Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience
Authors
Wagner, Kathryn M.Srinivasan, Visish M.
Srivatsan, Aditya
Ghali, Michael G. Z
Thomas, Ajith J.
Enriquez-Marulanda, Alejandro
Alturki, Abdulrahman Y.
Ogilvy, Christopher S.
Mokin, Maxim
Kuhn, Anna L.
Puri, Ajit
Grandhi, Ramesh
Chen, Stephen
Johnson, Jeremiah
Kan, Peter
UMass Chan Affiliations
Department of RadiologyDocument Type
Journal ArticlePublication Date
2019-01-11Keywords
flow diverterslenticulostriates
safety
infarcts
interventional neurosurgery
Cardiovascular Diseases
Nervous System Diseases
Neurology
Radiology
Surgery
Surgical Procedures, Operative
Metadata
Show full item recordAbstract
OBJECTIVE: With the increasing use of flow diversion as treatment for intracranial aneurysms, there is a concomitant increased vigilance in monitoring complications. The low porosity of flow diverters is concerning when the origins of vessels are covered, whether large circle of Willis branches or critical perforators. In this study, the authors report their experience with flow diverter coverage of the lenticulostriate vessels and evaluate their safety and outcomes. METHODS: The authors retrospectively reviewed 5 institutional databases of all flow diversion cases from August 2012 to June 2018. Information regarding patient presentation, aneurysm location, treatment, and outcomes were recorded. Patients who were treated with flow diverters placed in the proximal middle cerebral artery (MCA), proximal anterior cerebral artery, or distal internal carotid artery leading to coverage of the medial and lateral lenticulostriate vessels were included. Clinical outcomes according to the modified Rankin Scale were reviewed. Univariate and multivariate analyses were performed to establish risk factors for lenticulostriate infarct. RESULTS: Fifty-two patients were included in the analysis. Postprocedure cross-sectional images were available in 30 patients. Two patients experienced transient occlusion of the MCA during the procedure; one was asymptomatic, and the other had a clinical and radiographic ipsilateral internal capsule stroke. Five patients had transient symptoms without radiographic infarct in the lenticulostriate territory. Two patients experienced in-stent thrombosis, leading to clinical MCA infarcts (one in the ipsilateral caudate) after discontinuing antiplatelet therapy. Discontinuation of dual antiplatelet therapy prior to 6 months was the only variable that was significantly correlated with stroke outcome (p < 0.01, OR 0.3, 95% CI 0-0.43), and this significance persisted when controlled for other risk factors, including age, smoking status, and aneurysm location. CONCLUSIONS: The use and versatility of flow diversion is increasing, and safety data are continuing to accumulate. Here, the authors provide early data on the safety of covering lenticulostriate vessels with flow diverters. The authors concluded that the coverage of these perforators does not routinely lead to clinically significant ischemia when dual antiplatelet therapy is continued for 6 months. Further evaluation is needed in larger cohorts and with imaging follow-up as experience develops in using these devices in more distal circulation.Source
J Neurosurg. 2019 Jan 11:1-8. doi: 10.3171/2018.8.JNS18755. [Epub ahead of print] Link to article on publisher's site
DOI
10.3171/2018.8.JNS18755Permanent Link to this Item
http://hdl.handle.net/20.500.14038/48343PubMed ID
30641842Related Resources
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Publisher's PDF posted as allowed by publisher's copyright policy at: https://jns.msubmit.net/html/JNSPG_Editorial_and_Publishing_Policies.pdfae974a485f413a2113503eed53cd6c53
10.3171/2018.8.JNS18755