D P O Kaiser1,2, G Boulouis3, S Soize4, V Maus5, S Fischer5, D Lobsien6, J Klisch6, H Styczen7, C Deuschl7, N Abdullayev8, C Kabbasch8, A Jamous9, D Behme9,10, K Janot3, G Bellanger11, C Cognard11, L Pierot4, M Gawlitza12,2. 1. From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany. 2. Else Kröner-Fresenius Center for Digital Health (D.P.O.K., M.G.), Technical University Dresden, Dresden, Germany. 3. Department of Neuroradiology (G. Boulouis, K.J.), Regional and University Hospital Center Tours, Tours, France. 4. Department of Neuroradiology (S.S., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Reims, France. 5. Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine (V.M., S.F.), University Hospital Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität, Bochum, Germany. 6. Department of Diagnostic and Interventional Radiology and Neuroradiology (D.L., J.K.), Helios General Hospital Erfurt, Erfurt, Germany. 7. Institute of Diagnostic and Interventional Radiology and Neuroradiology (H.S., C.D.), University Hospital Essen, Essen, Germany. 8. Department of Diagnostic and Interventional Radiology (N.A., C.K.), University Hospital Cologne, Cologne, Germany. 9. Institute of Diagnostic and Interventional Neuroradiology (A.J., D.B.), Universitätsmedizin Göttingen, Göttingen, Germany. 10. Department of Neuroradiology (D.B.), University Hospital Magdeburg, Magdeburg, Germany. 11. Diagnostic and Therapeutic Neuroradiology (G. Bellanger, C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France. 12. From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany matthias.gawlitza@ukdd.de.
Abstract
BACKGROUND AND PURPOSE: Flow diversion is an effective treatment for aneurysms of the ICA with compression-related neuro-ophthalmologic symptoms, especially when treatment is initiated early after symptom onset and aneurysm occlusion is complete. However, non-negligible complication rates have been reported. Our aim was to identify risk factors for morbidity/mortality and incomplete aneurysm occlusion. MATERIALS AND METHODS: We performed a secondary analysis of a previous publication, which included all patients treated with flow diversion for an unruptured aneurysm of the ICA with compression-related symptoms. RESULTS: Fifty-four patients with 54 aneurysms (48 women, 88.9%; mean age, 59.2 [SD, 15.9] years; range, 21-86 years) treated with flow diversion were included. We observed morbidity and mortality rates of 7.4% and 3.7%. Increasing age (OR per decade, 3.2; 95% CI, 1.23-8.49; P = .02) and dual-antiplatelet therapy with ticagrelor (OR, 13.9; 95% CI, 1.16-165.97; P = .04) were significantly associated with morbidity/mortality. After a median follow-up of 13.3 [SD, 10.5] months, the rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 74%, 14%, and 12%. Incomplete occlusion at follow-up was less frequently observed in aneurysms treated with additional coil embolization (OR, 0.1; 95% CI, 0.01-0.86; P = .04). CONCLUSIONS: Although a promising treatment for compressive ICA aneurysms, flow diversion carries a relevant risk for complications and incomplete aneurysm occlusion. Our results may help identify patients in which flow diversion may not be the ideal treatment method. Additional coil embolization increased the likelihood of complete aneurysm occlusion at follow-up.
BACKGROUND AND PURPOSE: Flow diversion is an effective treatment for aneurysms of the ICA with compression-related neuro-ophthalmologic symptoms, especially when treatment is initiated early after symptom onset and aneurysm occlusion is complete. However, non-negligible complication rates have been reported. Our aim was to identify risk factors for morbidity/mortality and incomplete aneurysm occlusion. MATERIALS AND METHODS: We performed a secondary analysis of a previous publication, which included all patients treated with flow diversion for an unruptured aneurysm of the ICA with compression-related symptoms. RESULTS: Fifty-four patients with 54 aneurysms (48 women, 88.9%; mean age, 59.2 [SD, 15.9] years; range, 21-86 years) treated with flow diversion were included. We observed morbidity and mortality rates of 7.4% and 3.7%. Increasing age (OR per decade, 3.2; 95% CI, 1.23-8.49; P = .02) and dual-antiplatelet therapy with ticagrelor (OR, 13.9; 95% CI, 1.16-165.97; P = .04) were significantly associated with morbidity/mortality. After a median follow-up of 13.3 [SD, 10.5] months, the rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 74%, 14%, and 12%. Incomplete occlusion at follow-up was less frequently observed in aneurysms treated with additional coil embolization (OR, 0.1; 95% CI, 0.01-0.86; P = .04). CONCLUSIONS: Although a promising treatment for compressive ICA aneurysms, flow diversion carries a relevant risk for complications and incomplete aneurysm occlusion. Our results may help identify patients in which flow diversion may not be the ideal treatment method. Additional coil embolization increased the likelihood of complete aneurysm occlusion at follow-up.
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