Paul M Foreman1, Mohamed M Salem2, Christoph J Griessenauer3, Adam A Dmytriw4, Carmen Parra-Farinas5, Patrick Nicholson4, Nicola Limbucci6, Anna Luisa Kühn7, Ajit S Puri8, Leonardo Renieri6, Sergio Nappini6, Kimberly P Kicielinski2, Alejandro Bugarini9, Vitor Mendes Pereira4, Thomas R Marotta5, Clemens M Schirmer9, Christopher S Ogilvy2, Ajith J Thomas2. 1. Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA; Orlando Health, Neuroscience and Rehabilitation Institute, Orlando, Florida, USA. Electronic address: pforeman@geisinger.edu. 2. Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, USA. 3. Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria. 4. Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. 5. Department of Interventional Neuroradiology, St. Michael's Hospital, Toronto, Ontario, Canada. 6. Department of Interventional Neuroradiology, University of Florence, Florence, Italy. 7. Division of Neuroradiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, USA. 8. Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA. 9. Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA.
Abstract
BACKGROUND: Partially thrombosed intracranial aneurysms (PTIA) represent a unique subset of intracranial aneurysms with an ill-defined natural history, posing challenges to standard management strategies. This study aims to assess the efficacy of flow diversion in the treatment of this pathology. METHODS: A retrospective review of patients with flow-diverted PTIA at 6 cerebrovascular centers was performed. Clinical and radiographic data were collected from the medical records, with the primary outcome of aneurysmal occlusion and secondary outcomes of clinical status and complications. RESULTS: Fifty patients with 51 PTIA treated with flow diversion were included. Median age was 56.5 years. Thirty-three (64.7%) aneurysms were saccular and 16 (31.4%) were fusiform/dolichoectatic. The most common location was the internal carotid artery (54.9%) followed by the vertebral and basilar arteries (17.7% and 17.7%, respectively). Last imaging follow-up was performed at a median of 25.1 (interquartile range, 12.8-43) months. Complete occlusion at last radiographic follow-up was achieved in 37 (77.1%) aneurysms. Pretreatment aneurysm thrombosis of >50% was associated with a significantly lower rate of complete aneurysm occlusion (58.8 vs. 87.1%, P = 0.026) with a trend toward better functional outcome (modified Rankin scale <2) at last follow-up in patients with <50% pretreatment aneurysm thrombosis (96.8 vs. 82.4; P = 0.08). Ischemic complications occurred in 5 (9.8%) patients, producing symptoms in 4 (7.8%) and resultant mortality in 2 (4.2%) patients. CONCLUSIONS: Flow diversion treatment of PTIA has adequate efficacy along with a reasonable safety profile. Aneurysms harboring large amounts of pretreatment thrombus were associated with lower rates of complete occlusion.
BACKGROUND: Partially thrombosed intracranial aneurysms (PTIA) represent a unique subset of intracranial aneurysms with an ill-defined natural history, posing challenges to standard management strategies. This study aims to assess the efficacy of flow diversion in the treatment of this pathology. METHODS: A retrospective review of patients with flow-diverted PTIA at 6 cerebrovascular centers was performed. Clinical and radiographic data were collected from the medical records, with the primary outcome of aneurysmal occlusion and secondary outcomes of clinical status and complications. RESULTS: Fifty patients with 51 PTIA treated with flow diversion were included. Median age was 56.5 years. Thirty-three (64.7%) aneurysms were saccular and 16 (31.4%) were fusiform/dolichoectatic. The most common location was the internal carotid artery (54.9%) followed by the vertebral and basilar arteries (17.7% and 17.7%, respectively). Last imaging follow-up was performed at a median of 25.1 (interquartile range, 12.8-43) months. Complete occlusion at last radiographic follow-up was achieved in 37 (77.1%) aneurysms. Pretreatment aneurysm thrombosis of >50% was associated with a significantly lower rate of complete aneurysm occlusion (58.8 vs. 87.1%, P = 0.026) with a trend toward better functional outcome (modified Rankin scale <2) at last follow-up in patients with <50% pretreatment aneurysm thrombosis (96.8 vs. 82.4; P = 0.08). Ischemic complications occurred in 5 (9.8%) patients, producing symptoms in 4 (7.8%) and resultant mortality in 2 (4.2%) patients. CONCLUSIONS: Flow diversion treatment of PTIA has adequate efficacy along with a reasonable safety profile. Aneurysms harboring large amounts of pretreatment thrombus were associated with lower rates of complete occlusion.