Long-Term Clinical and Imaging Follow-Up of Complex Intracranial Aneurysms Treated by Endovascular Parent Vessel Occlusion

Matouk, Charles; Kaderali, Zul; terBrugge, Karel G.; Willinsky, Robert A.

doi:10.3174/ajnr.a3079

Cited by 21 publications

(6 citation statements)

References 47 publications

(67 reference statements)

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“…This may result in altered flow dynamics that contributes to a higher risk for PAO. It is important to note that PAO has been one of the accepted treatments for large fusiform aneurysms although a complication rate of up to 28.6% has been reported 27. Furthermore, SILK intervention for fusiform aneurysms in our study was technically successful at the time of deployment and it is important to note that none of the patients who developed PAO in our series developed neurological deficits immediately after the treatment and/or on follow-up.…”

Section: Discussionmentioning

confidence: 53%

“…Despite previous literature reports, the timing of PAO, clinical impact, and risk factors have not been fully elucidated. It is important to note that PAO has been one of the accepted treatments for large fusiform aneurysms 27. The purpose of our study was to analyze our single center database of intracranial aneurysms treated with SILK flow diverters (SFDs) and assess for occurrences, clinical outcomes, and contributing risk factors for PAO.…”

Section: Introductionmentioning

confidence: 99%

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Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Macdonald

Shankar

2018

J NeuroIntervent Surg

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BackgroundThe efficacy of SILK flow diverters (SFD) in the management of cerebral aneurysms has been established. However, the risk of complications with parent artery occlusion (PAO) remains to be fully elucidated. The purpose of our study was to analyze intracranial aneurysms treated with SFDs and assess for occurrences and potential risk factors for PAO.Materials and methodsBetween September 2010 and September 2017, 34 patients were treated for intracranial aneurysms using SFDs at a Canadian institution. This database was retrospectively analyzed for frequency of PAOs and statistical analysis performed for potential contributing factors.ResultsFollowing treatment with SFDs, average clinical and imaging follow-ups were 31 and 22 months, respectively. PAOs were identified in 21% (7/34) of patients and occurred between 8 days and 1.5 years from intervention but only in 11.8% in those compliant to anti-platelet medications. These were all associated with anterior circulation aneurysms (P=0.131) and had no associated neurological deficits. Of these, 57% (4/7) had a fusiform morphology compared with only 19% (5/27) in non-occluded patients (P=0.039). The presence of clinical symptoms at the time of initial SFD intervention was significantly associated with PAO (P=0.021).ConclusionDelayed PAO is not an uncommon outcome of flow diverter deployment and could be seen up to 1.5 years after treatment with no associated neurological deficits. Anti-platelet non-adherence remains a risk factor for PAO. Fusiform morphology of the aneurysm and symptoms at the time of intervention were associated with subsequent occlusion.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Macdonald

Shankar

2018

J NeuroIntervent Surg

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“…6,8,9,14,15,22 Clinical improvement after parent carotid artery occlusion after balloon test occlusion is probably even higher, ranging from 73%-90%. 16,21,22 Treatment with an open-cell stent has been shown to ameliorate symptoms as well.…”

Section: Discussionmentioning

confidence: 99%

Resolution of cranial neuropathies following treatment of intracranial aneurysms with the Pipeline Embolization Device

Moon¹,

Albuquerque²,

Ducruet³

et al. 2014

JNS

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Object. Intracranial aneurysms, especially those of the cavernous segment of the internal carotid artery (ICA), can present with cranial nerve (CN) palsies. The Pipeline Embolization Device (PED) has demonstrated safety and efficacy in the treatment of cerebral aneurysms by flow diversion, but little data exist reporting the outcomes of cranial neuropathies following treatment with the device.Methods. The prospectively maintained Barrow Neurological Institute's endovascular database was reviewed for all patients treated with the PED after presenting with one or more CN palsies secondary to a cerebral aneurysm since May 2011. Patient charts and digital subtraction angiograms were reviewed to report clinical and angiographic outcomes. Only patients with clinical follow-up were included in the analysis.Results. A total of 127 patients were treated with the PED at the authors' institution after FDA approval. Twentytwo patients presented with cranial neuropathies, for initial inclusion in this study. Of these, 20 had sufficient followup for analysis. Cranial neuropathies included those of CN II, III, V, and VI, with presenting symptoms of diplopia, decreased visual acuity, and facial numbness and/or pain. Thirteen lesions were cavernous segment ICA aneurysms, whereas the remainder included supraclinoid and petrous segment ICA, posterior communicating artery, and basilar trunk aneurysms. At an average clinical follow-up of 9.55 months, 15 patients (75%) had resolution or significant improvement of their cranial neuropathies, and the remaining 5 had stable symptoms. Of the 18 patients with angiographic follow-up, 12 (66.7%) demonstrated complete obliteration or small neck residual, whereas 6 (33.3%) had residual lesion. Patients with complete or near-complete obliteration of their lesion were significantly more likely to demonstrate symptomatic improvement at follow-up (p = 0.009). Two patients with persistent symptoms were eventually treated with microsurgical bypass. Transient complications in this series included 6 (30%) extracranial hemorrhagic complications related to dual-antiplatelet therapy, all of which were managed medically. There was 1 delayed right ICA occlusion following retreatment that led to microsurgical bypass.Conclusions. Intracranial aneurysms presenting with one or more CN palsies show a high rate of clinical improvement after treatment with the PED. Clinical outcomes must be weighed against the risks and challenges faced with flow diverters. Further research is warranted for patients whose symptoms do not respond optimally to device placement.

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“…We treated the aneurysm with a flow-diverting stent. Parent vessel occlusion is feasible in cases of spontaneous hemorrhagic intracranial vertebrobasilar dissection, [12][13][14][15] especially in unilateral vertebral artery dissection with codominant vertebral arteries. In the present case the option of occluding the non-fused dissecting limb was considered; however, the concern was that ipsilateral brainstem infarction would occur due to occlusion of the perforators arising from the affected limb.…”

Section: Discussionmentioning

confidence: 99%

Flow diverter placement for management of dissecting ruptured aneurysm in a non-fused basilar artery

Saliou¹,

Power

Krings

2015

Interv Neuroradiol

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Intracranial vertebral artery dissection can be associated with subarachnoid hemorrhage (SAH) and pseudoaneurysm formation. Dissecting aneurysms have a high risk of rebleeding in the acute phase. To our knowledge, the management of an acute vertebrobasilar junction dissecting aneurysm associated with a basilar non-fusion has not been previously reported. We report here a case of SAH due to rupture of a dissecting aneurysm involving the vertebrobasilar junction and extending to involve the right limb and proximal junction of a non-fused basilar artery, managed by insertion of a flow-diverting stent with excellent clinical outcome and long-term patency of the flow diverter.

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Long-Term Clinical and Imaging Follow-Up of Complex Intracranial Aneurysms Treated by Endovascular Parent Vessel Occlusion

Cited by 21 publications

References 47 publications

Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Resolution of cranial neuropathies following treatment of intracranial aneurysms with the Pipeline Embolization Device

Flow diverter placement for management of dissecting ruptured aneurysm in a non-fused basilar artery

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