Flow diversion treatment for acutely ruptured aneurysms

Abstract

Background and purposeFlow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.MethodsWe conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0–2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.ResultsAt follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3–6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size ≥20 mm and <20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).ConclusionFlow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.

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

“…In their multicenter observational study of 44 patients, ten Brinck et al reported a similar overall complication rate (45%). 10 In our study, the ischemic complication rate was 29%, which is notably higher than in previous reports. In a meta-analysis of 20 studies by Cognazzo et al, the rate of ischemic complications was reported as 8%.…”

“…Even though the overall rate of functional outcomes in the study by ten Brinck et al was 45% (n=20), aneurysm occlusion rates in the same study (93% vs 92% in our study) were similar to our study. 10 In our study, almost half of the ruptured aneurysms were either the blister-like or dissecting type. In the case of blisterlike, dissecting, and perforator aneurysms in posterior circulation, reconstructive treatment with FDs has been shown to be effective with an occlusion rate as high as 76%.…”

Comaneci-Assisted Coiling as a Treatment Option for Acutely Ruptured Wide Neck Cerebral Aneurysm: Case Series of 118 Patients

“…In terms of efficacy, the placement of flow diverter stent or other endoluminal adjunctive devices might lead to higher rates of complete occlusion in the long term. 33-35 The use of an intraluminal device in the acute setting is, however, a major concern due to the mandatory use of DAPT. Because of that, the stent placement is generally considered as a backup option in acutely ruptured cerebral aneurysms as its safety still remains controversial.…”

Non-visualizable stent-occlusion after treatment of a fusiform PCA-aneurysm–a case report

“…But recent innovations in endovascular treatment such as the flow-diverter provide new, solid options with fewer risks. However, this is only the second choice for acute ruptures because immediate aneurysm closure is rarely possible and the complication rate is increased [10] . That is why stent-assisted coiling was the treatment of choice in our case.…”