Cerebral aneurysm

Tiny Pipes: 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Sub-2.0mm.
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Tiny Pipes: 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Sub-2.0mm.

World Neurosurg. 2019 Mar 13;:

Authors: Bender MT, Zarrin DA, Campos JK, Lin LM, Huang J, Caplan JM, Tamargo RJ, Colby GP, Coon AL

INTRODUCTION: Flow diversion is increasingly used for off-label treatments of distal circulation aneurysms. Reports of use in sub-2.0mm vessels are scant.
METHODS: A prospectively-collected, IRB-approved cerebral aneurysm database was reviewed to identify patients who underwent flow diversion with a 2.5mm diameter PED.
RESULTS: Sixty-seven aneurysms were treated in 67 procedures (66(99%) successful, 64(96%) single device, 2(3%) with two devices) in 57 patients. Average age was 56 years and 60% were female. Aneurysm location was: 51(76%) ACA, 14(21%) MCA, and 2(3%) PCA. Aneurysm size was 4.1+/-3.0mm (1-20mm). Safety outcomes included 3 major strokes(4.5%) resulting in permanent neurological deficit (mRS 6,4,4), including one mortality(1.5%). Acute stent thrombosis was observed intra-procedurally or within 24 hours of each stroke. There were 2 small-volume (<10cc, 40cc) dependent ICH(3.0%) that resolved without permanent neurological deficit. For effectiveness, 71% of patients underwent follow-up angiography. Complete occlusion was achieved by 88% at 6-months, 86% at 12-months, and 89% at last follow-up. A slight vessel diameter reduction was apparent on average 6.9-months post-procedure, which was statistically significant at the proximal (p=0.001) but not distal (p=0.317) device end. Pre-operative average parent vessel diameter was 1.9mm proximally (1.1-2.6mm) and 1.7mm distally (1.0-2.3mm) of the PED. Follow-up average vessel diameter was 1.7mm proximally (0.7-2.4mm) and 1.6mm distally (0.6-2.1mm). Flow delay associated with vessel diameter reduction occurred once. There were zero cases of asymptomatic vessel occlusion.
CONCLUSION: Flow diversion can be safe and effective for aneurysms originating from vessels <2.0mm in diameter. Heightened vigilance for the prevention and management of acute stent and vessel thrombosis is warranted in these cases.

PMID: 30878751 [PubMed - as supplied by publisher]

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