Comparison between stenting and conservative management of posterior circulation perforator aneurysms: Systematic review and case series

Gardijan, Danilo; Herega, Tomislav; Premužić, Vedran; Jovanović, Ivan; Ozretić, David; Poljaković, Zdravka; Radoš, Marko

doi:10.1007/s00234-020-02618-2

Cited by 4 publications

(8 citation statements)

References 44 publications

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“…The re-evaluation showed that all negative results in the initial DSA examinations were true negatives. Nonetheless, in our series, only 28% of the aneurysms were diagnosed on the initial angiographic imaging study, which is in line with recent systematic reviews of non-trunk BAPAs by Granja et al [1] and of posterior circulation perforator aneurysms by Gardijan et al [14] reporting diagnosis of the aneurysm on the first DSA study in 50% and 39%, respectively. In absence of a confirmed rebleeding, we tried to perform the repeat DSA after confirmation of resolution of SAH-related vasospasm, using transcranial Doppler.…”

Section: Discussionsupporting

confidence: 91%

“…Our cohort showed an excellent occlusion rate on long-term follow-up angiography (100%) and favorable clinical outcome (mRS 0–2) in 81%. Similarly high occlusion rates for BAPAs (94%) were reported following endovascular treatment by the use of single stents (10%), telescoping stents (stent-in-stent, n = 45%) or FD stents (45%) in a recent review of the literature comprising only small retrospective case series (1–5 cases each) [ 14 ]. Overall, favorable outcome with these different stent/FD treatment strategies was 90% in their review.…”

Section: Discussionmentioning

confidence: 75%

“…In spite of an immediate angiographic incomplete occlusion, a direct protective effect of FD was observed in our cohort. Gardijan et al [14] reported a similar effect.…”

Section: Discussionmentioning

confidence: 76%

“…In another systematic review of non-saccular posterior circulation aneurysms treated by FD, the overall rate of periprocedural ischemia was 23% [21]. Likewise, high rates of ischemic complications were also encountered in other re-K ports of ruptured perforator aneurysms of the posterior circulation treated (32%), or by endovascular therapy using FD stents and mostly stent-in-stent techniques (20%) [14]. The overall high strokes rates are most likely related to the large number of perforators in the posterior circulation.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] and of posterior circulation perforator aneurysms by Gardijan et al. [ 14 ] reporting diagnosis of the aneurysm on the first DSA study in 50% and 39%, respectively. In absence of a confirmed rebleeding, we tried to perform the repeat DSA after confirmation of resolution of SAH-related vasospasm, using transcranial Doppler.…”

Section: Discussionmentioning

confidence: 99%

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Flow Diverter Treatment of Ruptured Basilar Artery Perforator Aneurysms

et al. 2022

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Purpose Ruptured basilar artery perforator aneurysms (BAPAs) represent a very rare cause of subarachnoid hemorrhage and an under-reported subtype of cerebral aneurysm. There is no consensus for the optimal treatment strategy (conservative vs. surgical vs. various endovascular approaches). We aim to present a multicenter experience of BAPA treatment using flow-diverter (FD) stents. Methods At five tertiary neurovascular centers, all cases of ruptured BAPAs treated by FD were retrospectively collected. Baseline imaging and clinical characteristics, complications, as well as early and long-term angiographic and clinical outcome (mRS) were analyzed. Results Eighteen patients (mean age, 57 years; SD, ±10.7 years) with acute SAH related to a BAPA were treated using 18 FD stents. Aneurysms were detected on initial imaging study in 28%; delayed diagnosis was triggered by clinical deterioration due to rebleeding in 15%. No rebleeding after FD was seen, 28% developed FD-related ischemic complications. At long term (n = 16), overall mortality was 13% (2/16), and favorable outcome (mRS 0–2) was 81% (13/16). All BAPAs (n = 13) were completely occluded at long-term angiographic follow-up. Conclusion In our multicenter experience, FD treatment of ruptured BAPAs appears to have comparable safety and efficacy outcomes to FD treatment of other ruptured posterior circulation aneurysms as well as to the conservative management of BAPAs. This treatment strategy for a ruptured BAPA achieved a high rate of angiographic occlusion and favorable clinical outcome; however, as the conservative management also seems to offer similar clinical outcomes an individualized treatment decision is warranted. Future prospective studies comparing both approaches are required.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 75%

“…In spite of an immediate angiographic incomplete occlusion, a direct protective effect of FD was observed in our cohort. Gardijan et al [14] reported a similar effect.…”

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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