Flow diversion treatment for acutely ruptured aneurysms
Department of Radiology, New England Center for Stroke Research
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology | Surgery
BACKGROUND AND PURPOSE: Flow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.
METHODS: We conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0-2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.
RESULTS: At follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3-6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size > /=20 mm and < 20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).
CONCLUSION: Flow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.
endovascular techniques, flow diversion, intracranial aneurysm, subarachnoid hemorrhage
DOI of Published Version
J Neurointerv Surg. 2019 Aug 24. pii: neurintsurg-2019-015077. doi: 10.1136/neurintsurg-2019-015077. [Epub ahead of print] Link to article on publisher's site
Journal of neurointerventional surgery
Ten Brinck MF, Jager M, de Vries J, Grotenhuis JA, Aquarius R, Morkve SH, Rautio R, Numminen J, Raj R, Wakhloo AK, Puri AS, Taschner CA, Boogaarts HD. (2019). Flow diversion treatment for acutely ruptured aneurysms. Radiology Publications and Presentations. https://doi.org/10.1136/neurintsurg-2019-015077. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/498