Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review

Ravindran, Krishnan; Salem, Mohamed M.; Alturki, Abdulrahman Y.; Thomas, Ajith J.; Ogilvy, Christopher S.; Moore, Justin M.

doi:10.3174/ajnr.a5955

Cited by 54 publications

(35 citation statements)

References 36 publications

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“…21,22 Immediately after the device is placed, endothelialization gradually progresses from the side of the parent artery to the aneurysm neck. 23,24 In particular, endothelialization of the aneurysm neck requires adhesion of smooth muscle cells to the neck to form a scaffold.…”

Section: Discussionmentioning

confidence: 99%

Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

et al. 2020

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Purpose Antiplatelet therapy initiated before flow diverter placement is effective for the prevention of ischemic complications. However, the effectiveness of oral anticoagulant treatment is unclear. This retrospective study evaluated the complications and obliteration rates after flow diverter placement in patients taking anticoagulants. Methods A total of 155 cases were treated by Pipeline Flex placement for unruptured large and giant cerebral aneurysms in our hospital between October 2015 and June 2019. The groups of 8 patients taking anticoagulants before operation and 147 patients not taking anticoagulants were compared. Results Clopidogrel oral dose ( P = 0.002) was significantly lower in the anticoagulant group. Delayed aneurysm rupture ( P = 0.002) and additional treatment ( P = 0.009) rates were significantly higher and complete obliteration rate ( P = 0.011) was lower in the anticoagulant group. Conclusions Additional oral anticoagulant administration before flow diverter placement does not reduce ischemic complications compared to dual antiplatelet therapy, but does increase hemorrhagic complications, especially delayed aneurysm rupture. Complete obliteration of the cerebral aneurysm is difficult to achieve in patients taking anticoagulants.

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Section: Discussionmentioning

confidence: 99%

Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

et al. 2020

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“…Identification of this biomarker may predict successful aneurysm occlusion. 31 Two ruptured aneurysms were included in our series. As the use of FDs will usually require administration of dual antiplatelet therapy, its use in acute SAH cases may carry a risk of aneurysm rebleeding, since aneurysm occlusion following flow diversion is a progressive process.…”

Section: Discussionmentioning

confidence: 99%

Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region

et al. 2020

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Introduction The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. Methods This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients’ demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. Results All patients except one underwent angiographic follow-up. The Karman–Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. Conclusion Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.

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“…The possible complications of coil embolization method were the need for recanalization and coil compaction in large series (14,15). The rate of recanalization was reported as 33.6% and the rate of re-treatments was 20.7% in the study of Raymond Its mechanisms of action are based on the internal change in hemodynamic parameters both in the main artery and within the aneurysm sac (16,17). Also, the indentations along the stent act as a nidus for endothelial cell growth in the neck of the aneurysm that results in exclusion of the aneurysm from the circulation.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of intracranial aneurysms: A single center experience

Yüce¹,

Taşar²

2020

GMJ

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Aims: Intracranial aneurysms (IA) are vascular anomalies that are mostly detected by life threatening complications such as intracerebral hematoma or subarachnoid hemorrhage. Recently endovascular treatments have become the major treatment modality. In this study, our objectives were to describe the clinical data of the patients with treated IAs, to evaluate the success rate of two treatment modalities [coil embolization and flow diverter stents (FDS)], and to document common complications. Methods:The patients who were admitted to our tertiary center and underwent endovascular treatment (with coil embolization/FDS) in the interventional radiology unit between December 2018 and October 2019 were enrolled. The clinical data of the patients including aneurysm size, subtype, location, treatment modality, and pre and post procedural complications were analyzed retrospectively.Results: Eighteen of 37 patients (48.6%) were male and 19 (51.3%) were female. The median age was 54 (minimum-maximum; 12-77) years. There was no predisposing factor in the clinical history except four patients. Regarding the aneurysm subtypes, 89% of IAs were saccular and 11% were fusiform. The most common localization was internal carotid artery (48%). Ten patients were admitted with ruptured aneurysm and twenty seven were asymptomatic and unruptured. Four patients died in the mean follow-up of nine months. Two patients had intervention-related complication (hemiparesis and hydrocephalus). Conclusions:IAs can be effectively treated with endovascular techniques since cure rates are high and complications rates are reasonably low. Coil, FDS or both can be used in selected cases of ruptured or unruptured aneurysms.

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Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review

Cited by 54 publications

References 36 publications

Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region

Endovascular treatment of intracranial aneurysms: A single center experience

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