Intracranial stenting as monotherapy in subarachnoid hemorrhage and sickle cell disease

Ediriwickrema, Asiri; Williamson, Theresa; Hebert, Ryan; Matouk, Charles; Johnson, Michele H.; Bulsara, Ketan R.

doi:10.1136/neurintsurg-2011-010224

Cited by 13 publications

(3 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, surgery may be at risk in SCD because of increased skull vascularity, especially in moyamoya syndrome. In both treatment options, careful management of hydration status, total haemoglobin, and haemoglobin S levels is recommended . Patients 1 and 3 are the first reported successful coil embolization procedures in paediatric patients with SCD.…”

Section: Discussionmentioning

confidence: 99%

“…In both treatment options, careful management of hydration status, total haemoglobin, and haemoglobin S levels is recommended. [22][23][24] Patients 1 and 3 are the first reported successful coil embolization procedures in paediatric patients with SCD. In patients 2 and 5, because of aneurysm characteristics such as distal location and large neck, the only treatment that could have been offered would have been parent vessel occlusion with a stenting device, which is associated with a higher risk of downstream ischaemic stroke.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral haemorrhagic risk in children with sickle‐cell disease

Kossorotoff

Brousse²,

Grévent

et al. 2014

Develop Med Child Neuro

View full text Add to dashboard Cite

Aim To address risk of first or recurrent cerebral haemorrhage in children with sickle‐cell disease (SCD) who are being managed with modern stroke prevention strategies. Method A systematically followed SCD paediatric cohort was retrospectively studied over a 9‐year period. Haemorrhagic risk was defined as intracranial haemorrhage occurrence or intracranial aneurysm diagnosis during the study period. Ischaemic risk was defined as cerebrovascular ischaemic event occurrence or transcranial Doppler/magnetic resonance imaging hallmarks of ischaemic risk finding during the study period. Results Among the 251 patients in the cohort, 36 patients were included in the ischaemic group. Seven patients were included in the haemorrhagic group, of which five also met the criteria for the ischaemic group. Age at first haemorrhagic symptom/hallmark of risk was older (10.4 vs 6.2 years old, p=0.036). Nine intracranial saccular aneurysms were found, mostly on the posterior circulation. Two patients had endovascular embolization. Interpretation The ratio of ischaemic to haemorrhagic risk was not modified with modern management compared with historical series. Intracranial aneurysm in children with SCD had specific characteristics, close to intracranial aneurysms described in adults with SCD. Data favoured concurrent development of intracranial SCD‐associated anterior stenosis and posterior dilation, suggesting common pathophysiology and management strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cerebral haemorrhagic risk in children with sickle‐cell disease

Kossorotoff

Brousse²,

Grévent

et al. 2014

Develop Med Child Neuro

View full text Add to dashboard Cite

show abstract

“…In Ediriwickrema et al a ''blister''-like posterior cerebral artery (PCA) aneurysm was treated with a non-flowdiverting open cell stent (Neuroform 3) as monotherapy without coiling. 14 In their case, it was felt that given the acute SAH, clopidogrel should be given only during the intervention and not subsequently; however, the stent used was not a flow diverter, which has a greater thromboembolic risk. In the setting of a ruptured aneurysm, the use of dual antiplatelet therapy is complicated given that the aneurysm may not have immediately occluded and thrombosis is usually gradual.…”

Section: Discussionmentioning

confidence: 99%

Use of a flow-diverting stent for ruptured dissecting aneurysm treatment in a patient with sickle cell disease

et al. 2015

View full text Add to dashboard Cite

Introduction Sickle cell disease (SCD) is a clinical phenotype that presents a unique challenge to the interventionalist, particularly when stent therapy is contemplated. Homozygous individuals are likely at increased risk for thromboembolic complications. There are no formal guidelines regarding antiplatelet therapy in the short or long term for intracranial stent use in SCD. The authors describe the novel use of a pipeline embolization device (PED) to treat a ruptured dissecting bilobed/fusiform vertebral artery V4 aneurysm in an SCD patient complicated by tortuous proximal anatomy and the anterior spinal artery arising from the diseased segment. Considerations regarding antiplatelet therapy in this scenario are discussed. Case report A 50-year-old woman with homozygous recessive SCD was transported to the emergency department and presented with diffuse subarachnoid hemorrhage. CT angiography demonstrated a left-sided 3 × 5 mm fusiform bi-lobulated presumed dissecting vertebral artery aneurysm, immediately distal to the origin of the posterior inferior cerebellar artery (PICA). A PED was deployed within the V4 segment across the aneurysm. Post-treatment angiography showed patency of the parent artery, and patency of the “jailed” anterior spinal artery and of the PICA. Discussion Selecting a treatment method in SCD patients with a ruptured intracranial aneurysm is challenging and there are no clinical trials comparing treatment methods in this population. The authors demonstrate that flow diversion is feasible in SCD, which has not been described in the literature. Additionally, the case stresses the peri- and post-procedural management of SCD, as well as long-term considerations with a flow-diverting stent in place.

show abstract