Patency of the anterior choroidal artery covered with a flow-diverter stent

Abstract

OBJECT The concept of the flow-diverter stent (FDS) is to induce aneurysmal thrombosis while preserving the patency of the parent vessel and any covered branches. In some circumstances, it is impossible to avoid dangerously covering small branches, such as the anterior choroidal artery (AChA), with the stent. In this paper, the authors describe the clinical and angiographic effects of covering the AChA with an FDS. METHODS Between April 2011 and July 2013, 92 patients with intracranial aneurysms were treated with the use of FDSs in the authors’ institution. For 20 consecutive patients (21.7%) retrospectively included in this study, this involved the unavoidable covering of the AChA with a single FDS during endovascular therapy. AChAs feeding the choroid plexus were classified as the long-course group (14 cases), and those not feeding the choroid plexus were classified as the short-course group (6 cases). Clinical symptoms and the angiographic aspect of the AChA were evaluated immediately after stent delivery and during follow-up. Neurological examinations were performed to rule out hemiparesis, hemihypesthesia, hemianopsia, and other cortical signs. RESULTS FDS placement had no immediate effect on AChA blood flow. Data were obtained from 1-month clinical follow-up in all patients and from midterm angiographic follow-up in 17 patients (85.0%), with a mean length of 9.8 ± 5.4 months. No patient in either group complained of transient or permanent symptoms related to an AChA occlusion. In all cases, the AChA remained patent without any flow changes. CONCLUSIONS The results of this study suggest that when impossible to avoid, the AChA may be safely covered with a single FDS during intracranial aneurysm treatment, irrespective of anatomy and anastomoses.

Pipeline embolization device for the treatment of vertebral artery aneurysms: the fate of covered branch vessels

“…It is generally believed that covered branch arteries will remain patent provided that flow is maintained through the PED 11 16. One theory is that demand phenomena continue to draw blood into the covered branch 17.…”

“…Chalouhi et al 5 described patency of a covered PICA 6 months after three overlapping PEDs were deployed for a left VA aneurysm. Other studies have reported the fate of covered branches of the anterior circulation or basilar artery 4 16 18–24. It is important to note that many perforating vessels in the vertebrobasilar system cannot be seen on angiography.…”

The Fate of Side Branches Covered by Flow Diverters–Results from 140 Patients

“…However, recent data suggests that coverage of the anterior choroidal artery is unlikely to result in occlusion. Neki et al 16 Reports of occlusion of the anterior cerebral artery (ACA) are limited and to our knowledge the only report that documents the flow status of the ACA following coverage with FDS is that by Rangel-Castilla et al 18 who reported two cases of occlusion of the A1 segment after a FDS was placed across the ICA bifurcation and into the M1 segment. In both cases flow into the A2 segments and distally was maintained by the contralateral A1 segment of the ACA and across the anterior communicating artery (AComA).…”

“…However, there is little literature on the fate of side branches that have been covered by the FDS secondary to the treatment of an aneurysm. Although small studies have looked at the fate of individual branches such as the anterior choroidal artery 16 or the ophthalmic artery 17 we are aware of only a single study that has reviewed the fate of all the major branches of the distal internal carotid artery (ICA) 18 .…”

Predictive modeling and in vivo assessment of cerebral blood flow in the management of complex cerebral aneurysms

“…[29][30][31][32] However, perforating artery patency (resulting in ischemic complications) remains one of the greatest concerns when placing a stent in these locations. Clinical and radiographic evaluation of named branch vessels in these locations, namely the ophthalmic artery, 33,34 the anterior choroidal artery, 35,36 and the posterior inferior cerebellar artery, 37 demonstrate that occlusion is rare and clinical sequelae from occlusion is exceedingly rare.…”