Abstract
Background: Cerebral aneurysms affect about 5% of the population and are associated with high mortality rates and severe complications for families and society. Complex aneurysm types include giant aneurysms, wide - necked aneurysms, blister - like aneurysms, recurrent aneurysms, fusiform aneurysms, and multiple aneurysms, which are difficult to manage with conventional endovascular or surgical methods due to complications such as coil migration and high rates of re - rupture. The development of flow diverter stents has been a breakthrough in recent decades and has been demonstrated to be safe and effective in treating aneurysms. The aim of this study was to evaluate the outcomes of flow diverter stent placement in the treatment of ruptured and unruptured cerebral aneurysms.
Methods: This was a descriptive prospective study that followed up on 23 patients diagnosed and treated for cerebral aneurysms with flow - diverter stent intervention at the Stroke Department of Hue Central Hospital from 6/2020 to 6/2022. The follow - up data after 6 months and 12 months were recorded.
Results: There were 23 patients (9 males, 14 females) with 28 cerebral aneurysms, with a mean age of 51.7 ± 9.9 years. Aneurysms were predominantly located in the anterior circulation (85.7%) and 14.3% in the posterior circulation. The most common aneurysm type was fusiform (75%), followed by dissecting (17.9%) and blister - like (7.1%). Most aneurysms had wide necks, with a neck - to - dome ratio < 1.5, accounting for 82.1%. Flow diverter stent placement was successfully performed in 91.3% of patients, with 27 stents used. Stents were properly positioned, well - expanded in 88.9%. The complication rate after intervention was 4.3%. Complete aneurysm occlusion rates at 6 to 12 months were 92.9% and 96.4%, respectively. The rate of mild in - stent stenosis without clinical symptoms was 4.3%. The good outcome rate (mRS 0 - 2) was 91.3%.
Conclusion: Flow diverter stent is effective and safe with high rate of successful and low procedural complications in the treatment of complex cerebral aneurysms.
References
Molyneux AJ, Kerr RSC, Yu L-M, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. The Lancet. 2005; 366(9488): 809-817.
Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovascular diseases. 2013; 35(2): 93-112.
Fiorella D, Woo HH, Albuquerque FC, Nelson PK. Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery. 2008; 62(5): 1115-1121.
Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bäzner H, et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012; 54: 369-382.
Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, et al. An update to the Raymond–Roy occlusion classification of intracranial aneurysms treated with coil embolization. Journal of neurointerventional surgery. 2015; 7(7): 496-502.
Binh NT, Lau VD, Thong PM, Cuong NN, Anh NQ, Tuan TA, et al. Flow diverter stent for treatment of cerebral aneurysms: a report of 130 patients with 134 aneurysms. Heliyon. 2020; 6(2): e03356.
Thủy TX, Tuyến NT, Linh NH. Nghiên cứu đặc điểm hình thái phình mạch máu não và đánh giá kết quả ngăn nắp can thiệp đặt stent chuyển hướng dòng chảy điều trị phình mạch máu não. Journal of 108-Clinical Medicine and Pharmacy. 2020.
John S, Bain M, Cerejo R, Bauer A, Masaryk T, Hussain MS, et al. Flow diverter treatment of tandem intracranial aneurysms. World Neurosurgery. 2017; 107: 142-147.
Cohen JE, Gomori JM, Moscovici S, Kayet AH, Shoshan Y, Spektor S, et al. Flow-diverter stents in the early management of acutely ruptured brain aneurysms: effective rebleeding protection with low thromboembolic complications. Journal of Neurosurgery. 2021; 135(5): 1394-1401.
Yu SC-H, Kwok C-K, Cheng P-W, Chan K-Y, Lau SS, Lui W-M, et al. Intracranial aneurysms: midterm outcome of pipeline embolization device prospective study in 143 patients with 178 aneurysms. Radiology. 2012; 265(3): 893-901.
Lubicz B, Collignon L, Raphaeli G, De Witte O. Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms. World neurosurgery. 2011; 76(1-2): 114-119.
Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D. The pipeline embolization device for the intracranial treatment of aneurysms trial. American Journal of Neuroradiology. 2011; 32(1): 34-40.
Cinar C, Bozkaya H, Oran I. Endovascular treatment of cranial aneurysms with the pipeline flow-diverting stent: preliminary mid-term results. Diagnostic and interventional radiology. 2013; 19(2): 154.
Kan P, Wakhloo AK, Mokin M, Puri A. Techniques in distal access of wide-necked giant intracranial aneurysms during treatment with flow diversion. Surgical Neurology International. 2015; 6(Suppl 7): S284.
Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ. A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke. 2007; 38(8): 2346-2352.
Murthy SB, Shah S, Shastri A, Rao CPV, Bershad EM, Suarez JI. The silk flow diverter in the treatment of intracranial aneurysms. Journal of Clinical Neuroscience. 2014; 21(2): 203-206.
Murthy SB, Shah S, Rao CPV, Bershad EM, Suarez JI. Treatment of unruptured intracranial aneurysms with the pipeline embolization device. Journal of Clinical Neuroscience. 2014; 21(1): 6-11.
| Published | 20-05-2023 | |
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| Issue | No. 86 (2023) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.86.6 | |
| Keywords | Cerebral aneurysm, cerebral intervention, pipeline, flow diverter stent. |
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