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Erschienen in: Neuroradiology 5/2014

01.05.2014 | Interventional Neuroradiology

Flow diversion for complex middle cerebral artery aneurysms

verfasst von: Mario Zanaty, Nohra Chalouhi, Stavropoula I. Tjoumakaris, L. Fernando Gonzalez, Robert Rosenwasser, Pascal Jabbour

Erschienen in: Neuroradiology | Ausgabe 5/2014

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Abstract

Introduction

This study aims to evaluate the safety and efficacy of flow diversion for treatment of large and complex middle cerebral artery (MCA) aneurysms.

Methods

We conducted a retrospective review of the clinical charts of all patients who underwent Pipeline Embolization Device (PED) placement for aneurysm at our institution from October 2010 to October 2013. We included ten patients, of which five had large MCA aneurysms and three had giant ones. Fusiform unruptured aneurysms represented seven of all ten aneurysms. Angiographic and clinical follow-up were available for all patients mostly between 7 and 12 months.

Results

We had no technical complications, one periprocedural morbidity, and no mortality. On follow-up, we had no hemorrhagic complications, no aneurysms rupture, and only one clinically significant thromboembolic event in a patient who discontinued antiplatelet therapy against medical advice. One patient had completely occluded his diseased vessel but remained asymptomatic. The overall complication rate is 3/10. On follow-up, complete occlusion occurred in seven patients (7/9).

Conclusion

PED treatment for large, giant, and bifurcation MCA aneurysms was feasible, with satisfying complete occlusion rate, no mortality, and reasonable morbidity rate.
Literatur
1.
Zurück zum Zitat International Study of Unruptured Intracranial Aneurysms Investigators (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 1339:1725–1733 International Study of Unruptured Intracranial Aneurysms Investigators (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 1339:1725–1733
2.
Zurück zum Zitat Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, Tjoumakaris S, Gonzalez LF, Dumont AS, Rosenwasser R, Randazzo CG (2013) Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44(5):1348–1353PubMedCrossRef Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, Tjoumakaris S, Gonzalez LF, Dumont AS, Rosenwasser R, Randazzo CG (2013) Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44(5):1348–1353PubMedCrossRef
3.
4.
Zurück zum Zitat Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E, Cirillo L, De Blasi R, Delehaye L, Di Paola F, Fontana A, Gasparotti R, Guidetti G, Divenuto I, Iannucci G, Isalberti M, Leonardi M, Lupo F, Mangiafico S, Manto A, Menozzi R, Muto M, Nuzzi NP, Papa R, Petralia B, Piano M, Resta M, Padolecchia R, Saletti A, Sirabella G, Bolgè LP (2012) Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis. Neuroradiology 54:1145–1152PubMedCrossRef Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E, Cirillo L, De Blasi R, Delehaye L, Di Paola F, Fontana A, Gasparotti R, Guidetti G, Divenuto I, Iannucci G, Isalberti M, Leonardi M, Lupo F, Mangiafico S, Manto A, Menozzi R, Muto M, Nuzzi NP, Papa R, Petralia B, Piano M, Resta M, Padolecchia R, Saletti A, Sirabella G, Bolgè LP (2012) Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis. Neuroradiology 54:1145–1152PubMedCrossRef
5.
Zurück zum Zitat Chalouhi N, Tjoumakaris S, Starke RM, Gonzalez LF, Randazzo C, Hasan D, McMahon JF, Singhal S, Moukarzel LA, Dumont AS, Rosenwasser R, Jabbour P (2013) Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke 44:2150–2154PubMedCrossRef Chalouhi N, Tjoumakaris S, Starke RM, Gonzalez LF, Randazzo C, Hasan D, McMahon JF, Singhal S, Moukarzel LA, Dumont AS, Rosenwasser R, Jabbour P (2013) Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke 44:2150–2154PubMedCrossRef
6.
Zurück zum Zitat Bodily KD, Cloft HJ, Lanzino G, Fiorella DJ, White PM, Kallmes DF (2011) Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 32(7):1232–1236PubMedCrossRef Bodily KD, Cloft HJ, Lanzino G, Fiorella DJ, White PM, Kallmes DF (2011) Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 32(7):1232–1236PubMedCrossRef
7.
Zurück zum Zitat Shapiro M, Babb J, Becske T, Nelson PK (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29(9):1777–1781PubMedCrossRef Shapiro M, Babb J, Becske T, Nelson PK (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29(9):1777–1781PubMedCrossRef
8.
Zurück zum Zitat Fiorella D, Albuquerque FC, Woo H, Rasmussen PA, Masaryk TJ, McDougall CG (2010) Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-up. J Neurointerv Surg 2(1):16–22PubMedCrossRef Fiorella D, Albuquerque FC, Woo H, Rasmussen PA, Masaryk TJ, McDougall CG (2010) Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-up. J Neurointerv Surg 2(1):16–22PubMedCrossRef
9.
Zurück zum Zitat Fargen KM, Hoh BL, Welch BG, Pride GL, Lanzino G, Boulos AS, Carpenter JS, Rai A, Veznedaroglu E, Ringer A, Rodriguez-Mercado R, Kan P, Siddiqui A, Levy EI, Mocco J (2012) Long-term results of enterprise stent-assisted coiling of cerebral aneurysms. Neurosurgery 71(2):239–244PubMedCrossRef Fargen KM, Hoh BL, Welch BG, Pride GL, Lanzino G, Boulos AS, Carpenter JS, Rai A, Veznedaroglu E, Ringer A, Rodriguez-Mercado R, Kan P, Siddiqui A, Levy EI, Mocco J (2012) Long-term results of enterprise stent-assisted coiling of cerebral aneurysms. Neurosurgery 71(2):239–244PubMedCrossRef
10.
Zurück zum Zitat Chow MM, Woo HH, Masaryk TJ, Rasmussen PA (2004) A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Y-configuration, double-stent technique. AJNR Am J Neuroradiol 25(3):509–512PubMed Chow MM, Woo HH, Masaryk TJ, Rasmussen PA (2004) A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Y-configuration, double-stent technique. AJNR Am J Neuroradiol 25(3):509–512PubMed
11.
Zurück zum Zitat Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Starke RM, Gordon D, Hann S, Tjoumakaris S (2012) Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery 71(4):785–794PubMedCrossRef Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Starke RM, Gordon D, Hann S, Tjoumakaris S (2012) Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery 71(4):785–794PubMedCrossRef
12.
Zurück zum Zitat Cekirge HS, Yavuz K, Geyik S, Saatci I (2011) A novel “Y” stent flow diversion technique for the endovascular treatment of bifurcation aneurysms without endosaccular coiling. AJNR Am J Neuroradiol 32(7):1262–1268PubMedCrossRef Cekirge HS, Yavuz K, Geyik S, Saatci I (2011) A novel “Y” stent flow diversion technique for the endovascular treatment of bifurcation aneurysms without endosaccular coiling. AJNR Am J Neuroradiol 32(7):1262–1268PubMedCrossRef
13.
Zurück zum Zitat Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69(3):598–603PubMedCrossRef Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69(3):598–603PubMedCrossRef
14.
Zurück zum Zitat Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41(1):110–115PubMedCrossRef Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41(1):110–115PubMedCrossRef
15.
Zurück zum Zitat Yavuz K, Geyik S, Saatci I, Cekirge HS (2013) Endovascular treatment of middle cerebral artery aneurysms with flow modification with the use of the pipeline embolization device. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A3692 Yavuz K, Geyik S, Saatci I, Cekirge HS (2013) Endovascular treatment of middle cerebral artery aneurysms with flow modification with the use of the pipeline embolization device. AJNR Am J Neuroradiol. doi:10.​3174/​ajnr.​A3692
16.
Zurück zum Zitat De Vries J, Boogaarts J, Van Norden A, Wakhloo AK (2013) New generation of flow diverter (surpass) for unruptured intracranial aneurysms: a prospective single-center study in 37 patients. Stroke 44:1567–1577PubMedCrossRef De Vries J, Boogaarts J, Van Norden A, Wakhloo AK (2013) New generation of flow diverter (surpass) for unruptured intracranial aneurysms: a prospective single-center study in 37 patients. Stroke 44:1567–1577PubMedCrossRef
17.
Zurück zum Zitat Lee DH, Arat A, Morsi H, Shaltoni H, Harris JR, Mawad ME (2008) Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: a single-center experience. AJNR Am J Neuroradiol 29:1389–1394PubMedCrossRef Lee DH, Arat A, Morsi H, Shaltoni H, Harris JR, Mawad ME (2008) Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: a single-center experience. AJNR Am J Neuroradiol 29:1389–1394PubMedCrossRef
18.
Zurück zum Zitat Fargen KM, Velat GJ, Lawson MF, Mocco J, Hoh BL (2012) Review of reported complications associated with the pipeline embolization device. World Neurosurg 77(3–4):403–404PubMedCrossRef Fargen KM, Velat GJ, Lawson MF, Mocco J, Hoh BL (2012) Review of reported complications associated with the pipeline embolization device. World Neurosurg 77(3–4):403–404PubMedCrossRef
19.
Zurück zum Zitat Babiker MH, Gonzalez L, Ryan J, Albuquerque F, Collins D, Elvikis A, Frakes DH (2012) Influence of stent configuration on cerebral aneurysm fluid dynamics. J Biomech 45(3):440–447PubMedCrossRef Babiker MH, Gonzalez L, Ryan J, Albuquerque F, Collins D, Elvikis A, Frakes DH (2012) Influence of stent configuration on cerebral aneurysm fluid dynamics. J Biomech 45(3):440–447PubMedCrossRef
20.
Zurück zum Zitat Bendok BR, Parkinson RJ, Hage ZA, Adel JG, Gounis MJ (2007) The effect of vascular reconstruction device-assisted coiling on packing density, effective neck coverage, and angiographic outcome: an in vitro study. Neurosurgery 61(4):835–840PubMedCrossRef Bendok BR, Parkinson RJ, Hage ZA, Adel JG, Gounis MJ (2007) The effect of vascular reconstruction device-assisted coiling on packing density, effective neck coverage, and angiographic outcome: an in vitro study. Neurosurgery 61(4):835–840PubMedCrossRef
21.
Zurück zum Zitat Kulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ, Renowden S, Gál G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rüfenacht DA (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32(1):20–25PubMed Kulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ, Renowden S, Gál G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rüfenacht DA (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32(1):20–25PubMed
22.
Zurück zum Zitat Byrne JV, Szikora I (2012) Flow diverters in the management of intracranial aneurysms: a review. EJMINT 1225000057 Byrne JV, Szikora I (2012) Flow diverters in the management of intracranial aneurysms: a review. EJMINT 1225000057
23.
Zurück zum Zitat Rohde S, Bendszus M, Hartmann M, Hähnel S (2010) Treatment of a wide-necked aneurysm of the anterior cerebral artery using two enterprise stents in “Y”-configuration stenting technique and coil embolization: a technical note. Neuroradiology 52(3):231–235PubMedCrossRef Rohde S, Bendszus M, Hartmann M, Hähnel S (2010) Treatment of a wide-necked aneurysm of the anterior cerebral artery using two enterprise stents in “Y”-configuration stenting technique and coil embolization: a technical note. Neuroradiology 52(3):231–235PubMedCrossRef
24.
Zurück zum Zitat Chalouhi N, Dumont AS, Hasan D, Tjoumakaris S, Gonzalez LF, Starke RM, Dalyai R, El Moursi S, Rosenwasser R, Jabbour P (2012) Is packing density important in stent-assisted coiling? Neurosurgery 71(2):386–387 Chalouhi N, Dumont AS, Hasan D, Tjoumakaris S, Gonzalez LF, Starke RM, Dalyai R, El Moursi S, Rosenwasser R, Jabbour P (2012) Is packing density important in stent-assisted coiling? Neurosurgery 71(2):386–387
25.
Zurück zum Zitat Darsaut TE, Bing F, Salazkin I, Gevry G, Raymond J (2012) Flow diverters failing to occlude experimental bifurcation or curved sidewall aneurysms: an in vivo study in canines. J Neurosurg 117:37–44PubMedCrossRef Darsaut TE, Bing F, Salazkin I, Gevry G, Raymond J (2012) Flow diverters failing to occlude experimental bifurcation or curved sidewall aneurysms: an in vivo study in canines. J Neurosurg 117:37–44PubMedCrossRef
26.
Zurück zum Zitat Chalouhi N, Tjoumakaris SI, Gonzalez LF, Hasan D, Pema PJ, Gould G, Rosenwasser RH, Jabbour PM (2013) Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 Cases. AJNR Am J Neuroradiol 34(12):2326–2330PubMedCrossRef Chalouhi N, Tjoumakaris SI, Gonzalez LF, Hasan D, Pema PJ, Gould G, Rosenwasser RH, Jabbour PM (2013) Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 Cases. AJNR Am J Neuroradiol 34(12):2326–2330PubMedCrossRef
Metadaten
Titel
Flow diversion for complex middle cerebral artery aneurysms
verfasst von
Mario Zanaty
Nohra Chalouhi
Stavropoula I. Tjoumakaris
L. Fernando Gonzalez
Robert Rosenwasser
Pascal Jabbour
Publikationsdatum
01.05.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Neuroradiology / Ausgabe 5/2014
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-014-1339-x

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