Progressive volume reduction and long-term aneurysmal collapse following flow diversion treatment of giant and symptomatic cerebral aneurysms

Sirakova, Kristina; Penkov, Marin; Matanov, Svetozar; Minkin, Krasimir; Ninov, Kristian; Hadzhiyanev, Asen; Karakostov, Vasil; Ivanova, I. F.; Sirakov, Stanimir

doi:10.3389/fneur.2022.972599

Cited by 8 publications

(10 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The p64 flow diverter has been extensively investigated in clinical application for treating cerebral aneurysms 35 – 37 . In one study exploring progressive volume decrease and long-term aneurysmal collapse after deployment of the p64 flow diverter for 36 giant and symptomatic intracranial aneurysms 37 , significant aneurysmal shrinkage was observed in 32 aneurysms at 24-months follow-up compared with 25 aneurysms at 6-month follow-up. After treatment, all 13 patients with the third cranial nerve palsy demonstrated improvements, and the total post-treatment complication rate was 8.3% with no deaths.…”

Section: Discussionmentioning

confidence: 99%

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Li,

Gao,

et al. 2024

Sci Rep

View full text Add to dashboard Cite

To investigate the safety and effect of Tubridge flow diverter deployment for the treatment of intracranial aneurysms, 85 patients with intracranial aneurysms treated with the Tubridge flow diverter were retrospectively enrolled. The clinical data including the baseline data, aneurysm parameters before and after treatment, and follow-up outcomes were assessed. Among 85 patients, there were 35 (41.2%) males and 50 females (58.8%) aged 17–77 (mean 56.7 ± 11.1) years with 110 aneurysms. Five (5.9%) patients initially presented with subarachnoid hemorrhage from aneurysm rupture. The aneurysm size was 2–30 (mean 8.6) mm, and the aneurysm neck was 2–10.6 (mean 5.7 ± 2.3) mm. Ninety-three Tubridge stents were deployed. Twenty-five (29.4%) patients experienced adjunctive loose coiling. Blood flow was significantly reduced from entering the aneurysm after stent deployment. Periprocedural complications occurred in three (3.5%) patients, including in-stent thrombosis during embolization in one patient (1.2%), conjunctiva edema on the right in one patient (1.2%), and acute multiple cerebral infarctions in one patient (1.2%). Angiographic follow-up was conducted in 67 (78.8%) patients 3–36 (mean 15.3 ± 5.6) months later. In 11 (16.4% or 11/67) patients, blood flow still entered the aneurysm with the O’Kelly-Marotta (OKM) grade B in two (3.0%) patients and grade C in nine (13.4%), whereas complete occlusion (OKM grade D) was achieved in the other 56 (83.6% or 56/67) aneurysms. In-stent stenosis was present in five (7.5%) patients with approximately 25% stenosis in three (4.5%) patients and 50% in two (3.0%). In conclusion, the Tubridge flow diverter can be safely and efficiently applied in the treatment of small and large intracranial aneurysms, with a low periprocedural complication rate, a high occlusion degree, and a low in-stent stenosis rate at follow-up even though large aneurysms may necessitate a longer surgical time and adjunctive coiling.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Li,

Gao,

et al. 2024

Sci Rep

View full text Add to dashboard Cite

show abstract

“… 5 The treatment goal is not only to prevent future hemorrhagic events but also to alleviate the associated mass effect and compression symptoms. 4 Treatment strategies for these uncommon intracranial aneurysms remain a matter of substantial debate because evidence from large clinical trials is lacking. 4 Recent reports have demonstrated the flow diversion efficacy for giant cerebral aneurysms in the posterior circulation.…”

Section: Discussionmentioning

confidence: 99%

“… 4 Treatment strategies for these uncommon intracranial aneurysms remain a matter of substantial debate because evidence from large clinical trials is lacking. 4 Recent reports have demonstrated the flow diversion efficacy for giant cerebral aneurysms in the posterior circulation. 4 , 6 However, a significantly higher risk of perforating branch infarction compared with that in anterior circulation aneurysms has also been shown.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 Endoluminal implants that reduce and redirect blood flow away from the aneurysm sac can diminish the pulsation phenomenon and induce steady intrasaccular thrombosis. 4 Similar to the wound-healing mechanism, the biotransformation and organization of the intrasaccular thrombus into fibrous scar tissue allow the aneurysmal structure to be reduced and eventually resorbed to some extent. 11 In the present case, we decided to implant an FD stent to stabilize the growing thrombosed aneurysm.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Partially thrombosed giant basilar artery aneurysm with attenuated contrast enhancement of the intraluminal thrombus on vessel wall MRI after flow diversion treatment: illustrative case

Matsukawa,

Ishii,

Fushimi

et al. 2023

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND The effect of vessel wall magnetic resonance imaging (VW-MRI) enhancement in partially thrombosed aneurysms has previously indicated aneurysmal instability and a rupture risk. However, whether the contrast effect of the wall changes before or after flow diversion treatment is still under investigation. OBSERVATIONS The authors report a case of a partially thrombosed basilar artery aneurysm that increased in size over a short period, worsened brainstem compression symptoms, and was treated with a flow diverter stent with good results. In this case, VW-MRI after surgery showed a reduced contrast effect on the intraluminal thrombus within the aneurysm. The aneurysm thrombosed and markedly regressed over the next 5 months, with remarkable improvement in the brainstem compression symptoms. LESSONS This finding on VW-MRI may indicate an attenuation of neovascularization in the thrombus wall and be a sign of aneurysm stabilization.

show abstract

“…Therefore, aneurysm shrinkage is significant not only because it relieves the mass effect on important surrounding structures, but also because it implies histopathologic repair of the aneurysm (8-10). However, although several reports have evaluated such shrinkage qualitatively, few reports have evaluated it quantitatively (11)(12)(13). Moreover, no reports so far have identified the predictors of aneurysm shrinkage yet.…”

Section: Introductionmentioning

confidence: 99%

Predictors of aneurysm shrinkage after flow diversion treatment for internal carotid artery aneurysms: quantitative volume analysis with MRI

Akiyama,

Ishii,

Kikuchi

et al. 2023

Front. Neurol.

View full text Add to dashboard Cite

Background and purposeAlthough aneurysm shrinkage often occurs after flow diversion treatment for intracranial aneurysms, no reports have addressed the factors associated with aneurysm shrinkage.Materials and methodsThis retrospective single-center study was performed to examine patients with unruptured internal carotid artery aneurysms who were treated using flow diversion and followed up by imaging for at least 12 months. The study outcome was aneurysm shrinkage (volume reduction of ≥10%) 12 months after treatment. Aneurysm volume was quantitatively assessed using the MRIcroGL software. Patient and aneurysm characteristics were statistically analyzed.ResultsThis study involved 81 patients with 88 aneurysms. At the 6 months, 12 months, and last follow-ups, the proportion of aneurysms that had shrunk was 50, 64, and 65%, respectively. No adjunctive coiling (odds ratio, 56.7; 95% confidence interval, 7.03–457.21; p < 0.001) and aneurysm occlusion (odds ratio, 90.7; 95% confidence interval, 8.32–988.66; p < 0.001) were significantly associated with aneurysm shrinkage. In patients treated by flow diversion with adjunctive coiling, only the volume embolization rate was a factor significantly associated with aneurysm shrinkage (p < 0.001). Its cutoff value was 15.5% according to the receiver operating characteristic curve analysis (area under the curve, 0.87; sensitivity, 0.87; specificity, 0.83).ConclusionThe rate of aneurysm shrinkage after flow diversion increased during the first 12 months after treatment, but not thereafter. No adjunctive coiling and aneurysm occlusion were predictors of aneurysm shrinkage, respectively. If adjunctive coiling is required, a volume embolization rate of ≤15.5% may be suggested for aneurysm regression.

show abstract

Progressive volume reduction and long-term aneurysmal collapse following flow diversion treatment of giant and symptomatic cerebral aneurysms

Cited by 8 publications

References 48 publications

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Partially thrombosed giant basilar artery aneurysm with attenuated contrast enhancement of the intraluminal thrombus on vessel wall MRI after flow diversion treatment: illustrative case

Predictors of aneurysm shrinkage after flow diversion treatment for internal carotid artery aneurysms: quantitative volume analysis with MRI

Contact Info

Product

Resources

About