Volker Maus1, Anastasios Mpotsaris2, Franziska Dorn3, Markus Möhlenbruch4, Jan Borggrefe5, Pantelis Stavrinou6, Nuran Abdullayev5, Utako Birgit Barnikol7, Thomas Liebig8, Christoph Kabbasch5. 1. Department of Neuroradiology, University Hospital Cologne, Cologne, Germany. Electronic address: volker.maus@uk-koeln.de. 2. Department of Neuroradiology, University Hospital Aachen, Aachen, Germany. 3. Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany. 4. Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany. 5. Department of Neuroradiology, University Hospital Cologne, Cologne, Germany. 6. Department of Neurosurgery, University Hospital Cologne, Cologne, Germany. 7. Clearing Unit Ethics, Medical Faculty of Cologne & Research Unit Ethics, Department of Child and Adolescence Psychiatry, University Hospital Cologne, Cologne, Germany. 8. Department of Neuroradiology, Charite, Berlin, Germany.
Abstract
OBJECTIVE: Acute dissecting aneurysms of the posterior circulation are a rare cause of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion 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: This is a multicentric retrospective analysis of 15 consecutive acutely ruptured dissecting posterior circulation aneurysms treated with flow diverters. The primary end point was favorable aneurysm occlusion, defined as OKM C1-3 and D (O'Kelly Marotta scale). Secondary end points were procedure-related complications and clinical outcome. RESULTS: Nine of 15 aneurysms (60%) arose from the intradural portion of the vertebral artery, 3 were located on the posterior inferior cerebellar artery and 1 each on the anterior inferior cerebellar artery, posterior cerebral artery, and basilar artery. Flow diverter placement was technically successful in 14 of 15 cases (93%). After endovascular treatment, none of the ruptured aneurysms rebled. Median clinical follow-up was 217 days and median angiographic follow-up was 203 days. Favorable occlusion was observed in 7 of 14 aneurysms (50%) directly after flow diverter placement; of those, 5 were completely occluded (36%). Seven patients (47%) with poor-grade subarachnoid hemorrhage died in the acute phase. Favorable clinical outcome (modified Rankin scale ≤2) was observed in 4 of 15 patients (27%) and a moderate outcome (modified Rankin scale 3/4) was observed in 5 of 15 patients (33%). All aneurysms showed complete occlusion at follow-up. CONCLUSIONS: Flow diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent rebleeding. Larger cohort studies are required to validate these results.
OBJECTIVE: Acute dissecting aneurysms of the posterior circulation are a rare cause of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion 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: This is a multicentric retrospective analysis of 15 consecutive acutely ruptured dissecting posterior circulation aneurysms treated with flow diverters. The primary end point was favorable aneurysm occlusion, defined as OKM C1-3 and D (O'Kelly Marotta scale). Secondary end points were procedure-related complications and clinical outcome. RESULTS: Nine of 15 aneurysms (60%) arose from the intradural portion of the vertebral artery, 3 were located on the posterior inferior cerebellar artery and 1 each on the anterior inferior cerebellar artery, posterior cerebral artery, and basilar artery. Flow diverter placement was technically successful in 14 of 15 cases (93%). After endovascular treatment, none of the ruptured aneurysms rebled. Median clinical follow-up was 217 days and median angiographic follow-up was 203 days. Favorable occlusion was observed in 7 of 14 aneurysms (50%) directly after flow diverter placement; of those, 5 were completely occluded (36%). Seven patients (47%) with poor-grade subarachnoid hemorrhage died in the acute phase. Favorable clinical outcome (modified Rankin scale ≤2) was observed in 4 of 15 patients (27%) and a moderate outcome (modified Rankin scale 3/4) was observed in 5 of 15 patients (33%). All aneurysms showed complete occlusion at follow-up. CONCLUSIONS: Flow diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent rebleeding. Larger cohort studies are required to validate these results.
Authors: D Lobsien; C Clajus; D Behme; M Ernst; C H Riedel; O Abu-Fares; F G Götz; D Fiorella; J Klisch Journal: AJNR Am J Neuroradiol Date: 2021-01-14 Impact factor: 3.825
Authors: Jens Maybaum; Hans Henkes; Marta Aguilar-Pérez; Victoria Hellstern; Georg Alexander Gihr; Wolfgang Härtig; André Reisberg; Dirk Mucha; Marie-Sophie Schüngel; Richard Brill; Ulf Quäschling; Karl-Titus Hoffmann; Stefan Schob Journal: Front Neurol Date: 2021-07-01 Impact factor: 4.003
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