Research

14 pages, 3355 KiB

Open AccessArticle

Flow Diverter Devices in the Treatment of Anterior Communicating Artery Region Aneurysms: Would the Regional Anatomy and the Aneurysm Location Affect the Outcomes?

by Mariangela Piano, Pietro Trombatore, Emilio Lozupone, Guglielmo Pero, Amedeo Cervo, Antonio Macera, Luca Quilici, Simone Peschillo, Luca Valvassori and Edoardo Boccardi

Brain Sci. 2022, 12(11), 1524; https://doi.org/10.3390/brainsci12111524 - 10 Nov 2022

Cited by 3 | Viewed by 1745

Abstract

Background: In this study, the authors evaluated the efficacy and the safety of flow diverter devices (FDD) in anterior communicating artery (ACoA) region aneurysms, focusing on anatomical factors that could affect the outcome, such as the location of the aneurysm along the ACoA [...] Read more.

Background: In this study, the authors evaluated the efficacy and the safety of flow diverter devices (FDD) in anterior communicating artery (ACoA) region aneurysms, focusing on anatomical factors that could affect the outcome, such as the location of the aneurysm along the ACoA (centered on ACoA or decentered on the A1–A2 junction) and the anatomy of the ACoA region. Methods: Clinical, procedural and follow-up data were analyzed. Aneurysms were classified according to the location along the ACoA (centered or decentered on the A1–A2 junction) and on the basis of the anatomical configuration of the ACoA region. Safety was assessed by recording intraprocedural, periprocedural and delayed complications to determine the morbidity and mortality rates. The functional outcome was evaluated with the modified Rankin scale (mRS) prior to and after the endovascular procedure. To assess the efficacy, midterm and long-term clinical, angiographic and cross-sectional imaging follow-ups were recorded. Subgroup analysis according to the different ACoA regional anatomical configurations and the ACoA aneurysm locations were performed. Results: 33 patients (17 males; 16 females) with ACoA region aneurysms were treated with FDDs. 27 aneurysms were located at the A1–A2 junction (82%) while the remaining six aneurysms were centered on the ACoA. No mortality was recorded. The overall morbidity rate was 6% (2/33 procedures). Major complications occurred in 33% (2/6) of ACoA aneurysms and in the 0% of A1–A2 junction aneurysms. Mid-term and long-term neuroimaging follow-ups showed the occlusion of the aneurysm in 28/33 cases (85%). Complete occlusion rates were 93% in the A1–A2 junction aneurysms and 50% in ACoA aneurysms. Conclusions: The FDD is a safe and effective tool that can be used in the treatment of selected cases of ACoA region aneurysms. The location of the aneurysm along the ACoA and the regional anatomy of the ACoA complex could affect the efficacy and safety. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

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21 pages, 5163 KiB

Open AccessArticle

The Role of Bypass Surgery for the Management of Complex Intracranial Aneurysms in the Anterior Circulation in the Flow-Diverter Era: A Single-Center Series

by Francesco Acerbi, Elio Mazzapicchi, Jacopo Falco, Ignazio Gaspare Vetrano, Francesco Restelli, Giuseppe Faragò, Emanuele La Corte, Giulio Bonomo, Anna Bersano, Isabella Canavero, Marco Gemma, Morgan Broggi, Marco Schiariti, Vanessa Ziliani, Gabriella Raccuia, Salvatore Mangiafico, Giuseppe Ganci, Elisa Ciceri and Paolo Ferroli

Brain Sci. 2022, 12(10), 1339; https://doi.org/10.3390/brainsci12101339 - 03 Oct 2022

Cited by 7 | Viewed by 2021

Abstract

Despite the increasing popularity of flow diverters (FDs) as an endovascular option for intracranial aneurysms, the treatment of complex aneurysms still represents a challenge. Combined strategies using a flow-preservation bypass could be considered in selected cases. In this study, we retrospectively reviewed our [...] Read more.

Despite the increasing popularity of flow diverters (FDs) as an endovascular option for intracranial aneurysms, the treatment of complex aneurysms still represents a challenge. Combined strategies using a flow-preservation bypass could be considered in selected cases. In this study, we retrospectively reviewed our series of patients with complex intracranial aneurysms submitted to bypass. From January 2015 to May 2022, 23 patients were selected. We identified 11 cases (47.8%) of MCA, 6 cases (26.1%) of ACA and 6 cases (26.1%) of ICA aneurysms. The mean maximal diameter was 22.73 ± 12.16 mm, 8 were considered as giant, 9 were fusiform, 8 presented intraluminal thrombosis, 10 presented wall calcification, and 18 involved major branches or perforating arteries. Twenty-five bypass procedures were performed in 23 patients (two EC–IC bypasses with radial artery graft, seventeen single- or double-barrel STA–MCA bypasses and six IC–IC bypasses in anterior cerebral arteries). The long-term bypass patency rate was 94.5%, and the total aneurysm exclusion was 95.6%, with a mean follow-up of 28 months. Median KPS values at last follow-up was 90, and a favorable outcome (KPS ≥ 70 and mRS ≤ 2) was obtained in 87% of the cases. The use of bypass techniques represents, in selected cases, a valid therapeutic option in the management of complex anterior circulation aneurysms when a simpler direct approach, including the use of FD, is considered not feasible. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

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9 pages, 383 KiB

Open AccessArticle

Clinical Results of Flow Diverter Treatments for Cerebral Aneurysms under Local Anesthesia

by Saujanya Rajbhandari, Hidetoshi Matsukawa, Kazutaka Uchida, Manabu Shirakawa and Shinichi Yoshimura

Brain Sci. 2022, 12(8), 1076; https://doi.org/10.3390/brainsci12081076 - 13 Aug 2022

Cited by 2 | Viewed by 1654

Abstract

Flow diverters (FD) have become the mainstay for the endovascular treatment of unruptured intracranial aneurysms (UIA). Most FD procedures are performed under general anesthesia, and the influence of local anesthesia (LA) on outcomes remains unknown. This study evaluated the results of FD placement [...] Read more.

Flow diverters (FD) have become the mainstay for the endovascular treatment of unruptured intracranial aneurysms (UIA). Most FD procedures are performed under general anesthesia, and the influence of local anesthesia (LA) on outcomes remains unknown. This study evaluated the results of FD placement under LA. Data of patients treated for FD under LA between August 2016 and January 2022 were analyzed retrospectively. A good outcome was defined as a modified Rankin scale score of 0–2. Major stroke, steno-occlusive events of FD, mortality, and satisfactory aneurysm occlusion were also evaluated. In total, 169 patients undertook 182 treatments (139 [82%) female, mean age 61 ± 11 years). The median maximum aneurysm size was 9.5 mm (interquartile range 6.1-14 mm). A flow re-directed endoluminal device and pipeline embolization device were used in 103 (57%) and 78 (43%) treatments. One patient (0.59%) experienced major stroke, and steno-occlusive events were observed in four patients (2.4%). A good outcome at 90 days was obtained in 164 patients (98%), and one patient died (0.59% mortality). During the median follow-up period of 345 days (interquartile range 176–366 days), satisfactory aneurysm occlusion was observed in 126 of 160 aneurysms (79%). Our results suggest that FD placement under LA is a safe and effective treatment for UIA. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

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10 pages, 1098 KiB

Open AccessArticle

Intrasaccular Flow Disruptor-Assisted Coiling of Intracranial Aneurysms Using the Novel Contour Neurovascular Systems and NEQSTENT: A Single-Center Safety and Feasibility Study

by Francesco Diana, Marta de Dios Lascuevas, Simone Peschillo, Eytan Raz, Shinichi Yoshimura, Manuel Requena Ruiz, David Hernández Morales and Alejandro Tomasello

Brain Sci. 2022, 12(8), 991; https://doi.org/10.3390/brainsci12080991 - 26 Jul 2022

Cited by 9 | Viewed by 2315

Abstract

Background: Intrasaccular flow disruptors (IFD) have been introduced in the treatment of intracranial aneurysms (IAs) to overcome the low aneurysm occlusion rate and the high recanalization rate of the coiling technique. Among them, the Contour Neurovascular System (CNS) and the Neqstent (NQS) were [...] Read more.

Background: Intrasaccular flow disruptors (IFD) have been introduced in the treatment of intracranial aneurysms (IAs) to overcome the low aneurysm occlusion rate and the high recanalization rate of the coiling technique. Among them, the Contour Neurovascular System (CNS) and the Neqstent (NQS) were designed to reconstruct the aneurysmal neck and both can be used as assisting coiling devices. We aimed to report our preliminary experience with the flow disruptor-assisted coiling (IFD-AC) technique. Methods: We performed a retrospective analysis of prospectively collected data of all patients with IAs treated with the IFD-AC. Results: Between February 2021 and April 2022, we treated 15 IAs with the IFD-AC: 10 ruptured and 5 unruptured. The IFD-AC was successfully performed in 13 cases, with a post-operative RROC 1 in 12 cases (92.3%) and RROC 2 in 1 case (7.7%). There was one ischemic event (6.7%) and no hemorrhagic complications. Twelve patients underwent a mid-term radiologic follow-up: Ten IAs (83.4%) presented an adequate occlusion, while 2 (16.7%) had a recurrence. Conclusions: The IFD-AC, both with the CNS and the NQS, seems a safe technique with promising efficacy profile. The IFD-AC has proved to be safe without antiplatelet therapy in ruptured cases. Further studies are needed to confirm our preliminary results. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

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7 pages, 230 KiB

Open AccessCommunication

Management of Cavernous Carotid Artery Aneurysms: A Retrospective Single-Center Experience

by Michael Karl Fehrenbach, Eric Dietel, Tim Wende, Johannes Kasper, Caroline Sander, Florian Wilhelmy, Ulf Quaeschling, Juergen Meixensberger and Ulf Nestler

Brain Sci. 2022, 12(3), 330; https://doi.org/10.3390/brainsci12030330 - 28 Feb 2022

Cited by 2 | Viewed by 4408

Abstract

Objective: While cavernous carotid aneurysms can cause neurological symptoms, their often-uneventful natural course and the increasing options of intravascular aneurysm closure call for educated decision-making. However, evidence-based guidelines are missing. Here, we report 64 patients with cavernous carotid aneurysms, their respective therapeutic strategies, [...] Read more.

Objective: While cavernous carotid aneurysms can cause neurological symptoms, their often-uneventful natural course and the increasing options of intravascular aneurysm closure call for educated decision-making. However, evidence-based guidelines are missing. Here, we report 64 patients with cavernous carotid aneurysms, their respective therapeutic strategies, and follow-up. Methods: We included all patients with cavernous carotid aneurysms who presented to our clinic between 2014 and 2020 and recorded comorbidities (elevated blood pressure, diabetes mellitus, and nicotine consumption), PHASES score, aneurysm site, size and shape, therapeutic strategy, neurological deficits, and clinical follow-up. Results: The mean age of the 64 patients (86% female) was 53 years, the mean follow-up time was 3.8 years. A total of 22 patients suffered from cranial nerve deficit. Of these patients, 50% showed a relief of symptoms regardless of the therapy regime. We found no significant correlations between aneurysm size or PHASES score and the occurrence of neurological symptoms. Conclusion: If aneurysm specific symptoms persist over a longer period of time, relief is difficult to achieve despite aneurysm treatment. Patients should be advised by experts in neurovascular centers, weighing the possibility of an uneventful course against the risks of treatment. In this regard, more detailed prospective data is needed to improve individual patient counseling. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

Review

Jump to: Research, Other

15 pages, 503 KiB

Open AccessReview

Surpass Evolve Flow Diverter for the Treatment of Intracranial Aneurysm: A Systematic Review

by Rania Issa, Zahrah Al-Homedi, Dawood Hasan Syed, Waseem Aziz and Basem Al-Omari

Brain Sci. 2022, 12(6), 810; https://doi.org/10.3390/brainsci12060810 - 20 Jun 2022

Cited by 4 | Viewed by 3271

Abstract

Purpose: This systematic review aims to summarize the evidence investigating the effectiveness and safety of the Surpass Evolve-Flow Diverter (SE-FD) to treat brain aneurysms. Method: We searched MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library from January 2019 to 29 March 2022. [...] Read more.

Purpose: This systematic review aims to summarize the evidence investigating the effectiveness and safety of the Surpass Evolve-Flow Diverter (SE-FD) to treat brain aneurysms. Method: We searched MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library from January 2019 to 29 March 2022. Terms related to the “intracranial aneurysm” and “surpass evolve flow diverter” concepts were used to search the databases; Medical Subject Headings (MeSH) and reference hand search were also utilized. Results: The searches primarily identified 1586 documents. A total of five studies (four case series and one cohort) were included in this review. In the included studies, 192 (74 male and 118 females) patients with 198 aneurysms were involved. In total, 153 SE-FDs were used to treat 145 aneurysms. Complete occlusion was achieved in 69/145 (48%) cases and near-complete occlusion in 24/145 (17%) cases from aneurysms treated with SE-FD. Reported postoperative complications included stent thrombosis (n = 4 patients), hemorrhage (n = 5 patients), ischemia (n = 9 patients), and neurological complications (n = 12 patients). In total, four deaths were reported with only one related to the SE-FD procedure. Conclusion: The results of this review are based on observational data, due to the absence of clinical trials. The findings of the included studies suggest that the effectiveness of the SE-FD procedure is lower than previous FDs but the safety is similar. The included studies also suggested that SE-FD has navigability and resistance to twisting, which makes the procedure an easier method to treat aneurysms that are proximal and distal to the circle of Willis deployment. This review highlights the urgency to conduct clinical trials to confirm these suggestions. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

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12 pages, 3734 KiB

Open AccessEditor’s ChoiceReview

Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)

by Michelle F. M. ten Brinck, Viktoria E. Shimanskaya, René Aquarius, Ronald H. M. A. Bartels, Frederick J. A. Meijer, Petra C. Koopmans, Guido de Jong, Ajay K. Wakhloo, Joost de Vries and Hieronymus D. Boogaarts

Brain Sci. 2022, 12(3), 394; https://doi.org/10.3390/brainsci12030394 - 15 Mar 2022

Cited by 7 | Viewed by 2545

Abstract

Background: patients with a subarachnoid hemorrhage (SAH) might need a flow diverter (FD) placement for complex acutely ruptured intracranial aneurysms (IAs). We conducted a meta-analysis and developed a prediction model to estimate the favorable clinical outcome after the FD treatment in acutely ruptured [...] Read more.

Background: patients with a subarachnoid hemorrhage (SAH) might need a flow diverter (FD) placement for complex acutely ruptured intracranial aneurysms (IAs). We conducted a meta-analysis and developed a prediction model to estimate the favorable clinical outcome after the FD treatment in acutely ruptured IAs. Methods: a systematic literature search was performed from 2010 to January 2021 in PubMed and Embase databases. Studies with more than five patients treated with FDs within fifteen days were included. In total, 1157 studies were identified. The primary outcome measure was the favorable clinical outcome (mRS 0–2). Secondary outcome measures were complete occlusion rates, aneurysm rebleeding, permanent neurologic deficit caused by procedure-related complications, and all-cause mortality. A prediction model was constructed using individual patient-level data. Results: 26 retrospective studies with 357 patients and 368 aneurysms were included. The pooled rates of the favorable clinical outcome, mortality, and complete aneurysm occlusion were 73.7% (95% CI 64.7–81.0), 17.1% (95% CI 13.3–21.8), and 85.6% (95% CI 80.4–89.6), respectively. Rebleeding occurred in 3% of aneurysms (11/368). The c-statistic of the final model was 0.83 (95% CI 0.76–0.89). All the studies provided a very low quality of evidence. Conclusions: FD treatment can be considered for complex ruptured IAs. Despite high complication rates, the pooled clinical outcomes seem favorable. The prediction model needs to be validated by larger prospective studies before clinical application. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

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Other

Jump to: Research, Review

8 pages, 935 KiB

Open AccessCase Report

Flow Preserving Endovascular Treatment of Traumatic Pseudoaneurysms of the Distal Anterior Cerebral Artery—Case Reports and Review of Literature

by Petr Krůpa, Antonín Krajina, Miroslav Lojík, Jaroslav Adamkov and Tomas Česák

Brain Sci. 2022, 12(5), 634; https://doi.org/10.3390/brainsci12050634 - 11 May 2022

Viewed by 3032

Abstract

Traumatic intracranial pseudoaneurysms (tIPAs) are a very rare pathology caused by blunt or penetrating head trauma. Diagnostic and therapeutic challenges of tIPAs are due to their unpredictable onset during the initial injury, or in a delayed manner, their unclear traumatic mechanism. Moreover, the [...] Read more.

Traumatic intracranial pseudoaneurysms (tIPAs) are a very rare pathology caused by blunt or penetrating head trauma. Diagnostic and therapeutic challenges of tIPAs are due to their unpredictable onset during the initial injury, or in a delayed manner, their unclear traumatic mechanism. Moreover, the presence of subarachnoid, subdural, or intraventricular hematoma may often cause them to be overlooked, which can potentially be followed by lethal rebleeding. Treatment of these lesions is controversial and on a case-by-case basis with regard to endovascular therapy or open surgery. We report two cases of three tIPAs of the distal anterior cerebral artery (dACA) with immediate and delayed onset after the trauma. Endovascular therapy resulted in complete obliteration of lesions with flow preservation in the parent artery using the flow diverter-assisted coiling strategy. The aim of this manuscript is to discuss the mechanism, angioanatomical characteristics, and current treatment options for these exceptional lesions. Full article

(This article belongs to the Special Issue Cerebral Aneurysms and the Flow: Flow Diversion, Flow Disruption, Flow Preservation)

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