Title

Flow Diversion for Treatment of Partially Thrombosed Aneurysms: A Multicenter Cohort

UMMS Affiliation

Department of Radiology, Division of Neuroimaging and Intervention

Publication Date

2020-03-01

Document Type

Article

Disciplines

Cardiovascular Diseases | Nervous System Diseases | Radiology

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.

Keywords

Aneurysm, Complication, Flow diverter, Occlusion, Pipeline, Thrombosed aneurysm, Thrombus

DOI of Published Version

10.1016/j.wneu.2019.11.084

Source

Foreman PM, Salem MM, Griessenauer CJ, Dmytriw AA, Parra-Farinas C, Nicholson P, Limbucci N, Kühn AL, Puri AS, Renieri L, Nappini S, Kicielinski KP, Bugarini A, Pereira VM, Marotta TR, Schirmer CM, Ogilvy CS, Thomas AJ. Flow Diversion for Treatment of Partially Thrombosed Aneurysms: A Multicenter Cohort. World Neurosurg. 2020 Mar;135:e164-e173. doi: 10.1016/j.wneu.2019.11.084. Epub 2019 Nov 21. PMID: 31760188. Link to article on publisher's site

Journal/Book/Conference Title

World neurosurgery

Comments

Full list of authors omitted for brevity. For full list see article.

Related Resources

Link to Article in PubMed

PubMed ID

31760188

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