Flow Diverter Apposition in Patients with Large or Giant Intracranial Aneurysms Evaluated on Three-Dimensional Fusion Images Acquired by High-Resolution Cone-Beam Computed Tomography and Digital Subtraction Angiography

Kato, Naoki; Yuki, Ichiro; Otani, Katharina; Ishibashi, Toshiyuki; Kakizaki, Shota; Nagayama, Gota; Maruyama, Fumiaki; Ikemura, Ayako; Kan, Issei; Kodama, Takahide; Abe, Yukiko; Murayama, Yuichi

doi:10.1016/j.wneu.2020.12.068

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…Insufficient adherence of the FD to the vessel is considered a risk factor for thromboembolism, as endothelialization of the stent surface is prevented. 23 , 24 In this case, mild malpositioning was observed at the proximal end of the FD, which may have triggered thrombus formation. Balloon angioplasty after FD deployment may have been necessary.…”

Section: Discussionmentioning

confidence: 72%

Paraclinoid internal carotid artery aneurysm with delayed stent occlusion after deployment of a flow diverter stent involving the orifice of the anterior cerebral artery: illustrative case

Imai,

Shimizu,

Yamamoto

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND In-stent thrombotic occlusion is a serious ischemic complication that can also result in ischemia in the distal perfusion territory and the territory of side branches for the artery in which the flow diverter (FD) stent is deployed. OBSERVATIONS A 49-year-old female with a large paraclinoid internal carotid artery (ICA) aneurysm was treated with an FD involving the orifice of the anterior cerebral artery (ACA). The antiplatelet dose was reduced because of an increased clopidogrel response postintervention. The patient developed aphasia 2 months later. Emergency magnetic resonance imaging and digital subtraction angiography of the brain indicated FD stent occlusion and a small infarct in the distal vascular territory of the ipsilateral ICA, but the anterior choroidal artery (AChoA) territory was preserved by collateral flow. Emergency superficial temporal artery to middle cerebral artery anastomosis was performed, and she was discharged without neurological deficit 2 weeks after the second operation. LESSONS In-stent occlusion after FD deployment involving the orifice of the ACA can cause severe cerebral ischemia that requires an adequate antiplatelet effect and careful follow-up. The AChoA territory can be preserved by collateral blood flow even in cases of in-stent occlusion.

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Section: Discussionmentioning

confidence: 72%

Paraclinoid internal carotid artery aneurysm with delayed stent occlusion after deployment of a flow diverter stent involving the orifice of the anterior cerebral artery: illustrative case

Imai,

Shimizu,

Yamamoto

et al. 2023

Journal of Neurosurgery: Case Lessons

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“…The results reveal that a discrepancy in the vessel diameter at which the FD is located distally and proximally, an FD proximal end dropping at the curve part and a larger curvature can increase the risk of FD tail malapposition. Kato et al (17) conducted research on the factors associated with FD malapposition in the treatment of large and giant aneurysms with a sample size of 26 patients. They also measured the proximal and distal vessel diameter discrepancy and siphon angle for analysis.…”

Section: Discussionmentioning

confidence: 99%

Flow diverter tail malapposition after implantation in the internal carotid artery for aneurysm treatment: a preliminary study

Wan,

Liu,

et al. 2023

Front. Neurol.

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Background and purposeFavorable wall apposition of a flow diverter (FD) is essential for the treatment of intracranial aneurysms. The irretrievability and final drop point uncertainty of the proximal tail of the FD increase the difficulty of achieving good tail apposition. Therefore, understanding the factors associated with FD tail malapposition would be helpful for clinical practice.MethodsA total of 153 patients with 161 FD deployments in the carotid artery between 2020 and 2023 were retrospectively collected from our center’s database for this study. Patient demographics, aneurysm characteristics, FDs, carotid artery anatomy, periprocedural complications, discharge modified Rankin scale (MRS) scores, and follow-up outcomes were investigated by comparing patients with and without FD tail malapposition. Comparisons were made with t tests or Kruskal–Wallis tests for continuous variables and the Pearson χ2 or Fisher exact test for categorical variables. Logistic regression was conducted to determine the predictors of malapposition.ResultsTail malapposition occurred for 41 out of the 161 FDs (25.5%). Univariate analysis revealed that the FD brand, FD length, FD distal to proximal vessel diameter ratio, FD tail position (straight or curved), and curvature of the vessel curve were significantly associated with FD tail malapposition (p < 0.05). Further multivariate analysis demonstrated that the application of a surpass FD (p = 0.04), the FD distal to proximal vessel diameter ratio (p = 0.022), the FD tail position (straight or curved) (p < 0.001) and the curvature of the vessel curve (p < 0.001) were factors significantly associated with FD tail malapposition. No significant difference was found in periprocedural or follow-up outcomes. The classification of FD tail malapposition was determined from imaging. The two major patterns of FD tail malapposition are unattached tails and protrusive tails.ConclusionFD tail malapposition might be associated with a larger FD distal to the proximal vessel diameter difference, a curved vessel where the FD tail is located, and a larger curvature of the vessel curve. FD tail malapposition can be classified into unattached tails and protrusive tails, which have their own characteristics and should be noted in clinical practice.

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“…Dobrocky et al 8 used the CBCT-A to demonstrate the absence of pontine perforators in the fusiform vessel segment of vertebra-basilar dolichoectasia. Two studies used the CBCT-A to evaluate the flow diverter braid expansion and conformability to the vessel wall, during treatment of brain aneurysms with flow diverters, 6,13 in order to avoid common complications of its deployment. To our knowledge this is the first study assessing CBCT-A applicability in IAD presenting with acute ischaemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…CBCT-A was visualized using the established angiographic system (AlluraClarity, Philips Healthcare, Best, Netherlands or Artis Q pure VD11C biplane, Siemens). CBCT-A was used to assess the angiographic criteria of IAD proposed by Labeyrie et al: 5 (1) progressive stenosis or occlusion (flame-shaped) of an intradural artery; (2) mural haematoma; (3) intraluminal transverse or longitudinal flap; (4) tubular or fusiform enlargement of the external calibre of the artery; (5) normalization of the calibre of the artery after stenting; (6) no clot after mechanical thrombectomy manoeuver. All procedures was performed under general anaesthesia.…”

Section: Methodsmentioning

confidence: 99%

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Cone-beam CT angiography to assess the microvascular anatomy of intracranial arterial dissections

Diana

Raz²,

Biraschi

et al. 2021

Neuroradiol J

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Background Intracranial artery dissection is a rare and generally under-recognized cause of ischaemic stroke or subarachnoid haemorrhage. Objectives The aim of this study was to analyse the efficacy of cone-beam computed tomography angiography (CBCT-A) to detect arterial ultrastructural alterations in intracranial artery dissection. Method This is an observational and retrospective case series. Results Between January 2018 and November 2020, four patients were admitted with an acute ischaemic stroke due to intracranial dissection studied with CBCT-A. In all cases, the CBCT-A documented vascular ultrastructural alterations related with the intracranial dissection. Conclusions CBCT-A is an intraprocedural diagnostic technique that is useful for the diagnosis of intracranial dissections.

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Flow Diverter Apposition in Patients with Large or Giant Intracranial Aneurysms Evaluated on Three-Dimensional Fusion Images Acquired by High-Resolution Cone-Beam Computed Tomography and Digital Subtraction Angiography

Cited by 5 publications

References 20 publications

Paraclinoid internal carotid artery aneurysm with delayed stent occlusion after deployment of a flow diverter stent involving the orifice of the anterior cerebral artery: illustrative case

Paraclinoid internal carotid artery aneurysm with delayed stent occlusion after deployment of a flow diverter stent involving the orifice of the anterior cerebral artery: illustrative case

Flow diverter tail malapposition after implantation in the internal carotid artery for aneurysm treatment: a preliminary study

Cone-beam CT angiography to assess the microvascular anatomy of intracranial arterial dissections

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