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    Flow diversion treatment for acutely ruptured aneurysms

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    Authors
    Ten Brinck, Michelle F. M.
    Jager, Maike
    de Vries, Joost
    Grotenhuis, J. Andre
    Aquarius, Rene
    Morkve, Svein H.
    Rautio, Riitta
    Numminen, Jussi
    Raj, Rahul
    Wakhloo, Ajay K.
    Puri, Ajit S.
    Taschner, Christian A.
    Boogaarts, Hieronymus D.
    Show allShow less
    UMass Chan Affiliations
    Department of Radiology, New England Center for Stroke Research
    Document Type
    Journal Article
    Publication Date
    2019-08-24
    Keywords
    endovascular techniques
    flow diversion
    intracranial aneurysm
    subarachnoid hemorrhage
    Analytical, Diagnostic and Therapeutic Techniques and Equipment
    Cardiovascular Diseases
    Nervous System Diseases
    Neurology
    Radiology
    Surgery
    
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    Link to Full Text
    https://doi.org/10.1136/neurintsurg-2019-015077
    Abstract
    BACKGROUND AND PURPOSE: Flow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms. METHODS: We conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0-2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up. RESULTS: At follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3-6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size > /=20 mm and < 20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%). CONCLUSION: Flow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.
    Source

    J Neurointerv Surg. 2019 Aug 24. pii: neurintsurg-2019-015077. doi: 10.1136/neurintsurg-2019-015077. [Epub ahead of print] Link to article on publisher's site

    DOI
    10.1136/neurintsurg-2019-015077
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/48387
    PubMed ID
    31446429
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1136/neurintsurg-2019-015077
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