scholarly journals Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

2020 ◽  
Vol 41 (10) ◽  
pp. 1856-1862 ◽  
Author(s):  
J.M. Ospel ◽  
P. Brouwer ◽  
F. Dorn ◽  
A. Arthur ◽  
M.E. Jensen ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Consensus Statement ◽  
Flow Diversion ◽  
Delphi Consensus ◽  
Ruptured Intracranial Aneurysms

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

Flow diversion for acutely ruptured intracranial aneurysms treatment: A retrospective study and literature review

2022 ◽  
Vol 31 (3) ◽  
pp. 106284
Author(s):  
Andrea Giorgianni ◽  
Edoardo Agosti ◽  
Stefano Molinaro ◽  
Alberto Vito Terrana ◽  
Francesco Alberto Vizzari ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Literature Review ◽  
Intracranial Aneurysms ◽  
Flow Diversion ◽  
Ruptured Intracranial Aneurysms

scholarly journals Early Versus Delayed Flow Diversion for Ruptured Intracranial Aneurysms: A Meta-Analysis

2019 ◽  
Vol 126 ◽  
pp. 41-52 ◽  
Author(s):  
Rimal Hanif Dossani ◽  
Devi P. Patra ◽  
Jennifer Kosty ◽  
Fareed Jumah ◽  
Okkes Kuybu ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Flow Diversion ◽  
Ruptured Intracranial Aneurysms

‘Plug and pipe’ strategy for treatment of ruptured intracranial aneurysms

2018 ◽  
Vol 11 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Brian M Howard ◽  
Jason M Frerich ◽  
Thomas P Madaelil ◽  
Jacques E Dion ◽  
Frank C Tong ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Acute Stage ◽  
Flow Diversion ◽  
Medical Illness ◽  
Ruptured Intracranial Aneurysm ◽  
Aneurysm Occlusion ◽  
Ruptured Intracranial Aneurysms

BackgroundAneurysmal subarachnoid hemorrhage is a potentially devastating condition, and among the first priorities of treatment is aneurysm occlusion to prevent re-hemorrhage. An emerging strategy to treat patients whose aneurysms are not ideal for surgical or endovascular treatment is subtotal coiling followed by flow diversion in the recovery phase or ‘plug and pipe’. However, data regarding the safety and efficacy of this strategy are lacking.MethodsA retrospective cohort study was performed to evaluate the efficacy and safety of ‘plug and pipe’. All patients with a ruptured intracranial aneurysm intentionally, subtotally treated by coiling in the acute stage followed by flow diversion after recovery, were included. The primary outcome was re-hemorrhage. Secondary outcomes included aneurysm occlusion and functional status. Complications were reviewed.Results22 patients were included. No patient suffered a re-hemorrhage, either in the interval between coiling and flow diversion or in follow-up. The median interval between aneurysm rupture and flow diversion was 3.5 months. Roy–Raymond (R-R) class I or II occlusion was achieved in 91% of target aneurysms at the last imaging follow-up (15/22(68%) R-R 1 and 5/22(23%) R-R 2). Complications occurred in 2 (9%) patients, 1 of which was neurological.ConclusionsOverall, these data suggest that subtotal coiling of ruptured intracranial aneurysms followed by planned flow diversion is both safe and effective. Patients who may most benefit from ‘plug and pipe’ are those with aneurysms that confer high operative risk and those whose severity of medical illness increases the risk of microsurgical clip ligation.

scholarly journals Flow Diversion in Ruptured Intracranial Aneurysms: A Meta-Analysis

2016 ◽  
Vol 38 (3) ◽  
pp. 590-595 ◽  
Author(s):  
T.P. Madaelil ◽  
C.J. Moran ◽  
D.T. Cross ◽  
A.P. Kansagra
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Flow Diversion ◽  
Ruptured Intracranial Aneurysms
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