Endovascular treatment of traumatic carotid pseudoaneurysm with Tubridge flow diverter: A case report

Tubridge Flow Diverter for the Treatment of Unruptured Dissecting Cerebral Aneurysms

BACKGROUND

The Tubridge flow diverter is a device widely used in China aimed at reconstructing parent artery and occluding complex aneurysm. The experience of the Tubridge in treating unruptured vertebrobasilar artery dissecting aneurysms is still limited. In this study, we aimed to evaluate the safety and efficacy of the Tubridge flow diverter for the treatment of vertebrobasilar artery dissecting aneurysms.

METHODS

We reviewed the clinical records of aneurysms treated with the Tubridge flow diverter between 2019 and 2021 in a national cerebrovascular disease center. Therapeutic process, occlusion rate, and clinical outcome were compared.

RESULTS

Twenty-three patients with 23 vertebrobasilar artery aneurysms were identified. The results showed that the mean length and mean maximal width were 15.14 and 9.14 mm, respectively, in the vertebrobasilar artery. Twenty-four Tubridge flow diverters were successfully implanted without unfold failure. A complete occlusion rate at the last angiographic follow-up was achieved in 78.26% of vertebrobasilar artery aneurysms. Fifteen branch arteries were covered, and only 1 branch artery disappeared at follow-up. Mild asymptomatic cerebral infarction occurred in 3 patients (13.04%); intracranial hemorrhage was not found in the patients.

CONCLUSIONS

Our preliminary experience suggests that the Tubridge flow diverter might be a safe and effective tool for dissecting cerebral aneurysms. Branch arteries were well protected and mild asymptomatic cerebral infarction occurred in some patients. Adequate evidence is required to clear the definite indications and complications in a multicenter randomized controlled trial with a long-term follow-up.

Treatment of Traumatic Internal Carotid Artery Aneurysm by Flow-Diverter: A Single-Center Experience

AIM

Traumatic intracranial aneurysm (TICA) is a rare vascular lesion with various etiologies and a high mortality rate when diagnosed late. In this study, we present our cases of TICA, which we treated with flow-diverter stents due to different etiological factors.

METHODS

Clinical data were recorded for 8 patients: age, gender, etiological factors, aneurysm location, aneurysm type, rupture, main artery status, and postoperative complications.

RESULTS

75% (n:6) of the patients were male and 25% (n:2) female. Etiologically, there was intracranial tumor surgery in 3 cases (37.5%), fall from height in 2 (25%), road accident in 2 (25%), and blunt trauma in 1 (12.5%). Reconstruction used a flow-diverting stent in all cases. One patient experienced intraoperative iatrogenic rupture of the distal arterioles due to a microwire. Mean angiographic follow-up was 17.8 months (range, 6-32 months). During follow-up, none of the patients required renewed endovascular treatment.

CONCLUSION

Traumatic aneurysm is a vascular lesion with high mortality when diagnosed late. In case of suspected vascular injury after trauma or intracranial surgery, further evaluation should be performed without delay. TICA can be safely treated with flow-diverter stents, conserving the main artery.

Treatment of Intracranial Pseudoaneurysms With a Novel Covered Stent: A Series of 19 Patients With Midterm Follow-Up

Background: The optimal treatment for intracranial pseudoaneurysm is unclear. This study aims to analyze the outcome of treating intracranial pseudoaneurysm with a novel covered stent.

Materials and Methods: The institutional imaging and clinical databases were retrospectively reviewed for patients with intracranial pseudoaneurysms treated with Willis covered stent from January 2017 to December 2019. The clinical presentations, etiology, intraoperative complications, and immediate and follow-up outcomes were analyzed.

Results: A total of 19 patients with 20 pseudoaneurysms were enrolled for analysis. Seventeen patients presented with vision loss and two with epistaxis. Nineteen Willis covered stents were used with one for each patient without technical failure. Intraoperative thrombosis was encountered in one patient (5.3%), which was recanalized by tirofiban. During clinical follow-up, no further epistaxis occurred, and visual acuity improved in three (17.6%) patients. Endoleak occurred in seven (36.8%) patients after the initial balloon inflation and persisted in one (5.3%) patient after balloon re-inflation. This endoleak disappeared at 8 month follow-up. Finally, during angiographic follow-up (median 13 months), parent artery occlusion and in-stent stenosis occurred in one (5.3%) patient. No stent-related ischemic event was encountered.

Conclusions: The Willis covered stent is feasible, safe, and efficient in treating intracranial pseudoaneurysms.