treated with endovascular ICA balloon occlusion. Alternative treatment or conservative treatment is offered only for patients who cannot tolerate permanent ICA occlusion. In this observational study, we report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort.

show abstract

Section: Discussionmentioning

confidence: 99%

Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients

Bechan

Majoie

Sprengers

et al. 2015

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…The process of aneurysm occlusion after FDD placement is also linked in part to the antiplatelet regimen administered. 73 Potential occlusion of the side branches or perforating arteries carries the risk of secondary ischemic complications. Further, overlap of FDDs potentially increases the risk of arterial branch or perforator occlusion and may be responsible for ischemic complications.…”

Section: Discussionmentioning

confidence: 99%

Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

Zhou

Yin

et al. 2017

Neurosurgical Focus

145

View full text Add to dashboard Cite

OBJECTIVEThe objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies.METHODSA systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies.RESULTSSixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%–20.5%) and a low mortality rate of 2.8% (95% CI 1.2%–4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%–5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2–4.3).CONCLUSIONSThe use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required.

show abstract

“…In select cases, access to the cavernous sinus via surgical access to the superior ophthalmic vein or direct transorbital puncture through the superior orbital fissure can also be attempted 19. Tanweer et al 13 treated one CCF with transvenous access via the ipsilateral facial vein, superior ophthalmic vein to the cavernous sinus. Generally, transvenous embolization more effectively treats indirect CCFs rather than direct CCFs.…”

Section: Discussionmentioning

confidence: 99%

“…13 Tanweer et al 13 reviewed their experience of CCA treatment with the PED and reported one CCF among a group of 41 patients with 43 treated CCAs at 6-month follow-up. The fistula was incidentally discovered and treated transvenously, as described above.…”

Section: Discussionmentioning

confidence: 99%

“…The long-term risks associated with PED treatment of intradural and extradural ICA aneurysms remain an area of debate and research 7 8. While delayed hemorrhagic and embolic complications following flow diversion have been well studied,9–12 CCFs following CCA treatment with the PED have not been commonly published 13 14. The management of CCFs after PED treatment of CCAs at a high-volume cerebrovascular tertiary care center is reported and the relevant literature reviewed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

Roy

Grossberg

Osbun

et al. 2016

J NeuroIntervent Surg

View full text Add to dashboard Cite

CCF formation is a known risk of PED treatment of CCA. Although transvenous embolization can be used for treating CCFs, parent artery sacrifice remains a viable option on the basis of these data. Studies support the view that adjunctive coiling may have a protective effect against post-PED CCF formation. None of the coiled aneurysms in our database or in the literature have ruptured. Follow-up data will lead to a better understanding of the safety profile of the PED for CCA.

show abstract

Cavernous Carotid Aneurysms in the Era of Flow Diversion: A Need to Revisit Treatment Paradigms

Cited by 42 publications

References 35 publications

Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients

Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients

Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

Contact Info

Product

Resources

About