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Dmytriw AA, Salim HA, Musmar B, Cancelliere NM, Griessenauer CJ, Regenhardt RW, Jones J, Tutino V, Hasan Z, Limbucci N, Lay SV, Spears J, Rabinov JD, Harrigan MR, Siddiqui AH, Levy EI, Stapleton CJ, Renieri L, Cognard C, Shaikh H, Kühn AL, Möhlenbruch MA, Tjoumakaris SI, Jabbour P, Taussky P, Settecase F, Heran MKS, Nguyen A, Volders D, Harker P, Devia DA, Puri AS, Psychogios M, Puentes JC, Leone G, Buono G, Tarantino M, Muto M, Briganti F, Dalal S, Gontu V, Alcedo Guardia RE, Vicenty-Padilla JC, Brouwer P, Schmidt MH, Schirmer C, Pickett GE, Andersson T, Söderman M, Marotta TR, Cuellar-Saenz H, Thomas AJ, Patel AB, Mendes Pereira V, Adeeb N. Comparative Efficacy of Flow Diverter Devices in the Treatment of Carotid Sidewall Intracranial Aneurysms: a Retrospective, Multicenter Study. Clin Neuroradiol 2024:10.1007/s00062-024-01435-x. [PMID: 39023541 DOI: 10.1007/s00062-024-01435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline (Stryker Neurovascular, Fremont, California), is not directly established and largely inferred. PURPOSE This study aimed to compare the efficacy of different FDs in treating sidewall ICA intracranial aneurysms. METHODS We conducted a retrospective review of prospectively maintained databases from eighteen academic institutions from 2009-2016, comprising 444 patients treated with one of four devices for sidewall ICA aneurysms. Data on demographics, aneurysm characteristics, treatment outcomes, and complications were analyzed. Angiographic and clinical outcomes were assessed using various imaging modalities and modified Rankin Scale (mRS). Propensity score weighting was employed to balance confounding variables. The data analysis used Kaplan-Meier curves, logistic regression, and Cox proportional-hazards regression. RESULTS While there were no significant differences in retreatment rates, functional outcomes (mRS 0-1), and thromboembolic complications between the four devices, the probability of achieving adequate occlusion at the last follow-up was highest in Surpass device (HR: 4.59; CI: 2.75-7.66, p < 0.001), followed by FRED (HR: 2.23; CI: 1.44-3.46, p < 0.001), PED (HR: 1.72; CI: 1.10-2.70, p = 0.018), and Silk (HR: 1.0 ref. standard). The only hemorrhagic complications were with Surpass (1%). CONCLUSION All the first-generation devices achieved good clinical outcomes and retreatment rates in treating ICA sidewall aneurysms. Prospective studies are needed to explore the nuanced differences between these devices in the long term.
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Affiliation(s)
- Adam A Dmytriw
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital: Brigham, Boston, USA.
- Women's Hospital, Harvard University, Boston, MA, USA.
| | - Hamza Adel Salim
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
| | - Basel Musmar
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA
| | | | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Salzburg, Austria
| | - Robert W Regenhardt
- Department of Neuroradiology, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA, USA
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vincent Tutino
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zuha Hasan
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Nicola Limbucci
- Department of Neurosurgery and Neuroradiology, New York Presbyterian Hospital and Weill Cornell School of Medicine, New York, NY, USA
| | - Sovann V Lay
- Department of Neuroradiology, Centre Hospitalier de Toulouse, Toulouse, France
| | - Julian Spears
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - James D Rabinov
- Department of Neuroradiology, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA, USA
| | - Mark R Harrigan
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Adnan H Siddiqui
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elad I Levy
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher J Stapleton
- Department of Neuroradiology, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Hamza Shaikh
- Department of Neuroradiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Anna Luisa Kühn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Markus A Möhlenbruch
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Fabio Settecase
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anh Nguyen
- Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - David Volders
- Divisions of Neuroradiology & Neurosurgery, QEII Health Sciences Centre, Dalhousie Medical School, Halifax, NS, USA
| | - Pablo Harker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Diego A Devia
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana School of Medicine Bogotá, Bogotá, Colombia
| | - Ajit S Puri
- Department of Neuroradiology, UMass Memorial Hospital, Worcester, MA, USA
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Juan C Puentes
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana School of Medicine Bogotá, Bogotá, Colombia
| | - Giuseppe Leone
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples, Italy
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Giuseppe Buono
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Margherita Tarantino
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Mario Muto
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples, Italy
| | - Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples, Italy
| | - Shamsher Dalal
- Departments of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA
| | - Vamsi Gontu
- Departments of Neuroradiology and Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | | | - Juan C Vicenty-Padilla
- Department of Neurosurgery, University of Puerto Rico, School of Medicine, San Juan, PR, USA
| | - Patrick Brouwer
- Departments of Neuroradiology and Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Matthias H Schmidt
- Divisions of Neuroradiology & Neurosurgery, QEII Health Sciences Centre, Dalhousie Medical School, Halifax, NS, USA
| | - Clemens Schirmer
- Departments of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA
| | - Gwynedd E Pickett
- Divisions of Neuroradiology & Neurosurgery, QEII Health Sciences Centre, Dalhousie Medical School, Halifax, NS, USA
| | - Tommy Andersson
- Departments of Neuroradiology and Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Söderman
- Departments of Neuroradiology and Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas R Marotta
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hugo Cuellar-Saenz
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA
| | - Ajith J Thomas
- Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA
| | - Aman B Patel
- Department of Neuroradiology, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA, USA
| | - Vitor Mendes Pereira
- Department of Neuroradiology, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA
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Ramirez-Velandia F, Enriquez-Marulanda A, Filo J, Young M, Fodor TB, Sconzo D, Muram S, Granstein JH, Shutran M, Taussky P, Ogilvy CS. Thromboembolic Events in the Posterior Circulation After Flow Diversion-A Closer Look at Coverage of the Posterior Cerebral Artery. World Neurosurg 2024; 187:e920-e928. [PMID: 38734173 DOI: 10.1016/j.wneu.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Flow diversion for bifurcation aneurysms requires excluding one of the branches from the parent artery, raising concern for ischemic events. We evaluated thromboembolic events and their relationship with covering the origin of the posterior cerebral artery (PCA). METHODS This retrospective analysis included patients with confirmed basilar and proximal PCA aneurysms treated with flow diversion between 2013 and 2023. Procedures were classified according to the coverage of the origin of the PCA. Thromboembolic events associated with the excluded PCA were evaluated. RESULTS Of the total 28 aneurysms included, 7 were at the basilar tip, 16 in the basilar trunk, and 5 in the first segment of the PCA; 15 were treated by excluding one of the PCAs. Dual antiplatelet therapy included aspirin and ticagrelor (57.1%), aspirin and clopidogrel (35.7%), or aspirin and prasugrel (3.57%). Complete and near-complete aneurysm occlusion was achieved in 80.8% of the aneurysms treated at a median follow-up of 12.31 months. Thromboembolic complications occurred in 3 patients (2 with basilar perforator stroke and 1 with basilar in-stent thrombosis). However, the difference in these events was not statistically significant between patients with PCA coverage and those without (P = 0.46). Diminished flow and a lack of flow was seen in 8 and 7 of the covered vessels, respectively. A modified Rankin scale score of ≤2 was reported for 89.3% of patients at a median clinical follow-up of 5.5 months. CONCLUSIONS The incidence of thromboembolic events is high in distal basilar and proximal PCA aneurysms; however, PCA coverage was not associated with their occurrence. There was no difference in postprocedural disability between patients whose aneurysms were treated by excluding one of the PCAs and those who were not.
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Affiliation(s)
- Felipe Ramirez-Velandia
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jean Filo
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Young
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas B Fodor
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Sconzo
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sandeep Muram
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin H Granstein
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Max Shutran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Philipp Taussky
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Greco E, Ghaith AKA, Rios-Zermeno J, Ghanem M, Perez-Vega C, Kashyap S, Freeman WD, Miller DA, Huynh TJ, Bydon M, Middlebrooks EH, Sandhu SJS, Tawk RG. Long-Term Safety and Efficacy of Pipeline Embolization Device in Anterior and Posterior Circulation Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 185:103-112. [PMID: 38307200 DOI: 10.1016/j.wneu.2024.01.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Flow diversion using the pipeline embolization device (PED) has been a paradigm shift for anterior circulation (AC) aneurysms. However, only a few studies report the long-term (≥1 year) angiographic and clinical outcomes for posterior circulation (PC) aneurysms. This study aims to compare the long-term safety and efficacy of treatment of AC and PC aneurysms with PED. METHODS The databases included Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane, and Scopus. Studies with at least 10 patients and 1-year follow-up were included. Twenty-four studies met our inclusion criteria. A random effect meta-analysis was performed to estimate the ischemic and hemorrhagic complications. A meta-analysis of proportions was performed to estimate the pooled rates of long-term complete aneurysmal occlusion, symptomatic stroke, aneurysmal rupture, and intracranial hemorrhage. RESULTS There were 1952 aneurysms, of which 1547 (79.25%) were in the AC and 405 (20.75%) in the PC. The 1-year occlusion rate was 78% in AC compared to 73% in PC aneurysms (P < 0.01). The symptomatic infarct rate was 5% in AC compared to 13% in PC (P < 0.01). While the rupture rate was 1% in AC compared to 4% in PC (P = 0.01), the rate of intracranial hemorrhage was 2% for both (P = 0.99). CONCLUSIONS The long-term occlusion rate after PED was higher in AC aneurysms, and the cumulative incidence of stroke and aneurysm rupture was higher in PC aneurysms.
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Affiliation(s)
- Elena Greco
- Research Fellow in the Department of Radiology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA; Research Fellow in the Department of Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Abdul Karim A Ghaith
- Research Fellow in the Neuro-Informatics Laboratory, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jorge Rios-Zermeno
- Research Fellow in the Department of Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Carlos Perez-Vega
- Resident in the Department of Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Samir Kashyap
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - W David Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurology, and Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - David A Miller
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Thien J Huynh
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik H Middlebrooks
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
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Bocanegra-Becerra JE, Acha Sánchez JL, Contreras Montenegro L. Microsurgery for brain aneurysms in an accessory A2 and basilar arteries: a rare case presentation and surgical video. J Surg Case Rep 2024; 2024:rjad742. [PMID: 38239374 PMCID: PMC10795898 DOI: 10.1093/jscr/rjad742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024] Open
Abstract
We present the case of a 58-year-old male with a 3-day history of sudden onset headache, loss of consciousness, and uncontrolled vomiting. The patient had 3/5 quadriparesis and a Glasgow coma scale (GCS) score of 8, which merited neurocritical intensive care. Brain imaging suggested the presence of two lesions: (i) a fusiform aneurysm of 12 × 7 mm in an accessory A2 artery of the anterior cerebral artery and (ii) an unruptured saccular aneurysm of 3.3 × 2.8 mm in the distal segment of the basilar artery. He was deemed a candidate for microsurgical management. Postoperatively, he had 4/5 quadriparesis, paresis of the right oculomotor nerve, and a GCS score of 13. A 3-month follow-up showed a significant improvement in neurological function with a score of 2 on the modified Rankin scale. The presented case illustrates the relevance of a nuanced acquaintance to operate in diseased anatomical variants and complex pathologies of narrow corridors.
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Affiliation(s)
| | - José Luis Acha Sánchez
- Vascular Neurosurgery and Skull Base Division, Department of Neurosurgery, Hospital Nacional Dos de Mayo, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Luis Contreras Montenegro
- Vascular Neurosurgery and Skull Base Division, Department of Neurosurgery, Hospital Nacional Dos de Mayo, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Zhou M, Wu Z, Maalim AA, Zeng Y, Guo X, Zhang Z, Yuan X, Enos ZM, Shu K, Lei T, Zhu M. Overlapping Stent Treatment for Ruptured Dissecting Aneurysms in Posterior Circulation. Brain Sci 2023; 13:1507. [PMID: 38002469 PMCID: PMC10669846 DOI: 10.3390/brainsci13111507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
Ruptured dissecting aneurysms in posterior intracranial circulation present significant clinical challenges and often cause poor prognoses. Our cohort used overlapping stents as the primary treatment. We analyzed the medical records of 27 patients (18 men/nine women) with ruptured posterior circulation dissecting aneurysms (PCDAs). Their average age was 52 years. We selected 11 patients who used Enterprise (EP) and LVIS stents overlappingly and matched them 1:1 with counterparts who received either EP or LVIS stents individually. Overlapping stents was a feasible treatment in all 27 cases. We successfully followed up 26 patients for ≥6 months. Regrettably, one patient died from intracranial hypertension on Day 7 post-procedure. Immediate post-procedure angiographies indicated Raymond grade I, II, and III occlusions of PCDAs in 16 (59.3%), 7 (25.9%), and 4 (14.8%) cases, respectively. At an average follow-up duration of 16.2 months, 25 patients (96.2%) had modified Rankin Scale scores of 0-2, signifying positive outcomes. One patient (3.8%) had a score of 3-4. Recurrence rates for the EP and LVIS stent groups were higher than those of the overlapping stent group (45.45% vs. 9.09%, p = 0.15 and 27.27% vs. 9.09%, p = 0.59, respectively). No significant difference in recurrence rates existed between the overlapping and single-stent groups. Similarly, follow-up outcomes were consistent between the two groups. Overlapping stents could be an efficient method for treating ruptured PCDAs.
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Affiliation(s)
- Minghui Zhou
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Zengbao Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Ali Abdi Maalim
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Ying Zeng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Xiao Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Zhenhua Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Xiaohong Yuan
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Zacharia Majaliwa Enos
- Department of Neurosurgery, Tongji Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430030, China;
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Mingxin Zhu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
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Qi P, Tong X, Liang X, Xue X, Wu Z, Feng X, Zhang M, Jiang Z, Wang D, Liu A. Flow diversion for posterior circulation aneurysms: a multicenter retrospective study. Ther Adv Neurol Disord 2023; 16:17562864231176187. [PMID: 37324979 PMCID: PMC10262625 DOI: 10.1177/17562864231176187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/29/2023] [Indexed: 06/17/2023] Open
Abstract
Background The prevalence of intracranial aneurysms is approximately 3% worldwide. Posterior circulation (PC) aneurysms have a higher risk of treatment complications than anterior circulation aneurysms. Improving the survival rate and quality of life of patients with PC aneurysms remains one of the most important issues in the field. Objectives Flow diverter (FD) treatment of PC aneurysms remains controversial. We aimed to investigate the effects of FD treatment and analyze differences among different application methods or aneurysm types in PC aneurysms. Design This is a multicenter retrospective study. Methods Patients with PC aneurysms treated with the pipeline embolization device (PED) or Tubridge embolization device (TED) between 2015 and 2020 in five neurovascular centers were retrospectively enrolled. The primary outcomes were major perioperative complication, clinical outcome, and aneurysm occlusion rates. Univariable and multivariable logistic regression analyses were used to determine the risk factors of each outcome. Results In total, 252 aneurysms were included. Major perioperative complication, favorable clinical outcome, and complete occlusion rates were 7.5%, 91.0%, and 79.1%, respectively. Compared with other types of aneurysms, dissecting aneurysms had the best clinical outcome and highest occlusion rate. Both clinical and angiographic outcomes were independently associated with the aneurysm location at the basilar artery. Aneurysm size was not associated with any outcome. TED had similar clinical and angiographic outcomes compared with PED but more perioperative major complications. Tandem treatment and coiling assistance may have poorer clinical outcomes but similar occlusion rates. Single- and multiple-stent treatments had similar outcomes. Conclusion FD treatment of PC aneurysms achieved favorable clinical outcomes and long-term aneurysm occlusion rates with acceptable perioperative complication rates, especially in dissecting and non-basilar artery aneurysms. There was no additional improvement in outcomes with coiling assistance, multi-stent application, or tandem treatment. Therefore, the use of PC aneurysms should be carefully considered.
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Affiliation(s)
- Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Liang
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaopeng Xue
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongxue Wu
- Neurointerventional Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of the Education Ministry of China on the Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Meng Zhang
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Zhiqun Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1, Dongdan Dahua Road, Dongcheng District, Beijing 100005, China
| | - Aihua Liu
- Neurointerventional Center, Department of Neurointervention, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 119 Fanyang Road, Fengtai District, Beijing 100070, China
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7
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Zhang H, Zhang H, Liu J, Song D, Zhao Y, Guan S, Maimaitili A, Wang Y, Feng W, Wang Y, Wan J, Mao G, Shi H, Luo B, Shao Q, Chang K, Zhang Q, He Y, Zhang P, Yang X, Li L, Li TX. Pipeline Embolization Device for Small and Medium Vertebral Artery Aneurysms: A Multicenter Study. Neurosurgery 2023; 92:971-978. [PMID: 36700744 PMCID: PMC10158919 DOI: 10.1227/neu.0000000000002319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pipeline embolization devices (PEDs) have been increasingly used for the treatment of posterior circulation aneurysms. OBJECTIVE To investigate the safety and efficacy of PED in the treatment of small to medium unruptured vertebral artery intracranial aneurysms (VAIAs). METHODS Data from 76 patients with 78 unruptured small and medium (≤12 mm) VAIAs were analyzed. Data for this study come from the PLUS study, which was conducted at 14 centers in China from 2014 to 2019. Univariate analyses were performed to evaluate predictors of the occlusion and complication. RESULTS Seventy-eight aneurysms in 76 patients were treated with PED. The mean aneurysm size was 8.28 ± 2.13 mm, and all PEDs were successfully placed. The median follow-up was 7 months and available for 67 (85.9%) aneurysms. Complete occlusion was seen in 60 (89.6%) aneurysms, which 86.6% met the primary efficacy outcome. All patients received clinical follow-up, the combined major morbidity and mortality was 2.6%, and 98.7% of patients had a good prognosis. Ischemic stroke occurred in 10.5% of patients, and adjuvant coil and successful after adjustment were predictors of ischemic stroke in the early postoperative and follow-up, respectively. There was no significant difference in the occlusion rate of aneurysm involving posterior inferior cerebellar artery ( P = .78). In cases where posterior inferior cerebellar artery was covered by PED, there was no significant difference in ischemic stroke. CONCLUSION In the treatment of unruptured ≤12 mm VAIAs, PED has a high surgical success rate, a high degree of occlusion, and low morbidity and mortality. PED may be a promising endovascular technique.
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Affiliation(s)
- Hongyun Zhang
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan province, China
- Neurosurgery Department of Stroke Center, Henan Provincial People's, Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianmin Liu
- Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Donglei Song
- Shanghai Donglei Brain Hospital, Shanghai, China
| | - Yuanli Zhao
- Peking University International Hospital, Beijing, China
| | - Sheng Guan
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Aisha Maimaitili
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yunyan Wang
- Qilu Hospital of Shandong University, Jinan, China
| | - Wenfeng Feng
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Wang
- First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jieqing Wan
- Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guohua Mao
- Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huaizhang Shi
- First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bin Luo
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiuji Shao
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan province, China
- Neurosurgery Department of Stroke Center, Henan Provincial People's, Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Kaitao Chang
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan province, China
- Neurosurgery Department of Stroke Center, Henan Provincial People's, Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Qianqian Zhang
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan province, China
- Neurosurgery Department of Stroke Center, Henan Provincial People's, Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Yingkun He
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan province, China
- Neurosurgery Department of Stroke Center, Henan Provincial People's, Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan province, China
- Neurosurgery Department of Stroke Center, Henan Provincial People's, Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Tian xiao Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan province, China
- Neurosurgery Department of Stroke Center, Henan Provincial People's, Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
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8
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Turhon M, Kang H, Li M, Liu J, Zhang Y, Zhang Y, Huang J, Luo B, Liu J, Zhang H, Li T, Song D, Zhao Y, Guan S, Aximujiang A, Maimaitili A, Wang Y, Feng W, Wang Y, Wan J, Mao G, Shi H, Zhang X, Gu Y, Yang X. Treatment of fusiform aneurysms with a pipeline embolization device: a multicenter cohort study. J Neurointerv Surg 2023; 15:315-320. [PMID: 35354575 DOI: 10.1136/neurintsurg-2021-018539] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/10/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intracranial fusiform aneurysms are less common than saccular aneurysms, but are associated with higher mortality and morbidity. We conducted this study to determine the safety and efficacy of the pipeline embolization device (PED) to treat intracranial fusiform aneurysms. METHODS This was a multicenter, retrospective, and observational study. Data for this study came from the PLUS study conducted from 2014 to 2019 across 14 centers in China. Univariate and multivariable logistic regression analyses were performed to evaluate predictors of the occlusion rate and complication. RESULTS A total of 1171 consecutive patients with 1322 intracranial aneurysms participated in this study. Among the participants, 104 patients with 109 fusiform aneurysms were eligible for this analysis (mean age 49 years, 36.5% women, aneurysm mean size 14.7 mm, 55% in the posterior circulation, and 6% in the basilar artery). Mean follow-up time was 9.0 months (range 3-36 months). The last DSA angiographic follow-up was available for 85 patients, and 58 aneurysms (68.2%) were completely occluded. The overall complication rate and mortality were 17.3% and 2.8%, respectively. Multivariate analysis demonstrated that age (OR=1.007, p=0.037) and cerebral atherosclerosis (OR=1.441, p=0.002) were associated with incomplete occlusion of fusiform aneurysms after PED treatment. CONCLUSION PEDs may be an effective treatment for intracranial fusiform aneurysms, with a favorable occlusion rate. However, because these treatments have a relatively high rate of complications, PED treatment for fusiform aneurysms should be carefully and strictly controlled. Our analysis showed that PEDs with adjunctive coiling did not significantly improve the occlusion rate of fusiform aneurysms.
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Affiliation(s)
- Mirzat Turhon
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huibin Kang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mengxing Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jiliang Huang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bin Luo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurosurgery, Peking University International Hospital, Beijing, People's Republic of China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Shanghai, Shanghai, People's Republic of China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tianxiao Li
- Department of Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Donglei Song
- Department of Neurosurgery, Shanghai Donglei Brain Hospital, Shanghai, People's Republic of China
| | - Yuanli Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, People's Republic of China
| | - Sheng Guan
- Department of Intervention Neuroradiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Axir Aximujiang
- Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, People's Republic of China
| | - Aisha Maimaitili
- Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, People's Republic of China
| | - Yunyan Wang
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Wenfeng Feng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yang Wang
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,Department of Neurosurgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jieqing Wan
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Shanghai, People's Republic of China
| | - Guohua Mao
- Department of Neurosurgery, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Huaizhang Shi
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Xiaolong Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, Shanghai, People's Republic of China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, Shanghai, People's Republic of China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China .,Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
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9
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Li W, Zhu W, Wang Y, Zhao Y, Wang Y, Liu X, Zhang Y. Stent-alone treatment of unruptured vertebral artery fusiform aneurysms: A comparison of flow diverter and conventional stents. Front Neurol 2022; 13:1012382. [DOI: 10.3389/fneur.2022.1012382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTreatment of vertebral artery fusiform aneurysms (VAFAs) is complex and controversial. This study aimed to compare the safety and efficacy between flow diverter and conventional stents in patients with VAFAs undergoing endovascular stent-alone treatment (SAT).MethodsThirty-six patients with 36 VAFAs who underwent SAT between January 2014 and December 2018 were retrospectively analyzed. Patient and aneurysm characteristics, procedural details, complications, and angiographic and clinical outcomes were compared between flow diverter stent patients (n = 22) and conventional stent patients (n = 14).ResultsMore branches covered with stent were found in the conventional stent group (88.9 vs. 33.3%; p = 0.008). The number of stents placed was significantly higher in the conventional stent group (1.57 ± 0.76 vs. 1.09 ± 0.29; p = 0.016). The proportion of patients with significant or moderate stasis within the aneurysm immediately after stent placement was higher in the flow diverter stent group (95.5 vs. 57.1%; p = 0.004). The proportion of patients with complete obliteration or only a residual neck on follow-up angiography was significantly higher in the flow diverter stent group (86.3 vs 50.0%; p = 0.047). However, the incidence of parent artery stenosis or occlusion was also higher in the flow diverter stent group (27.3% vs. zero; p = 0.032). The rate of complications did not significantly differ between the groups.ConclusionsSAT was safe and effective in patients with VAFAs. Flow diverter stents are associated with a significantly better complete occlusion rate than conventional stents; however, they are also associated with an increased risk of parent artery stenosis.
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10
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Adeeb N, Dibas M, Griessenauer CJ, Cuellar HH, Salem MM, Xiang S, Enriquez-Marulanda A, Hong T, Zhang H, Taussky P, Grandhi R, Waqas M, Aldine AS, Tutino VM, Aslan A, Siddiqui AH, Levy EI, Ogilvy CS, Thomas AJ, Ulfert C, Möhlenbruch MA, Renieri L, Bengzon Diestro JD, Lanzino G, Brinjikji W, Spears J, Vranic JE, Regenhardt RW, Rabinov JD, Harker P, Müller-Thies-Broussalis E, Killer-Oberpfalzer M, Islak C, Kocer N, Sonnberger M, Engelhorn T, Kapadia A, Yang VXD, Salehani A, Harrigan MR, Krings T, Matouk CC, Mirshahi S, Chen KS, Aziz-Sultan MA, Ghorbani M, Schirmer CM, Goren O, Dalal SS, Finkenzeller T, Holtmannspötter M, Buhk JH, Foreman PM, Cress MC, Hirschl RA, Reith W, Simgen A, Janssen H, Marotta TR, Stapleton CJ, Patel AB, Dmytriw AA. Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study. AJNR Am J Neuroradiol 2022; 43:1615-1620. [PMID: 36229166 PMCID: PMC9731249 DOI: 10.3174/ajnr.a7679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
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Affiliation(s)
- N Adeeb
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M Dibas
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - C J Griessenauer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - H H Cuellar
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M M Salem
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - S Xiang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - A Enriquez-Marulanda
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - T Hong
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - H Zhang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - P Taussky
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - R Grandhi
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - M Waqas
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A S Aldine
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - V M Tutino
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A Aslan
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - A H Siddiqui
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - C S Ogilvy
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- Department of Neurological Surgery (A.J.T.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - C Ulfert
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - M A Möhlenbruch
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - L Renieri
- Department of Interventional Neuroradiology (L.R.), University of Florence, Florence, Italy
| | - J D Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - G Lanzino
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - J Spears
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - J E Vranic
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R W Regenhardt
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J D Rabinov
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Harker
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E Müller-Thies-Broussalis
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - M Killer-Oberpfalzer
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - C Islak
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - N Kocer
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Sonnberger
- Department of Neuroradiology (M.S.), Kepler Universitätsklinikum Linz, Linz, Austria
| | - T Engelhorn
- Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany
| | - A Kapadia
- Departments of Medical Imaging and Neurosurgery (A.K.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
| | - A Salehani
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M R Harrigan
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - T Krings
- Division of Interventional Neuroradiology (T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - C C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut
| | - S Mirshahi
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K S Chen
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M A Aziz-Sultan
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Ghorbani
- Division of Vascular and Endovascular Neurosurgery (M.G.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - C M Schirmer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - O Goren
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - S S Dalal
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - T Finkenzeller
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
| | - M Holtmannspötter
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
- Department of Neuroradiology (M.H.), Klinikum Weiden, Weiden, Germany
| | - J-H Buhk
- Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - P M Foreman
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - M C Cress
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - R A Hirschl
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - W Reith
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Simgen
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - H Janssen
- Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany
| | - T R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C J Stapleton
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A B Patel
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A A Dmytriw
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Siddiqui AH, Monteiro A, Hanel RA, Kan P, Mohanty A, Cortez GM, Rabinovich M, Matouk C, Sujijantarat N, Romero C, Stone J, Ebersole K, Fry L, Natarajan SK, Owusu-Adjei B, Ortega-Gutierrez S, Vivanco-Suarez J, Wakhloo AK, Levy EI. Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters. J Neurointerv Surg 2022:jnis-2022-019151. [DOI: 10.1136/jnis-2022-019151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022]
Abstract
BackgroundDolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries high risk of perforator occlusion and progression of brainstem compression. Elaborate antithrombotic strategies are needed to preserve perforator patency while vessel remodeling occurs. We compared triple therapy (TT (DAPT plus oral anticoagulation)) and DAPT alone in patients with DVBFAs treated with FD.MethodsRetrospective comparison of DAPT and TT in patients with DVBFAs treated with FD at eight US centers.ResultsThe groups (DAPT=13, TT=14) were similar in age, sex, clinical presentation, baseline disability, and aneurysm characteristics. Radial access use was significantly higher in the TT group (71.4% vs 15.3%; P=0.006). Median number of flow diverters and adjunctive coiling use were non-different between groups. Acute ischemic stroke rate during the oral anticoagulation period was lower in the TT group than the DAPT group (7.1% vs 30.8%; P=0.167). Modified Rankin Scale score decline was significantly lower in the TT group (7.1% vs 69.2%; P=0.001). Overall rates of hemorrhagic complications (TT, 28.6% vs DAPT, 7.7%; P=0.162) and complete occlusion (TT, 25% vs DAPT, 54.4%; P=0.213) were non-different between the groups. Rate of moderate-to-severe disability at last follow-up was significantly lower in the TT group (21.4% vs 76.9%; P=0.007).ConclusionsPatients with DVBFAs treated with FD in the TT group had fewer ischemic strokes, less symptom progression, and overall better outcomes at last follow-up than similar patients in the DAPT group.
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12
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Adeeb N, Dibas M, Diestro JDB, Cuellar-Saenz HH, Sweid A, Kandregula S, Lay SV, Guenego A, Renieri L, Sundararajan SH, Saliou G, Aslan A, Möhlenbruch M, Vranic JE, Regenhardt RW, Savardekar A, Mamilly A, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Waqas M, Parra Farinas C, Tutino VM, Inoue Y, Mirshahi S, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Sporns P, Brehm A, Jones J, Psychogios M, Spears J, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Stapleton CJ, Siddiqui A, Ducruet AF, Albuquerque FC, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Limbucci N, Jabbour P, Cognard C, Patel AB, Dmytriw AA. Multicenter Study for the Treatment of Sidewall versus Bifurcation Intracranial Aneurysms with Use of Woven EndoBridge (WEB). Radiology 2022; 304:372-382. [DOI: 10.1148/radiol.212006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
Posterior circulation aneurysms have a higher tendency to rupture and become symptomatic in comparison to anterior circulation aneurysms. Current treatment modalities for aneurysms in these locations vary widely including microsurgical clipping, trapping with bypass, wrapping, and various endovascular methods such as coiling, balloon or stent-assisted coiling, flow diversion, and vessel sacrifice, among others.Overall, surgical versus endovascular treatment of posterior circulation aneurysms continue to be a controversial topic in cerebrovascular neurosurgery. At our center, multi-disciplinary assessments including surgeons capable of both endovascular and microsurgical treatments of these aneurysms are employed to guide the treatment strategies. As advancements in both fields are made, this will continue to be a topic for debate. Anatomy and individual patient's characteristics will dictate the correct approach and therefore proficiency in the microsurgical techniques required to treat these aneurysms will continue to be both relevant and important.
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Affiliation(s)
- Demi Dawkins
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Sima Sayyahmelli
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA.
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14
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Musmar B, Adeeb N, Ansari J, Sharma P, Cuellar HH. Endovascular Management of Hemorrhagic Stroke. Biomedicines 2022; 10:biomedicines10010100. [PMID: 35052779 PMCID: PMC8772870 DOI: 10.3390/biomedicines10010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Significant advances in endovascular neurosurgery tools, devices, and techniques are changing the approach to the management of acute hemorrhagic stroke. The endovascular treatment of intracranial aneurysms emerged in the early 1990s with Guglielmi detachable coils, and since then, it gained rapid popularity that surpassed open surgery. Stent-assisted coiling and balloon remodeling techniques have made the treatment of wide-necked aneurysms more durable. With the introduction of flow diverters and flow disrupters, many aneurysms with complex geometrics can now be reliably managed. Arteriovenous malformations and fistulae can also benefit from endovascular therapy by embolization using n-butyl cyanoacrylate (NBCA), Onyx, polyvinyl alcohol (PVA), and coils. In this article, we describe the role of endovascular treatment for the most common causes of intracerebral and subarachnoid hemorrhages, particularly ruptured aneurysms and vascular malformations.
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Alwakeal A, Shlobin NA, Golnari P, Metcalf-Doetsch W, Nazari P, Ansari SA, Hurley MC, Cantrell DR, Shaibani A, Jahromi BS, Potts MB. Flow Diversion of Posterior Circulation Aneurysms: Systematic Review of Disaggregated Individual Patient Data. AJNR Am J Neuroradiol 2021; 42:1827-1833. [PMID: 34385140 DOI: 10.3174/ajnr.a7220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/29/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Experience with endoluminal flow diversion for the treatment of posterior circulation aneurysms is limited. PURPOSE We sought to investigate factors associated with the safety and efficacy of this treatment by collecting disaggregated patient-level data from the literature. DATA SOURCES PubMed, EMBASE, and Ovid were searched up through 2019 for articles reporting flow diversion of posterior circulation aneurysms. STUDY SELECTION Eighty-four studies reported disaggregated data for 301 separate posterior circulation aneurysms. DATA ANALYSIS Patient, aneurysm, and treatment factors were collected for each patient. Outcomes included the occurrence of major complications, angiographic occlusion, and functional outcomes based on the mRS. DATA SYNTHESIS Significant differences in aneurysm and treatment characteristics were seen among different locations. Major complications occurred in 22%, angiographic occlusion was reported in 65% (11.3 months of mean follow-up), and good functional outcomes (mRS 0-2) were achieved in 67% (13.3 months of mean follow-up). Multivariate analysis identified age, number of flow diverters used, size, and prior treatment to be associated with outcome measures. Meta-analysis combining the current study with prior large nondisaggregated series of posterior circulation aneurysms treated with flow diversion found a pooled incidence of 20% (n = 712 patients) major complications and 75% (n = 581 patients) angiographic occlusions. LIMITATIONS This study design is susceptible to publication bias. Use of antiplatelet therapy was not uniformly reported. CONCLUSIONS Endoluminal flow diversion is an important tool in the treatment of posterior circulation aneurysms. Patient age, aneurysm size, prior treatment, and the number of flow diverters used are important factors associated with complications and outcomes.
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Affiliation(s)
- A Alwakeal
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - N A Shlobin
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - P Golnari
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - W Metcalf-Doetsch
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - P Nazari
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - S A Ansari
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - M C Hurley
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - D R Cantrell
- Department of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Shaibani
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - B S Jahromi
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - M B Potts
- From the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Liu X, Bao K, Luo W, Wan W, Peng T, Huang C. Flow diverters for the posterior inferior cerebellar artery aneurysms: A systematic review and a single-arm meta-analysis. Interv Neuroradiol 2021; 28:482-488. [PMID: 34519241 PMCID: PMC9326854 DOI: 10.1177/15910199211035902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment of posterior inferior cerebellar artery aneurysms is controversial. Recently, flow diverters have emerged as an attractive treatment option. Here, we performed a systematic review and meta-analysis of the angiographic and clinical outcomes of flow diverter-treated posterior inferior cerebellar artery aneurysms. METHODS We searched the PubMed, EMBASE and Web of Science databases for studies published from inception to January 2021. We included studies that described flow diverters procedures for posterior inferior cerebellar artery aneurysms with ≥2 patients. The outcomes were the complete occlusion rate and flow diverter-related complication rate. Meta-analysis was performed using a random or fixed effects model based on heterogeneity. RESULTS We included six studies involving 46 posterior inferior cerebellar artery aneurysms. There were 14 ruptured aneurysms. All flow diverters were successfully released and the technical success rate was 100%. The complete occlusion rate was 81% (95% confidence interval = 65-93%; I2 = 0.00%; P < 0.01). The flow diverter-related complication rate was 18% (95% confidence interval = 5-36%; I2 = 0.00%; P < 0.01). One patient died of rebleeding. The mortality rate was <1% (95% confidence interval = -1-1%; I2 = 0.00%; P = 0.951). CONCLUSIONS Treatment of posterior inferior cerebellar artery aneurysms with flow diverters is feasible and carries a high degree of technical success. However, this treatment is underutilized in patients with posterior inferior cerebellar artery aneurysms due to a higher complication rate and lower occlusion rate compared with clipping and traditional endovascular treatment. Further well-designed prospective and randomized studies are required to fully understand the effects of flow diverters especially in posterior inferior cerebellar artery aneurysms patients requiring endovascular treatment.
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Affiliation(s)
- Xiang Liu
- Department of Neurosurgery, 556508The Affiliated Hospital of Southwest Medical University, P.R. China.,Sichuan Clinical Research Centre for Neurosurgery, P.R. China.,Academician (Expert) Workstation of Sichuan Province, P.R. China
| | - Kunyang Bao
- Department of Neurosurgery, 556508The Affiliated Hospital of Southwest Medical University, P.R. China.,Sichuan Clinical Research Centre for Neurosurgery, P.R. China.,Academician (Expert) Workstation of Sichuan Province, P.R. China
| | - Wenzhang Luo
- Department of Neurosurgery, 556508The Affiliated Hospital of Southwest Medical University, P.R. China.,Sichuan Clinical Research Centre for Neurosurgery, P.R. China.,Academician (Expert) Workstation of Sichuan Province, P.R. China
| | - Weifeng Wan
- Department of Neurosurgery, 556508The Affiliated Hospital of Southwest Medical University, P.R. China.,Sichuan Clinical Research Centre for Neurosurgery, P.R. China.,Academician (Expert) Workstation of Sichuan Province, P.R. China
| | - Tangming Peng
- Department of Neurosurgery, 556508The Affiliated Hospital of Southwest Medical University, P.R. China.,Sichuan Clinical Research Centre for Neurosurgery, P.R. China.,Academician (Expert) Workstation of Sichuan Province, P.R. China
| | - Changren Huang
- Department of Neurosurgery, 556508The Affiliated Hospital of Southwest Medical University, P.R. China.,Sichuan Clinical Research Centre for Neurosurgery, P.R. China.,Academician (Expert) Workstation of Sichuan Province, P.R. China
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Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms: comparison of LVIS stents with laser-cut stents. Chin Neurosurg J 2021; 7:19. [PMID: 33653398 PMCID: PMC7927374 DOI: 10.1186/s41016-021-00237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms. Methods Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling (LVIS stent group) and laser-cut stent-assisted coiling (laser-cut stent group) were retrospectively reviewed from January 2014 to December 2017. Propensity score matching was used to adjust for potential differences in age, sex, aneurysm location, aneurysm size, neck width, Hunt-Hess grade, and modified Fisher grade. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors. Results A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching. The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group (92.7% vs 80.6%; 3.7% vs 9.7%, P = 0.078). The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences (P = 0.495 and P = 0.875, respectively). The rates of intraprocedural thrombosis, postprocedural thrombosis, postoperative early rebleeding, and procedure-related death were 0.7% (1/142), 1.4% (2/142), 2.8% (4/142), and 2.1% (3/142) in the LVIS stent group, respectively, and 4.3% (4/93), 2.2% (2/93), 1.1% (1/93), and 3.2% (3/93) in the laser-cut stent group, respectively (P = 0.082, 0.649, 0.651, and 0.683). Nevertheless, the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group (5.6% vs 14.0%, P = 0.028; 0.7% vs 6.5%, P = 0.016). Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedure-related complications (OR = 2.727, P = 0.037); a history of diabetes (OR = 7.275, P = 0.027) and other cerebrovascular diseases (OR = 8.083, P = 0.022) were independent predictors for ischemic complications, whereas none of the factors were predictors for hemorrhagic complications. Conclusions Compared with laser-cut stent-assisted coiling, LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.
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18
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Wang Y, Xu K, Song J, Yu J. Endovascular Therapy for Basilar Arterial Trunk Aneurysms. Front Neurol 2021; 12:625909. [PMID: 33658978 PMCID: PMC7917204 DOI: 10.3389/fneur.2021.625909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Although aneurysms rarely occur in the basilar artery (BA) trunk, the majority of those that do are dissection aneurysms. Currently, the mainstream therapy for BA trunk aneurysms is endovascular therapy (EVT), which mainly includes single coiling or conventional low-metal-coverage stent-assisted EVT, but the efficacy remains to be evaluated. Methods: A retrospective study was performed for the patients who were admitted to our institution for BA trunk aneurysms and underwent EVT. A total of 28 patients were collected in this study. Results: The patients were aged 23-71 years (53.7 ± 11.5 years on average); nine were female (32.1%, 9/28), and 19 were male (67.9%, 19/28). The patients were given single coiling or conventional low-metal-coverage stent-assisted EVT. Among the 28 patients, 10 (35.7%, 10/28) developed complications, 90% (9/10) of which were ischemic and 10% (1/10) were hemorrhagic. Among the 28 patients, 5 (17.9%, 5/28) died. The surviving 23 patients (82.1%, 23/28) recovered well. Conclusions: This study found that for BA trunk aneurysms, single coiling or conventional low-metal-coverage stent-assisted EVT still had some risks. The risks are mainly from brainstem ischemia. Therefore, the perforators of the BA trunk must be carefully evaluated and prevented from receiving damage from the EVT procedure. This study also shows that 82.1% of patients recovered well. Therefore, EVT can result in an acceptable prognosis.
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Affiliation(s)
- Yiheng Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jia Song
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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