Flow diversion of fusiform intracranial aneurysms.
Adolescent
Adult
Aged
Aneurysm
/ diagnostic imaging
Blood Vessel Prosthesis
Cerebrovascular Circulation
/ physiology
Child
Endovascular Procedures
/ instrumentation
Female
Follow-Up Studies
Humans
Intracranial Aneurysm
/ diagnostic imaging
Male
Middle Aged
Retrospective Studies
Self Expandable Metallic Stents
Treatment Outcome
Young Adult
Flow diversion
Fusiform aneurysm
Pipeline embolization device
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
16
03
2020
accepted:
04
06
2020
revised:
03
05
2020
pubmed:
21
6
2020
medline:
14
7
2021
entrez:
21
6
2020
Statut:
ppublish
Résumé
Fusiform aneurysms are less common than saccular aneurysms, but have higher associated mortality and rebleeding rates. Recently, flow diversion has emerged as a possible treatment option. The purpose of this study was to determine the safety and efficacy of the Pipeline Embolization Device (PED) for the treatment of ruptured and unruptured fusiform aneurysms. This was a retrospective analysis of patients with fusiform intracranial aneurysms treated with a PED at a quaternary care center between January 2012 and September 2019. Occlusion rates, neurologic morbidity/mortality, and other clinical variables were analyzed. Twenty-nine patients with 30 fusiform aneurysms were treated with a PED. Sixteen aneurysms (53%) were located in the anterior circulation and 14 aneurysms (47%) were in the posterior circulation. The mean maximal diameter of the aneurysms was 10.1 ± 5.6 mm (range 2.3-25 mm). Angiographic and clinical follow-up were available for 28 aneurysms (93%). The median follow-up was 17.4 months (IQR 4.8 to 28 months) and occlusion rates were graded according to the O'Kelly-Marotta (OKM) scale. Of patients with DSA follow-up, 15 aneurysms (60%) were completely occluded (OKM D) and 19 aneurysms (76%) had a favorable occlusion result (OKM C1-3 and D). The overall complication rate was 26.7% with a neurological morbidity rate of 6.7% and neurological mortality rate of 3.4%. Flow diversion can be an effective treatment for both ruptured and unruptured fusiform aneurysms. Nevertheless, complete occlusion rates are lower than for saccular aneurysms. Therefore, flow diversion should be considered only if other more direct treatment options, such as clipping or stent/coiling are not applicable. Flow diversion should be used cautiously in patients presenting with rupture.
Identifiants
pubmed: 32562019
doi: 10.1007/s10143-020-01332-0
pii: 10.1007/s10143-020-01332-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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