Title
Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience
UMMS Affiliation
Department of Radiology
Publication Date
2019-01-11
Document Type
Article
Disciplines
Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology | Surgery | Surgical Procedures, Operative
Abstract
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.
Keywords
flow diverters, lenticulostriates, safety, infarcts, interventional neurosurgery
Rights and Permissions
Publisher's PDF posted as allowed by publisher's copyright policy at: https://jns.msubmit.net/html/JNSPG_Editorial_and_Publishing_Policies.pdf
DOI of Published Version
10.3171/2018.8.JNS18755
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
Journal/Book/Conference Title
Journal of neurosurgery
Related Resources
PubMed ID
30641842
Repository Citation
Wagner KM, Srinivasan VM, Srivatsan A, Ghali MG, Thomas AJ, Enriquez-Marulanda A, Alturki AY, Ogilvy CS, Mokin M, Kuhn AL, Puri A, Grandhi R, Chen S, Johnson J, Kan P. (2019). Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience. Radiology Publications and Presentations. https://doi.org/10.3171/2018.8.JNS18755. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/453
Included in
Cardiovascular Diseases Commons, Nervous System Diseases Commons, Neurology Commons, Radiology Commons, Surgery Commons, Surgical Procedures, Operative Commons