Early Fatal Hemorrhage After Endovascular Cerebral Aneurysm Treatment with a Flow Diverter (SILK-Stent): Do We Need to Rethink Our Concepts?

Overview

Journal Neuroradiology

Specialties Neurology
Radiology

Date 2010 Mar 27

PMID 20339842

Citations 105

Authors

Bernd Turowski

Stephan Macht

Zolt Kulcsar

Daniel Hanggi

Walter Stummer

Affiliations

Soon will be listed here.

Abstract

A 69-year-old woman presenting with short lasting recent episodes of visual impairment was treated uneventfully with a flow diverter covering the neck of a large paraophthalmic aneurysm. As angiography showed immediate flow reduction we abstained from additional coiling which was initially planned. Eleven days later CT demonstrated nearly complete thrombosis of the aneurysm. Twenty days after treatment the patient suffered a lethal subarachnoid hemorrhage after rupture of the aneurysm. All available data were reviewed and beside hemodynamic factors instability of the intra-aneurysmal thrombus is discussed as a possible cofactor leading to this disastrous event.

Citing Articles

Key influencers in an aneurysmal thrombosis model: A sensitivity analysis and validation study.

Liu Q, Lassila T, Lin F, MacRaild M, Patankar T, Islim F APL Bioeng. 2025; 9(1):016107.

PMID: 39959383 PMC: 11826514. DOI: 10.1063/5.0223753.

Efficacy of endovascular therapy in short-term two-stage operation for thrombosed giant cerebral aneurysm.

Fujii K, Toyooka T, Yamamoto T, Nitta Y, Nakagawa M, Yoshiura T Surg Neurol Int. 2024; 15:374.

PMID: 39524604 PMC: 11544463. DOI: 10.25259/SNI_706_2024.

How Flow Diverter Selection Can Affect the Flow Changes within a Jailed Ophthalmic Artery: A Computational Fluid Dynamics Study.

Unsal C, Guclu G, Olcay A, Hassankhani A, Bilgin C, Hakyemez B Asian J Neurosurg. 2024; 19(3):426-434.

PMID: 39205892 PMC: 11349421. DOI: 10.1055/s-0044-1787868.

Coiling embolization strategy for medium-to-giant-sized intracranial aneurysms treated with pipeline embolization device: a propensity score-weighted study.

Tong X, Han M, Xue X, Wu Z, Chen J, Liu A Eur Radiol. 2023; 33(11):7967-7977.

PMID: 37314476 DOI: 10.1007/s00330-023-09800-z.

Silk + flow-diverter stent for the treatment of intracranial aneurysms associated with balloon angioplasty: A retrospective study.

Almeida Filho J, Oberman D, Freitas D, Costa R, Brandao T, Junior O Surg Neurol Int. 2023; 14:160.

PMID: 37292391 PMC: 10246341. DOI: 10.25259/SNI_97_2023.

References

Wanke I, Forsting M . Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology. 2008; 50(12):991-8. DOI: 10.1007/s00234-008-0460-0. View

Fiorella D, Woo H, Albuquerque F, Nelson P . Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery. 2008; 62(5):1115-20. DOI: 10.1227/01.neu.0000325873.44881.6e. View

Sluzewski M, Menovsky T, van Rooij W, Wijnalda D . Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results. AJNR Am J Neuroradiol. 2003; 24(2):257-62. PMC: 7974128. View

Gacko M, Glowinski S . Activities of proteases in parietal thrombus of aortic aneurysm. Clin Chim Acta. 1998; 271(2):171-7. DOI: 10.1016/s0009-8981(97)00246-5. View

Weisel J, Litvinov R . The biochemical and physical process of fibrinolysis and effects of clot structure and stability on the lysis rate. Cardiovasc Hematol Agents Med Chem. 2008; 6(3):161-80. DOI: 10.2174/187152508784871963. View

Kirchhof K, Welzel T, Mecke C, Zoubaa S, Sartor K . Differentiation of white, mixed, and red thrombi: value of CT in estimation of the prognosis of thrombolysis phantom study. Radiology. 2003; 228(1):126-30. DOI: 10.1148/radiol.2273020530. View

Blinc A, Kennedy S, Bryant R, Marder V, Francis C . Flow through clots determines the rate and pattern of fibrinolysis. Thromb Haemost. 1994; 71(2):230-5. View

Radaelli A, Augsburger L, Cebral J, Ohta M, Rufenacht D, Balossino R . Reproducibility of haemodynamical simulations in a subject-specific stented aneurysm model--a report on the Virtual Intracranial Stenting Challenge 2007. J Biomech. 2008; 41(10):2069-81. DOI: 10.1016/j.jbiomech.2008.04.035. View

Wohner N . Role of cellular elements in thrombus formation and dissolution. Cardiovasc Hematol Agents Med Chem. 2008; 6(3):224-8. PMC: 2496953. DOI: 10.2174/187152508784871972. View

10.

Kallmes D, Ding Y, Dai D, Kadirvel R, Lewis D, Cloft H . A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke. 2007; 38(8):2346-52. DOI: 10.1161/STROKEAHA.106.479576. View

11.

Carr Jr M, Hardin C . Fibrin has larger pores when formed in the presence of erythrocytes. Am J Physiol. 1987; 253(5 Pt 2):H1069-73. DOI: 10.1152/ajpheart.1987.253.5.H1069. View

12.

Bendszus M, Hagel C, Maurer M, Schutz A, Vince G, Monoranu M . Fatal recurrent subarachnoid hemorrhage after complete endovascular aneurysm occlusion. AJNR Am J Neuroradiol. 2006; 27(10):2058-60. PMC: 7977210. View

13.

Cebral J, Castro M, Appanaboyina S, Putman C, Millan D, Frangi A . Efficient pipeline for image-based patient-specific analysis of cerebral aneurysm hemodynamics: technique and sensitivity. IEEE Trans Med Imaging. 2005; 24(4):457-67. DOI: 10.1109/tmi.2005.844159. View

14.

Blinc A, Keber D, Lahajnar G, Zupancic I, Demsar F . Magnetic resonance imaging of retracted and nonretracted blood clots during fibrinolysis in vitro. Haemostasis. 1992; 22(4):195-201. DOI: 10.1159/000216319. View

15.

Fiorella D, Kelly M, Albuquerque F, Nelson P . Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device. Neurosurgery. 2008; 64(2):212-7. DOI: 10.1227/01.NEU.0000337576.98984.E4. View

16.

Zhao Z, Deng J, Gao G . [Angiographic outcomes of cerebral aneurysms embolized with Matrix coils]. Zhonghua Yi Xue Za Zhi. 2007; 87(1):37-40. View

17.

Grunwald I, Papanagiotou P, Struffert T, Politi M, Krick C, Gul G . Recanalization after endovascular treatment of intracerebral aneurysms. Neuroradiology. 2006; 49(1):41-7. DOI: 10.1007/s00234-006-0153-5. View

18.

Ahlhelm F, Roth C, Kaufmann R, Schulte-Altedorneburg G, Romeike B, Reith W . Treatment of wide-necked intracranial aneurysms with a novel self-expanding two-zonal endovascular stent device. Neuroradiology. 2007; 49(12):1023-8. DOI: 10.1007/s00234-007-0281-6. View