Flow diverters for the posterior inferior cerebellar artery aneurysms: A systematic review and a single-arm meta-analysis

2021 ◽  
pp. 159101992110359
Author(s):  
Xiang Liu ◽  
Kunyang Bao ◽  
Wenzhang Luo ◽  
Weifeng Wan ◽  
Tangming Peng ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Complication Rate ◽  
Meta Analysis ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
Technical Success ◽  
Related Complication ◽  
Cerebellar Artery ◽  
Occlusion Rate ◽  
Flow Diverters

Background The treatment of posterior inferior cerebellar artery aneurysms is controversial. Recently, flow diverters have emerged as an attractive treatment option. Here, we performed a systematic review and meta-analysis of the angiographic and clinical outcomes of flow diverter-treated posterior inferior cerebellar artery aneurysms. Methods We searched the PubMed, EMBASE and Web of Science databases for studies published from inception to January 2021. We included studies that described flow diverters procedures for posterior inferior cerebellar artery aneurysms with ≥2 patients. The outcomes were the complete occlusion rate and flow diverter-related complication rate. Meta-analysis was performed using a random or fixed effects model based on heterogeneity. Results We included six studies involving 46 posterior inferior cerebellar artery aneurysms. There were 14 ruptured aneurysms. All flow diverters were successfully released and the technical success rate was 100%. The complete occlusion rate was 81% (95% confidence interval = 65–93%; I2 = 0.00%; P < 0.01). The flow diverter-related complication rate was 18% (95% confidence interval = 5–36%; I2 = 0.00%; P < 0.01). One patient died of rebleeding. The mortality rate was <1% (95% confidence interval = -1–1%; I2 = 0.00%; P = 0.951). Conclusions Treatment of posterior inferior cerebellar artery aneurysms with flow diverters is feasible and carries a high degree of technical success. However, this treatment is underutilized in patients with posterior inferior cerebellar artery aneurysms due to a higher complication rate and lower occlusion rate compared with clipping and traditional endovascular treatment. Further well-designed prospective and randomized studies are required to fully understand the effects of flow diverters especially in posterior inferior cerebellar artery aneurysms patients requiring endovascular treatment.

scholarly journals Vertebral artery aneurysms and the risk of cord infarction following spinal artery coverage during flow diversion

2020 ◽  
pp. 1-10
Author(s):  
Adam A. Dmytriw ◽  
Anish Kapadia ◽  
Alejandro Enriquez-Marulanda ◽  
Carmen Parra-Fariñas ◽  
Anna Luisa Kühn ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
Thromboembolic Complication ◽  
Flow Diversion ◽  
Cerebellar Artery ◽  
Aneurysm Occlusion ◽  
Aneurysm Diameter ◽  
Flow Diverters

OBJECTIVECoverage of the anterior spinal artery (ASA) ostia is a source of considerable consternation regarding flow diversion (FD) in vertebral artery (VA) aneurysms due to cord supply. The authors sought to assess the association between coverage of the ASA, posterior spinal artery (PSA), or lateral spinal artery (LSA) ostia when placing flow diverters in distal VAs and clinical outcomes, with emphasis on cord infarction.METHODSA multicenter retrospective study of 7 institutions in which VA aneurysms were treated with FD between 2011 and 2019 was performed. The authors evaluated the risk of ASA and PSA/LSA occlusion, associated thromboembolic complication, complications overall, aneurysm occlusion status, and functional outcome.RESULTSSixty patients with 63 VA and posterior inferior cerebellar artery aneurysms treated with FD were identified. The median aneurysm diameter was 7 mm and fusiform type was the commonest morphology (42.9%). During a procedure, 1 (61.7%) or 2 (33.3%) flow diverters were placed. Complete occlusion was achieved in 71.9%. Symptomatic thromboembolic complications occurred in 7.4% of cases and intracranial hemorrhage in 10.0% of cases. The ASA and PSA/LSA were identified in 51 (80.9%) and 35 (55.6%) complications and covered by the flow diverter in 29 (56.9%) and 13 (37.1%) of the procedures, respectively. Patency after flow diverter coverage on last follow-up was 89.2% for ASA and 100% for PSA/LSA, not significantly different between covered and noncovered groups (p = 0.5 and p > 0.99, respectively). No complications arose from coverage.CONCLUSIONSFD aneurysm treatment in the posterior circulation with coverage of ASA or PSA/LSA was not associated with higher rates of occlusion of these branches or any instances of cord infarction.

scholarly journals The use of flow diverters to treat aneurysms of the posterior inferior cerebellar artery: Report of three cases

2018 ◽  
Vol 24 (5) ◽  
pp. 489-498 ◽  
Author(s):  
Pervinder Bhogal ◽  
Jorge Chudyk ◽  
Carlos Bleise ◽  
Ivan Lylyk ◽  
Hans Henkes ◽  
...  
Keyword(s):  
Treatment Option ◽  
Intraoperative Complications ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Coiling ◽  
Medical Illness ◽  
Unruptured Aneurysms ◽  
Alternative Treatment Option ◽  
Cerebellar Artery ◽  
Flow Diverters

Objective The objective of this study was to report our experience on the use of flow diverting stents placed within the posterior inferior cerebellar artery (PICA) as a treatment option for aneurysms of the PICA. Methods Three patients with aneurysms of the PICA, both ruptured and unruptured, underwent treatment of their aneurysms with placement of a single flow diverter in the PICA across the neck of the aneurysm. Adjunctive techniques such as coiling were not used. We present the angiographic and clinical follow-up data. Results The procedure was a technical success in all cases and there were no intraoperative complications. Follow-up data were available for two patients and this showed complete occlusion of the aneurysm with the PICA remaining patent. There was no evidence, either clinical or radiological, of medullary or pontine infarction. One patient died during the follow-up period from an unrelated medical illness (community acquired pneumonia). Conclusion Flow diverters can be successfully placed within the PICA to treat both ruptured and unruptured aneurysms, and they represent an alternative treatment option to endovascular coiling or microscopic neurosurgery.

The Experience With Flow Diverters in the Treatment of Posterior Inferior Cerebellar Artery Aneurysms

2019 ◽  
Vol 17 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Elias Atallah ◽  
Hassan Saad ◽  
Jonathan Li ◽  
Ayan Kumar ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Flow Diverters

Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 363-370 ◽  
Author(s):  
Gilbert Dominique Puippe ◽  
Julian Suesstrunk ◽  
Antonio Nocito ◽  
Roger Pfiffner ◽  
Michael Glenck ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Complication Rate ◽  
Mesenteric Ischaemia ◽  
Technical Success ◽  
Related Complication ◽  
Aspiration Thrombectomy ◽  
Technical Success Rate ◽  
Explorative Laparotomy ◽  
Catheter Directed Thrombolysis ◽  
Picture Archiving And Communication

Abstract. Summary: Background: Acute embolic or thrombotic mesenteric ischaemia (AMI) is a rare but life-threatening clinical condition. Despite diagnostic and therapeutic advances, the mortality rate remains high, between 60 % and 90 %. Over the last years revascularisation was increasingly performed by endovascular techniques. The aim of this study was to retrospectively analyse the clinical outcome of catheter-directed thrombolysis (CDT) and aspiration thrombectomy (AT) in patients with AMI with regard to technical success, intervention-related complication rate, need for secondary abdominal surgery, clinical course and 30-day mortality rate. Patients and methods: Thirteen patients (4 men, 9 women; mean age 74.5 ± 17 years) with 12 embolic and one thrombotic occlusion of the superior mesenteric artery (SMA) underwent emergent endovascular revascularisation of SMA. Clinical data including all imaging reports, laboratory analysis and follow-up data were derived from the electronic patient file and images were reviewed on a Picture Archiving and Communication System. Results: Eleven patients (n = 11; 84.6 %) underwent CDT and AT, and two patients (n = 2; 15.4 %) had AT alone. Technical success with complete restoration of SMA perfusion was achieved in 38.5 % (n = 5). Adjunctive angioplasty ± stenting was mandatory in 2 patients. Overall, the intervention-related complication rate was 38.5 %. In total, 46.2 % (n = 6) clinically improved following the intervention, while 38.5 % required explorative laparotomy after the intervention, with 2 colectomies and 2 small bowel resections. Overall, the 30-day mortality rate was 30.8 %. Conclusions: Endovascular revascularisation with CDT in combination with AT is feasible, with a technical success rate of 38.5 % (n = 5). Endovascular revascularisation was beneficial for 46.2 % (n = 6) of the patients, who clinically improved following the intervention. The need for secondary explorative laparotomy was rather low, with 38.5 % (n = 5) of the patients. The 30-day-mortality remains high with 30.8 %.

Abstract 1122‐000103: FlowDiverter:A Study Safety and Efficacy in a Consecutive Group of 53 Patient and 60 Aneurysm

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Marcelo Bolcato ◽  
ana Carolina Dalmonico ◽  
Leo Ditzel ◽  
Savio Machareti ◽  
Thiago Yoshida ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Consecutive Series ◽  
Safety And Efficacy ◽  
Grading Scale ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Flow Diverters

Introduction : Endovascular flow diverters are increasingly used for the treatment of cerebral aneurysms. We assessed the safety and efficacy of the Flow Diverters in a consecutive series of 53 patients and 60 aneurysms. Methods : Inclusion criteria were wide‐neck, blister‐like, or fusiform aneurysms independent of size, treated with the FRED, PIPELINE and SILK between December 2014 and Junho 2021. Assessment criteria were aneurysm occlusion, manifest ischemic stroke, bleeding, or death. The occlusion rate was assessed at 6 months and 1 year with DSA by using the Raymond classification and the O'Kelly‐Marotta grading scale. Results : Fifty three patients (mean age 54.3 years;81.1% female) with 60 aneurysms were treated with 9 Silk, 38 FREDs and 13 Pipeline. Aneurysm size ranged from 2.5 to 30 mm. Deployment of the Flow diverters was successful in 52 aneurysms. Three patient developed mild stroke symptoms that fully receded within days, 4 patients occlusion total carotid because resistant antiagregation and another patient’s development Swelling syndrome. There has been one death. Initial follow‐up at 6 months showed complete occlusion in 90% of the overall study group and 93,33% at 1 year. Conclusions : The flow diverter is a safe device for the treatment of cerebral aneurysms of various types. Our data reveal high occlusion rates at 6 months and 1 year. Long‐term occlusion rates are expected.

scholarly journals Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

2017 ◽  
Vol 42 (6) ◽  
pp. E17 ◽  
Author(s):  
Geng Zhou ◽  
Ming Su ◽  
Yan-Ling Yin ◽  
Ming-Hua Li
Keyword(s):  
Mortality Rate ◽  
Complication Rate ◽  
Meta Analysis ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Morbidity Rate ◽  
Complication Rates ◽  
Significant Difference ◽  
Neurological Morbidity ◽  
Electronic Database Search

OBJECTIVEThe objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies.METHODSA systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies.RESULTSSixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%–20.5%) and a low mortality rate of 2.8% (95% CI 1.2%–4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%–5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2–4.3).CONCLUSIONSThe use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required.

Acute Treatment of Ruptured Fusiform Posterior Circulation Posterior Cerebral, Superior Cerebellar, and Posterior Inferior Cerebellar Artery Aneurysms With FRED Flow Diverter: Report of 5 Cases

2018 ◽  
Vol 16 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Dan Laukka ◽  
Riitta Rautio ◽  
Melissa Rahi ◽  
Jaakko Rinne
Keyword(s):  
Treatment Time ◽  
Brain Infarction ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
External Ventricular Drainage ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Technical Success Rate ◽  
Cerebellar Artery

Abstract BACKGROUND Flow diverter (FD) treatment of ruptured fusiform posterior cerebral artery (PCA), posterior inferior cerebellar artery (PICA), and superior cerebellar artery (SCA) aneurysms are limited to single reports. OBJECTIVE To study the safety and efficacy of FD treatment for ruptured fusiform aneurysms of the PCA, SCA, and PICA. METHODS Five patients with ruptured posterior circulation fusiform aneurysms and treated with a Flow-Redirection Endoluminal Device (FRED/FRED Jr; Microvention, Tustin, California) stent in the acute phase of subarachnoid hemorrhage between 2013 and 2016 were included and reviewed retrospectively. RESULTS Two aneurysms located on the PICA, 2 on PCA, and 1 on the SCA. Mean treatment time with FD was 5.8 d (range, 0-11 d) from ictus. The technical success rate was 100%. On admission 2 patients were Hunt and Hess grade 1, 2 patients grade 3, and 1 patient grade 4. At discharge, 4 patients (80%) were independent (modified Ranking Scale (mRS) ≤2) and 1 patient had severe disability (mRS 4). None of the patients had aneurysmal rebleeding. All 5 aneurysms were completely occluded on angiographic follow-up (range, 3-22 mo). One patient had permanent intraprocedural in stent thrombosis and brain infarction. One patient had spontaneous nonaneurysmal intracerebral hemorrhage 1 mo after FD treatment. External ventricular drainage was inserted in 3 patients and ventriculoperitoneal shunt in 2 patients without hemorrhagic complications despite dual antiplatelet therapy. CONCLUSION FD could be considered as a treatment option for ruptured fusiform aneurysms located on PCA, PICA, or SCA when other treatment options are challenging.

scholarly journals Use of flow diverters in the treatment of unruptured saccular aneurysms of the anterior cerebral artery

2016 ◽  
Vol 9 (3) ◽  
pp. 283-289 ◽  
Author(s):  
P Bhogal ◽  
R Martinez Moreno ◽  
O Ganslandt ◽  
H Bäzner ◽  
H Henkes ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Flow Diverter ◽  
Related Complication ◽  
Unruptured Aneurysms ◽  
Neck Size ◽  
Angiographic Data ◽  
High Degree ◽  
Flow Diverters

BackgroundFew publications have dealt exclusively with the use of flow diverter stents for the treatment of aneurysms of the anterior cerebral artery (ACA).ObjectiveTo determine the efficacy of flow-diverting stents in the treatment of small, unruptured aneurysms of the ACA.MethodsWe retrospectively reviewed our database of prospectively collected information for all patients treated with flow diversion for an unruptured saccular aneurysm of the ACA between September 2009 and July 2016. The aneurysm fundus size, neck size, number and type of flow-diverting stent (FDS), complications, and follow-up data were recorded.ResultsIn total 26 patients, with 27 aneurysms were identified that matched our inclusion criteria (11 male and 15 female). The average age of the patients was 59.3 years (range 27–77 years). All patients, except one, had a single aneurysm affecting the ACA. Fourteen aneurysms were located on the left (51.9%). The average aneurysm fundus size was 2.9 mm (range 2–6 mm). Twenty patients had follow-up angiographic studies. In total, 16 aneurysms were completely excluded, 1 aneurysm showed a very small remnant, and no follow-up angiographic data are available for the remaining patients. One patient had a treatment-related complication.ConclusionsTreatment of aneurysms arising from the ACA with flow diverters is technically feasible and carries a high degree of success with low complication rate.

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