Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience

Srinivasan, Visish M.; Ghali, Michael George Zaki; Cherian, Jacob; Mokin, Maxim; Puri, Ajit S; Grandhi, Ramesh; Chen, Stephen R.; Johnson, Jeremiah N.; Kan, Peter

doi:10.1136/neurintsurg-2017-013466

Cited by 19 publications

(16 citation statements)

References 36 publications

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“…However, certain aneurysms in these locations are considered for FD specifically because they are not amenable to surgical clipping or endovascular coiling because of their complex fusiform morphology and/or giant size. Our previous experience in covering large or essential vessels with FDs did not show clinically significant infarcts, 26 which is similar to other reports. 18,21,23,27,31 Here, we present a multicenter experience for treating distal ICA aneurysms and proximal MCA and ACA aneurysms with the Pipeline embolization device (PED; Medtronic) covering medial and lateral lenticulostriate vessels.…”

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confidence: 90%

Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience

Wagner¹,

Srinivasan²,

Srivatsan³

et al. 2020

Journal of Neurosurgery

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OBJECTIVEWith the increasing use of flow diversion as treatment for intracranial aneurysms, there is a concomitant increased vigilance in monitoring complications. The low porosity of flow diverters is concerning when the origins of vessels are covered, whether large circle of Willis branches or critical perforators. In this study, the authors report their experience with flow diverter coverage of the lenticulostriate vessels and evaluate their safety and outcomes.METHODSThe authors retrospectively reviewed 5 institutional databases of all flow diversion cases from August 2012 to June 2018. Information regarding patient presentation, aneurysm location, treatment, and outcomes were recorded. Patients who were treated with flow diverters placed in the proximal middle cerebral artery (MCA), proximal anterior cerebral artery, or distal internal carotid artery leading to coverage of the medial and lateral lenticulostriate vessels were included. Clinical outcomes according to the modified Rankin Scale were reviewed. Univariate and multivariate analyses were performed to establish risk factors for lenticulostriate infarct.RESULTSFifty-two patients were included in the analysis. Postprocedure cross-sectional images were available in 30 patients. Two patients experienced transient occlusion of the MCA during the procedure; one was asymptomatic, and the other had a clinical and radiographic ipsilateral internal capsule stroke. Five patients had transient symptoms without radiographic infarct in the lenticulostriate territory. Two patients experienced in-stent thrombosis, leading to clinical MCA infarcts (one in the ipsilateral caudate) after discontinuing antiplatelet therapy. Discontinuation of dual antiplatelet therapy prior to 6 months was the only variable that was significantly correlated with stroke outcome (p < 0.01, OR 0.3, 95% CI 0–0.43), and this significance persisted when controlled for other risk factors, including age, smoking status, and aneurysm location.CONCLUSIONSThe use and versatility of flow diversion is increasing, and safety data are continuing to accumulate. Here, the authors provide early data on the safety of covering lenticulostriate vessels with flow diverters. The authors concluded that the coverage of these perforators does not routinely lead to clinically significant ischemia when dual antiplatelet therapy is continued for 6 months. Further evaluation is needed in larger cohorts and with imaging follow-up as experience develops in using these devices in more distal circulation.

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confidence: 90%

Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience

Wagner¹,

Srinivasan²,

Srivatsan³

et al. 2020

Journal of Neurosurgery

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“…Because the AchA supplies the blood flow to the eloquent areas, 12 which have a high flow demand, such as the posterior limb of the internal capsule, the optic radiation, the acoustic radiation, the internal (medial) globus pallidus, the tail of the caudate nucleus, the uncinate gyrus, the head of the hippocampus, the amygdala, the piriform cortex and the lateral geniculate body, occlusion of the AchA is considered to be extremely rare. 21 Chen et al 22 reported a case in which, although there was an occlusion at the distal end of the FD after FD deployment for an unruptured aneurysm in the internal carotid artery, the flow to the middle cerebral artery was preserved using a pipeline strut. The authors described the event as being caused by the flow demand in the region supplied by the middle cerebral artery.…”

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confidence: 99%

Patency of anterior choroidal artery after flow diverter deployment with assessment of magnetic resonance imaging follow-up

et al. 2018

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We aimed to analyse the patency rate of the anterior choroidal artery, and presented imaging and neurological findings, after deployment of a flow diverter in the anterior choroidal artery in the treatment of patients with intracranial aneurysms. Methods: Among the 139 patients who underwent a flow diverter deployment from December 2012 to September 2017 in our hospital, there were 21 patients (15.1%) for whom their anterior choroidal artery was covered for the procedure with a flow diverter. The patients' age, sex, size of aneurysm and the presence or absence of an anterior choroidal artery occlusion, neurological findings and postoperative infarction in the anterior choroidal artery region were analysed retrospectively. Results: The mean age of the six male and 15 female patients was 61.5 years (range 32-77 years). The mean maximal diameter of the aneurysms was 16.4 mm (range 10.0-29.4 mm). The anterior choroidal artery was patent in all 21 patients; however, a haemodynamic alteration in the anterior choroidal artery was detected in one patient. Postoperatively, hemiparesis was observed in two patients (9.5%) and a visual field defect in one patient (4.8%), both of which were the symptoms of infarction of the cortical branch of the middle cerebral artery or retinal artery ischaemia. However, no patients had symptoms due to ischaemia of the anterior choroidal artery confirmed with magnetic resonance imaging. Conclusions: In all patients who underwent flow diverter deployment, the anterior choroidal artery was patent and no ischaemia was detected in the imaging or evidenced by neurological findings. Therefore, flow diverter deployment in the anterior choroidal artery was considered to be a safe procedure.

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“…[5][6][7][8][9][10] Regarding the anterior choroidal artery, an extremely low occlusion rate was reported. [11][12][13][14][15][16] NMC Case Report Journal Vol. 8,2021 In this study, we described a rare case of delayed anterior choroidal artery occlusion which led to critical neurological deficit following the deployment of a flow diverter stent for a large internal carotid artery aneurysm.…”

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confidence: 99%

Delayed Occlusion of the Anterior Choroidal Artery Following Flow Diverter Stent Deployment for Unruptured Aneurysm: A Case Report and Literature Review

Hosoo

Tsuruta

Dofuku

et al. 2021

NMC Case Report Journal

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Flow diverter stent has been a promising device for intracranial aneurysm treatment. For treating aneurysms located in the anterior circulation, critical branches may be covered by flow diverter stent. The occlusion incidence of these branches has been reported, and even if branch vessel occlusions occur, associated neurological deficits are extremely rare. We present a 55-year-old woman who had a large saccular aneurysm at the right internal carotid artery (ICA). A developed fetal-type posterior communicating artery (PCOM) originated from the sac. We administered flow diverter stent deployment with coil insertion following surgical anastomosis of the superficial temporal artery to the posterior cerebral artery (STA-PCA) with ligation of the origin of the PCOM. On the seventh morning following the intervention, ischemic complication developed due to anterior choroidal artery occlusion jailed by the flow diverter stent. The occlusion of anterior choroidal artery covered by flow diverter stent is extremely rare. However, if the branch arises from the aneurysm sac, occlusion can transpire and induce serious complication. The most probable cause of occlusion in this case was that the orifice was jailed apart from the stent strut because the branch originated from the sac rather than the neck. Furthermore, the progression rate of intra-aneurysm thrombus formation is also an important factor affecting the side branch occlusion.

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Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience

Cited by 19 publications

References 36 publications

Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience

Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience

Patency of anterior choroidal artery after flow diverter deployment with assessment of magnetic resonance imaging follow-up

Delayed Occlusion of the Anterior Choroidal Artery Following Flow Diverter Stent Deployment for Unruptured Aneurysm: A Case Report and Literature Review

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