Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms

Journal of Clinical Medicine

Ronen Leker¹  José E. Cohen²  Gustavo Rajz³  John Moshe Gomori⁴  Hans Henkes⁵ 

[1] Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel;Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel;Department of Neurosurgery, Shaare Zedek Medical Center, Jerusalem 91031, Israel;Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel;Neuroradiologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, Germany;

关键词: blister aneurysm;    brain aneurysm;    flow diverter stent;    hemorrhagic stroke;    internal carotid artery;    microaneurysm;   

DOI  :  10.3390/jcm10225249

来源: DOAJ

【 摘 要 】

Flow diversion is a promising option in selected patients with acutely ruptured microaneurysms. In this article, we reviewed our experience. Patients with acute spontaneous subarachnoid hemorrhage (SAH) after rupture of a blister-like or saccular microaneurysm (≤2 mm maximal diameter) at a nonbranching ICA site treated from January 2016 to June 2019 using flow diversion as standalone therapy were included in this study. An EVD was usually placed preventively. Antiplatelet effects of pre-procedure DAPT were evaluated (target PRU, 80–160). After the intervention, DAPT was continued for ≥6 months, aspirin—indefinitely. Angiographic controls were obtained. Fifteen patients (12 female; mean age, 46.4 years) with 15 ruptured ICA microaneurysms (mean diameter, 1.8 mm) were included. An EVD was placed in 12 patients (75%) before DAPT administration and stenting. PRU values immediately before FDS were 1–134 (mean, 72.1). One patient died 27 days after flow diversion due to a suspected fulminant pulmonary embolism. Aneurysms were completely occluded at the 6–12-month angiographic follow-up in 14/14 surviving patients, with no rebleeding at a mean of 14 months. Late mRS was 0–2 in 13/14 patients and 3 in one due to sequelae of the original hemorrhage. Flow diversion provided robust aneurysm rebleeding control. Angiographic follow-up confirmed complete aneurysm occlusion in all the cases.

【 授权许可】

Unknown