Romain Capocci1, Eimad Shotar1,2, Federico Di Maria3, Claudia Rolla-Bigliani1, Amira Al Raaisi1, Arthur André2,4, Jugurtha Mahtout5, Anne-Laure Boch4, Vincent Degos2,5, Nader Sourour1, Frédéric Clarençon6,7. 1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France. 2. Sorbonne University. Pierre and Marie Curie, Paris, France. 3. Department of Neuroradiology, Foch Hospital, Suresnes, France. 4. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France. 5. Department of Neuro-Intensive Care, Pitié-Salpêtrière Hospital, Paris, France. 6. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France. frederic.clarencon@aphp.fr. 7. Sorbonne University. Pierre and Marie Curie, Paris, France. frederic.clarencon@aphp.fr.
Abstract
BACKGROUND AND PURPOSE: Ruptured blister-like aneurysms (BLAs) are challenging lesions to treat, without any consensus on their management. Few studies have evaluated the safety and effectiveness of flow diverter stents (FDS) for this indication, with promising results. The goal was to evaluate the safety and effectiveness of a delayed (≥5 days) flow diversion strategy for the treatment of ruptured intracranial BLAs. MATERIAL AND METHODS: A monocentric retrospective analysis of a prospectively collected database of intracranial aneurysms was performed. Eight consecutive patients with 9 ruptured intracranial BLAs from November 2010 to June 2018 were included in the study. The BLA treatment with FDS was delayed from the rupture (minimum rupture to treatment delay = 5 days, mean = 16.9 ± 9.2 days). Procedure-related complications were systematically recorded. Rebleeding occurrences were systematically assessed. Long-term clinical and angiographic follow-ups were recorded. RESULTS: No procedure-related death was recorded. Neither early nor late rebleeding was observed and one (12.5%) major procedure-related complication occurred (ischemic stroke). Most of the patients (5/8; 62.5%) had an mRS <2 at discharge. The immediate periprocedural control angiogram showed a complete exclusion of the aneurysm in one patient (12.5%) but at follow-up (mean delay = 19.8 months) all patients had a complete aneurysm occlusion. All patients had a long-term mRS <2. CONCLUSION: This case series suggests that a delayed treatment (≥5 days after the hemorrhagic event) of ruptured BLAs with FDS is feasible, and may be safe and effective in terms of rebleeding prevention and long-term angiographic outcome.
BACKGROUND AND PURPOSE: Ruptured blister-like aneurysms (BLAs) are challenging lesions to treat, without any consensus on their management. Few studies have evaluated the safety and effectiveness of flow diverter stents (FDS) for this indication, with promising results. The goal was to evaluate the safety and effectiveness of a delayed (≥5 days) flow diversion strategy for the treatment of ruptured intracranial BLAs. MATERIAL AND METHODS: A monocentric retrospective analysis of a prospectively collected database of intracranial aneurysms was performed. Eight consecutive patients with 9 ruptured intracranial BLAs from November 2010 to June 2018 were included in the study. The BLA treatment with FDS was delayed from the rupture (minimum rupture to treatment delay = 5 days, mean = 16.9 ± 9.2 days). Procedure-related complications were systematically recorded. Rebleeding occurrences were systematically assessed. Long-term clinical and angiographic follow-ups were recorded. RESULTS: No procedure-related death was recorded. Neither early nor late rebleeding was observed and one (12.5%) major procedure-related complication occurred (ischemic stroke). Most of the patients (5/8; 62.5%) had an mRS <2 at discharge. The immediate periprocedural control angiogram showed a complete exclusion of the aneurysm in one patient (12.5%) but at follow-up (mean delay = 19.8 months) all patients had a complete aneurysm occlusion. All patients had a long-term mRS <2. CONCLUSION: This case series suggests that a delayed treatment (≥5 days after the hemorrhagic event) of ruptured BLAs with FDS is feasible, and may be safe and effective in terms of rebleeding prevention and long-term angiographic outcome.
Authors: A Scerrati; J Visani; M E Flacco; L Ricciardi; S Trungu; A Raco; F Dones; P De Bonis; C L Sturiale Journal: AJNR Am J Neuroradiol Date: 2020-12-24 Impact factor: 3.825