Intra-Aneurysmal Thrombosis as a Possible Cause of Delayed Aneurysm Rupture after Flow-Diversion Treatment

Abstract

BACKGROUND AND PURPOSE: FD technology enables reconstructive repair of otherwise difficult-totreat intracranial aneurysms. These stentlike devices may induce progressive aneurysm thrombosis without additional implants and may initiate complete reverse vessel remodeling. The associated vascular biologic processes are as yet only partially understood.

Silk Flow-Diverter Stent for the Treatment of Intracranial Aneurysms: A Series of 58 Patients with Emphasis on Long-Term Results

“…18 Our results confirm these findings because we did not observe any bleeding in the present series, with most of our patients having mid-to-long-term follow-up. In our daily practice, we always add coils in ruptured aneurysms and in very large or giant unruptured aneurysms.…”

Enhanced Aneurysmal Flow Diversion Using a Dynamic Push-Pull Technique: An Experimental and Modeling Study

“…With regard to the clinical implications of flow reduction, it is understood that more flow reduction leads to more immediate and complete thrombotic occlusion, therefore avoiding the complications related to aneurysm rupture. 11,12 The orifice coverage of the first clinical case matched the current high-compaction mesh of the sidewall aneurysm (46% versus 50%), indicating comparable flow reduction. The low-compaction mesh of the other case was favorable for branch vessel preservation, but with compromised flow reduction.…”

Evolution of Flow-Diverter Endothelialization and Thrombus Organization in Giant Fusiform Aneurysms after Flow Diversion: A Histopathologic Study

“…However, these publications were soon followed by reports on late complications, including late thrombosis of the FD within 2 years. 9 Of 13 delayed ruptures after FD treatment reported by Kulcsár et al, 22 4 were in patients with a GFA. In a series by Siddiqui et al, 10 after FD treatment for posterior circulation GFAs in 7 patients, 4 patients died and 2 had a poor outcome.…”