Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Alpay, Kemal; Hinkka, Tero; Lindgren, Antti; Isokangas, Juha Matti; Raj, Rahul; Parkkola, Riitta; Sinisalo, Matias; Numminen, Jussi; Pienimäki, Juha Pekka; Saari, Petri; Seppänen, Janne; Palosaari, Kari; Rautio, Riitta

doi:10.1136/neurintsurg-2021-017641

Cited by 10 publications

(13 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22 The incidence of perioperative ischemic events in early studies ranged from 10% to 30%, in cases in which a low dose of IIb/IIIa receptor antagonists was applied. 9,23 In our study, although perioperative ischemic events occurred in a relatively small number of cases-just 3 (7.3%)-the following issues should not be neglected. First, 1 patient who stopped tirofiban 12 hours after the procedure and was given a loading dose of dual-antiplatelet drugs suffered a cerebral embolism 24 hours later.…”

Section: Discussionmentioning

confidence: 63%

Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

Chen

Gong

You

et al. 2023

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVE The use of a flow diverter (FD) in the treatment of ruptured aneurysms is limited due to the increased risk of perioperative ischemia and hemorrhagic complications. Adjunctive coil embolization and an evidence-based antithrombotic regimen may improve therapeutic safety, although evidence from relevant clinical research is limited. The authors’ aim was to further assess the perioperative safety and long-term efficacy of this strategy. METHODS Data on patients with FD insertion and coil embolization were collected retrospectively at two centers. The perioperative antithrombotic regimen consists of intraoperative tirofiban and continues for 24 hours postoperatively, with the initiation of an orally administered dual-antiplatelet regimen 4 hours prior to tirofiban cessation, rather than purposeful preoperative antiplatelet therapy. Perioperative cerebral ischemia and hemorrhagic complications and long-term aneurysm occlusion rates were recorded to evaluate the safety and efficacy of the procedure, respectively. RESULTS In total, 67 cases were screened and 41 cases were ultimately included in this study. A total of 2 cases (4.9%) of perioperative cerebral hemorrhagic events occurred, 1 of which (2.4%) was attributable to rerupture of the aneurysm. Cerebral ischemic events were reported in 3 patients, including 1 with cortical thromboembolism and 2 with perforator occlusion of the basilar artery. A median 8-month follow-up was attained in 25 patients (61.0%), with a 92% complete or near-complete occlusion rate. CONCLUSIONS FD insertion combined with coil embolization is a potentially safe and effective therapeutic strategy for ruptured aneurysms when accompanied with perioperative evidence-based antithrombotic therapy.

show abstract

Section: Discussionmentioning

confidence: 63%

Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

Chen

Gong

You

et al. 2023

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…The use of flow diverters provides an excellent option for the endovascular treatment of intracranial pseudoaneurysms; however, their use does not come without risks. Complication rates have been reported around 17% with permanent morbidity rates and mortality rates of 3.7% and 2.8%, respectively [11]. Rates of rebleeding and ophthalmic artery occlusion have been reported at around 3% each [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Complication rates have been reported around 17% with permanent morbidity rates and mortality rates of 3.7% and 2.8%, respectively [11]. Rates of rebleeding and ophthalmic artery occlusion have been reported at around 3% each [11,12]. Other possible complications include ipsilateral stroke, stent migration/occlusion, thromboembolism, need for additional endovascular intervention, epistaxis, groin hemorrhage, gastrointestinal bleeding, and death.…”

Section: Discussionmentioning

confidence: 99%

Internal Carotid Artery Pseudoaneurysm After Transsphenoidal Pituitary Tumor Resection: A Case Report

Montagne¹,

Lloyd²,

Sagalow³

et al. 2023

Cureus

View full text Add to dashboard Cite

Here, we present a case report on internal carotid artery pseudoaneurysm (ICAP) which highlights a rare but potentially life-threatening complication of transsphenoidal pituitary surgery. A 32-year-old male underwent resection of a pituitary tumor and developed a large cerebrospinal fluid (CSF) leak during surgery, which was reconstructed with a fat graft and nasoseptal flap. Postoperatively, he was recovering well and discharged without complications; however, eight days after surgery he returned with massive epistaxis and hematemesis. This was initially managed with endoscopic exploration, nasal packing, and transfusion of blood products. Imaging revealed a pseudoaneurysm on the right internal carotid artery. The patient was started on aspirin and clopidogrel, and a flow diverter stent was placed without complications. Our case emphasizes the importance of prompt recognition and management of vascular injuries such as an internal carotid pseudoaneurysm after transsphenoidal pituitary surgery to prevent catastrophic outcomes.

show abstract

“…7 Intraluminal flow-diverters provide 90% occlusion with a low complication profile for unruptured IAs 8,9 ; however, they carry high risk of complications in treatments of acutely ruptured IAs. 10 Intrasaccular flow-diversion with the Woven EndoBridge (WEB) (Woven EndoBridge, WEB, Microvention, Tustin, CA, USA) is a treatment for wide-necked bifurcation aneurysms. The WEB is a self-expandable, retrievable, and detachable nitinol braided cage.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Woven EndoBridge for intracranial aneurysms: Radiological outcomes and factors influencing occlusions at 6 and 24 months

et al. 2022

Self Cite

View full text Add to dashboard Cite

Purpose To identify factors influencing short- and mid-term radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB). Methods A total of 112 patients were treated for IAs with the WEB in at our institution between 2013 and 2020. Patients with 6- and/or 24-months follow-up data were included in the study. Aneurysm occlusion was evaluated using the Raymond-Roy occlusion classification (RR). RR 1 and RR 2 were considered as adequate outcomes, while RR 3 inadequate. Results Data were available for 91 patients (56 females, 62%) at 6 months and 62 of those patients (39 females, 58%) at 24 months. The adequate occlusion (RR 1/RR 2) rate was 89% ( n = 81/91) at the 6-months follow-up and 91% ( n = 56/62) at the 24-months follow-up. The treatment-related morbidity rate was 4% ( n = 4/91), and mortality rate was 1% ( n = 1/91). The predictor for inadequate occlusion at the 6-months follow-up was the lobular shape of an aneurysm ( p = .01). The aneurysm’s height ( p = .02), maximal diameter ( p = .001), width ( p = .002), aspect ratio ( p = .03), dome-to-neck ratio ( p = .04), and lobular shape ( p= .03) were predictive factors for inadequate occlusion at 24 months. All the thrombosed aneurysms ( n = 3) showed unfavorable radiological outcomes and required re-treatment within 24 months. None of the patient-related factors were significant. Conclusions The WEB provides favorable occlusion rates and low complications for both ruptured and unruptured wide-necked IAs. Unfavorable radiological outcomes after WEB treatment may be related to aneurysm morphology and size.

show abstract

Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Cited by 10 publications

References 21 publications

Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

Internal Carotid Artery Pseudoaneurysm After Transsphenoidal Pituitary Tumor Resection: A Case Report

The Woven EndoBridge for intracranial aneurysms: Radiological outcomes and factors influencing occlusions at 6 and 24 months

Contact Info

Product

Resources

About