Waldo R Guerrero1, Santiago Ortega-Gutierrez1, Minako Hayakawa2, Colin P Derdeyn2, James D Rossen3, David Hasan4, Edgar A Samaniego5. 1. Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. 2. Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. 3. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. 4. Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. 5. Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. Electronic address: edgarsama@gmail.com.
Abstract
OBJECTIVE: Treatment of ruptured posterior circulation dissecting aneurysms is technically challenging with potentially high morbidity and mortality. We sought to assess the safety and feasibility of using a flow-diversion device (FDD) and a specific acute antiplatelet aggregation protocol in the management of ruptured dissecting aneurysms. METHODS: Subjects with ruptured dissecting aneurysms treated during a 3-year period were retrospectively identified from a prospective registry. Intraoperative complications, morbidity, and mortality were recorded. Tirofiban maintenance infusion without bolus was administered intravenously immediately after deployment of the FDD, and almost all patients were loaded with dual antiplatelet (aspirin and clopidogrel) post procedure. Clinical follow-up evaluation and modified Rankin Scale were assessed. RESULTS: Nine subjects with ruptured posterior circulation dissecting aneurysms were treated with an FDD: 5 vertebral artery, 2 basilar artery, and 2 posterior inferior cerebellar artery aneurysms. Average World Federation of Neurosurgical Societies score was 2 (range 1-5). Seven patients had external ventricular drain placed acutely for hydrocephalus. Eight patients received tirofiban infusion without bolus after FDD. No intraoperative complications occurred. Two subjects developed asymptomatic intraparenchymal hemorrhage found on surveillance noncontrast computed tomography. One subject suffered a major intraparenchymal hemorrhage and died a few days post intervention after additional anticoagulation was started for a left ventricular assist device. Follow-up modified Rankin Scale within 12 months was 0 in 3 subjects, 1 in 3 subjects, 2 in 1 subject, and 4 in 1. CONCLUSIONS: Treatment of dissecting posterior circulation aneurysms with FDDs is feasible and a potential alternative to deconstructive techniques.
OBJECTIVE: Treatment of ruptured posterior circulation dissecting aneurysms is technically challenging with potentially high morbidity and mortality. We sought to assess the safety and feasibility of using a flow-diversion device (FDD) and a specific acute antiplatelet aggregation protocol in the management of ruptured dissecting aneurysms. METHODS: Subjects with ruptured dissecting aneurysms treated during a 3-year period were retrospectively identified from a prospective registry. Intraoperative complications, morbidity, and mortality were recorded. Tirofiban maintenance infusion without bolus was administered intravenously immediately after deployment of the FDD, and almost all patients were loaded with dual antiplatelet (aspirin and clopidogrel) post procedure. Clinical follow-up evaluation and modified Rankin Scale were assessed. RESULTS: Nine subjects with ruptured posterior circulation dissecting aneurysms were treated with an FDD: 5 vertebral artery, 2 basilar artery, and 2 posterior inferior cerebellar artery aneurysms. Average World Federation of Neurosurgical Societies score was 2 (range 1-5). Seven patients had external ventricular drain placed acutely for hydrocephalus. Eight patients received tirofiban infusion without bolus after FDD. No intraoperative complications occurred. Two subjects developed asymptomatic intraparenchymal hemorrhage found on surveillance noncontrast computed tomography. One subject suffered a major intraparenchymal hemorrhage and died a few days post intervention after additional anticoagulation was started for a left ventricular assist device. Follow-up modified Rankin Scale within 12 months was 0 in 3 subjects, 1 in 3 subjects, 2 in 1 subject, and 4 in 1. CONCLUSIONS: Treatment of dissecting posterior circulation aneurysms with FDDs is feasible and a potential alternative to deconstructive techniques.
Authors: Edgar A Samaniego; Sudeepta Dandapat; Jorge A Roa; Mario Zanaty; Daichi Nakagawa; David M Hasan Journal: Oper Neurosurg (Hagerstown) Date: 2019-11-01 Impact factor: 2.703
Authors: Sami Al Kasab; Waldo R Guerrero; Daichi Nakagawa; Edgar A Samaniego; Santiago Ortega-Gutierrez; David Hasan Journal: Interv Neurol Date: 2019-01-16
Authors: Michelle F M Ten Brinck; Viktoria E Shimanskaya; René Aquarius; Ronald H M A Bartels; Frederick J A Meijer; Petra C Koopmans; Guido de Jong; Ajay K Wakhloo; Joost de Vries; Hieronymus D Boogaarts Journal: Brain Sci Date: 2022-03-15