» Articles » PMID: 30370818

Flow-diverter Stents in the Endovascular Treatment of Remnants in Previously Clipped Ruptured Aneurysms: a Feasibility Study

Overview
Publisher Sage Publications
Specialty Neurology
Date 2018 Oct 30
PMID 30370818
Citations 5
Authors
Affiliations
Soon will be listed here.
Abstract

Background: The rate of intracranial aneurysm remnants/recurrences after microsurgical clipping varies widely. The optimal management for these patients remains a matter of debate. Repeat surgery in particular bears a high risk of periprocedural complications due to anatomical distortion from prior procedures. This study aims to evaluate the risk-benefit profile of flow-diverter stents in these patients.

Methods: The patient database of our neurovascular centre was queried to identify patients with clipped aneurysms who subsequently underwent endovascular treatment with intraluminal flow-diverter stents. The outcome analysis consisted of an assessment of clinical parameters (modified Rankin scale) and the post-interventional angiographic occlusion status (according to the Raymond-Roy occlusion classification).

Results: Six patients underwent endovascular treatment with flow-diverter stents of recurrent aneurysms after clipping. Treatment was necessary in two patients due to progressive neurological deficits, and due to angiographic proof of an increasing aneurysm size in the other four patients. Median aneurysm size was 0.45 cm. All patients had a prior history of subarachnoid haemorrhage. The time from primary clipping to recurrence was 10.6 years. Complete radiological aneurysm occlusion was feasible in five out of six cases. Two patients who had experienced pre-interventional neurological deficits showed a complete remission of symptoms on last follow-up. No periprocedural morbidity or mortality was recorded and no patient required retreatment within the median follow-up.

Conclusion: This case series suggests that endovascular treatment with flow-diverter stents of aneurysm remnants after previous microsurgical clipping is a feasible treatment concept with a low-risk profile, which might prevent the treatment burden and risks of repeat surgery.

Citing Articles

Efficacy and safety of flow diverters in retreatment of recurrent intracranial aneurysms-A systematic review and meta-analysis.

Zarrintan A, Ghozy S, Maroufi S, Reda A, Brinjikji W, Kadirvel R Interv Neuroradiol. 2024; :15910199241282713.

PMID: 39275854 PMC: 11559761. DOI: 10.1177/15910199241282713.


Intracranial post-clipping residual or recurrent aneurysms: Current status and treatment options (Review).

Piao J, Luan T, Qu L, Yu J Med Int (Lond). 2023; 1(1):1.

PMID: 36698683 PMC: 9855273. DOI: 10.3892/mi.2021.1.


Flow diverter retreatment for intracranial aneurysms: A meta-analysis of efficacy and feasibility.

Lee I, Kao Y, Lai Y, Yen H Interv Neuroradiol. 2022; 30(1):37-42.

PMID: 35505615 PMC: 10956466. DOI: 10.1177/15910199221095972.


Endovascular Treatment of Ruptured Middle Cerebral Artery Bifurcation Aneurysms. A Retrospective Observational Study of Short- and Long-Term Follow-Up.

Hagen F, Berlis A, Skalej M, Maurer C Cardiovasc Intervent Radiol. 2021; 44(4):587-595.

PMID: 33392679 DOI: 10.1007/s00270-020-02718-9.


Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas.

Limbucci N, Leone G, Renieri L, Nappini S, Cagnazzo F, Laiso A Neurosurgery. 2019; 86(Suppl 1):S85-S94.

PMID: 31838532 PMC: 6911737. DOI: 10.1093/neuros/nyz334.

References
1.
Tsutsumi K, Ueki K, Morita A, Usui M, Kirino T . Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography. Stroke. 2001; 32(5):1191-4. DOI: 10.1161/01.str.32.5.1191. View

2.
Roy D, Milot G, Raymond J . Endovascular treatment of unruptured aneurysms. Stroke. 2001; 32(9):1998-2004. DOI: 10.1161/hs0901.095600. View

3.
Kim B, Kim D, Kim D, Park S, Suh S, Won Y . Clinical presentation and outcomes of coil embolization of remnant or recurred intracranial aneurysm after clipping. Neurosurgery. 2010; 66(6):1128-33. DOI: 10.1227/01.NEU.0000367998.33743.D6. View

4.
Mangiafico S, Cellerini M, Villa G, Ammannati F, Paoli L, Mennonna P . Endovascular Coiling of Aneurysm Remnants after Clipping in Patients with Follow-up. A Single Center Experience. Interv Neuroradiol. 2010; 11(1):41-8. PMC: 3403786. DOI: 10.1177/159101990501100106. View

5.
El-Beltagy M, Muroi C, Roth P, Fandino J, Imhof H, Yonekawa Y . Recurrent intracranial aneurysms after successful neck clipping. World Neurosurg. 2011; 74(4-5):472-7. DOI: 10.1016/j.wneu.2010.06.036. View