Treatment of blood blister aneurysms of the internal carotid artery with flow diversion

Abstract

Our data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.

Commentary on ‘Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms’

“…Specifically, the appropriate duration of dual (then single) antiplatelet therapy required to maintain the patency of the device and covered side branches remains uncertain; because of the need for dual antiplatelet medications, the use of PED in patients with acute subarachnoid haemorrhage remains controversial; and the safety and efficacy of PED use to treat bifurcation aneurysms remains unknown. Indeed, two recently published JNIS papers reporting the results on the use of PED in ruptured blister-like aneurysm3 and bifurcation aneurysms4 showed encouraging results, but data remain insufficient to consider using PED or other flow diverters in these challenging clinical situations.…”

Flow diversion for treatment of intracranial aneurysms: Mechanism and implications

“…53,72 There were no major strokes or neurologic deaths at the 30-day or 1-year postprocedure follow-up, indicating the safety of the Pipeline Shield FD for use in intracranial aneurysm treatment. 11 Patients also had good clinical outcome, with mRS scores between 0 and 2 at the 3 month follow-up. Ninety percent of patients had immediate total or near occlusion of the blister aneurysm (1 patient's aneurysm remained patent; this patient died 10 days after initial rupture) and retained good function at 90 days postprocedure (8 patients had a modified Rankin Scale [mRS] score of 0, 1 patient had an mRS score of 1).…”

“…73 Mokin et al also showed safety of the PED FD in blood blister aneurysms of the ICA, with complete obliteration on angiographic follow-up in 87.5%, decreased filling in 9.4%, and persistent filling in only 3.1% of treated aneurysms. 11 Patients also had good clinical outcome, with mRS scores between 0 and 2 at the 3 month follow-up. These indicate the safety of FDs for both unruptured and ruptured aneurysm treatment.…”

“…5 However, stent-assisted coiling may not appropriately treat aneurysms with certain geometries, particularly fusiform or partially thrombosed, and the technique remains subject to aneurysmal recanalization. [11][12][13][14][15] To date, published data on the performance of FDs has been encouraging, with high rates of complete aneurysm occlusion (up to 93% of patients with complete occlusion at 180 days) despite the various sizes and complex geometries of aneurysms treated. 1 At this time, FDs require the use of dual antiplatelet therapy to prevent in-stent thrombosis.…”

“…[8][9][10] FDs in other unique rupture situations such as blister and dissecting aneurysms have demonstrated value. [11][12][13][14][15] To date, published data on the performance of FDs has been encouraging, with high rates of complete aneurysm occlusion (up to 93% of patients with complete occlusion at 180 days) despite the various sizes and complex geometries of aneurysms treated. 8,16 The purpose of this review is to examine the available data derived from varied numerical simulations, imaging modalities, animal models, and human cases to garner a further understanding of the mechanism by which FDs achieve aneurysmal occlusion for both the vascular specialist and other members of the clinical neurosciences including generalists.…”