The Use of Flow-Diverter in Ruptured, Dissecting Intracranial Aneurysms of the Posterior Circulation.

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The Use of Flow-Diverter in Ruptured, Dissecting Intracranial Aneurysms of the Posterior Circulation.

World Neurosurg. 2017 Dec 22;:

Authors: Maus V, Mpotsaris A, Dorn F, Möhlenbruch M, Borggrefe J, Stavrinou P, Abdullayev N, Barnikol UB, Liebig T, Kabbasch C

Abstract
OBJECTIVE: Acute dissecting aneurysms of the posterior circulation are a rare cause of SAH. Established endovascular treatment options include PAO and stent-assisted coiling, but appear to be associated with an increased risk of ischemic stroke. Vessel reconstruction with flow-diverters is an alternative treatment option, however, its safety and efficacy in the acute stage remains unclear.
METHODS: Multi-centric retrospective analysis of 15 consecutive acutely ruptured dissecting posterior circulation aneurysms treated with flow-diverters. The primary endpoint was favorable aneurysm occlusion, defined as OKM C1-3 and D (O´Kelly Marotta Scale). Secondary endpoints were procedure-related complications and clinical outcome.
RESULTS: Nine out of 15 aneurysms (60%) arose from the intradural portion of the vertebral artery, three were located on the PICA and one each on the AICA, PCA and BA. Flow-diverter placement was technically successful in 14/15 cases (93%). After endovascular treatment, none of the ruptured aneurysms re-bled. Median clinical follow-up was 217 days and median angiographic follow-up 203 days. Favorable occlusion was observed in 7/14 aneurysms (50%) directly after flow-diverter placement; of those, 5 were completely occluded (36%). Seven patients (47%) with poor-grade SAH died in the acute phase. Favorable clinical outcome (mRS≤2) was observed in 4/15 patients (27%) and a moderate outcome (mRS 3/4) in 5/15 patients (33%). All aneurysms showed complete occlusion at follow-up.
CONCLUSION: Flow-diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent re-bleeding. Larger cohort studies are required to validate these results.

PMID: 29277587 [PubMed - as supplied by publisher]

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