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Research ArticleInterventional

Flow-Diversion Treatment for Unruptured ICA Bifurcation Aneurysms with Unfavorable Morphology for Coiling

F. Cagnazzo, I. Derraz, C. Dargazanli, P.-H. Lefevre, I. Coelho Ferreira, G. Gascou, C. Riquelme, A. Fanti, R. Ahmed, J. Frandon, A. Bonafe and V. Costalat
American Journal of Neuroradiology June 2021, 42 (6) 1087-1092; DOI: https://doi.org/10.3174/ajnr.A7125
F. Cagnazzo
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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I. Derraz
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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C. Dargazanli
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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P.-H. Lefevre
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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I. Coelho Ferreira
bNeurosurgical Department (I.C.F.), Hospital Santa Lucia, Distrito Federal, Brazil
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G. Gascou
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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C. Riquelme
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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A. Fanti
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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R. Ahmed
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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J. Frandon
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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A. Bonafe
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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V. Costalat
aFrom the Neuroradiology Department (F.C., I.D., C.D., P.-H.L., G.G., C.R., A.F., R.A., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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Abstract

BACKGROUND AND PURPOSE: Few reports described flow diversion for ICA bifurcation aneurysms. Our aim was to provide further insight into flow diversion for ICA bifurcation aneurysms difficult to treat with other strategies.

MATERIALS AND METHODS: Consecutive patients receiving flow diverters for unruptured ICA bifurcation aneurysms were collected. Aneurysm occlusion (O'Kelly-Marotta grading scale) and clinical outcomes were evaluated.

RESULTS: Twenty saccular ICA bifurcation aneurysms were treated with the Pipeline Embolization Device deployed from the M1 to the ICA, covering the aneurysm and the A1 segment. All patients presented with an angiographic visualized contralateral flow from the anterior communicating artery. Mean aneurysm size was 6.5 (SD, 3.2) mm (range, 4.5–20 mm). All lesions had an unfavorable dome-to-neck ratio (mean/median, 1.6/1.6; range, 0.8–2.8; interquartile range = 0.5) or aspect ratio for coiling (mean/median = 1.5/1.55; range, 0.8–2.5; interquartile range = 0.6). One was a very large aneurysm (20 mm). Nineteen medium-sized lesions were completely occluded during the angiographic follow-up (13 months). No cases of aneurysm rupture or retreatment were reported. No adverse events were described. Aneurysm occlusion was associated with the asymptomatic flow modification of the covered A1 that was occluded and contralaterally filled among 10 patients (50%), narrowed among 9 patients (45%), and unchanged in 1 subject (5%). There was no difference in the mean initial diameter of the occluded (2.1 [SD 0.4] mm; range, 1.6–3 mm) and narrowed (2 [SD, 0.2] mm; range, 1.7–2.6 mm) A1 segments.

CONCLUSIONS: Medium-sized unruptured ICA bifurcation aneurysms with unfavorable morphology for coiling can be treated with M1 ICA flow diversion. Aneurysm occlusion is associated with flow modifications of the covered A1 that seems safe in the presence of a favorable collateral anatomy through the anterior communicating artery complex.

ABBREVIATIONS:

AcomA
anterior communicating artery
ICAbifA
ICA bifurcation aneurysm
OKM
O'Kelly-Marotta grading scale
PED
Pipeline Embolization Device
WEB
Woven EndoBridge
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American Journal of Neuroradiology: 42 (6)
American Journal of Neuroradiology
Vol. 42, Issue 6
1 Jun 2021
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Flow-Diversion Treatment for Unruptured ICA Bifurcation Aneurysms with Unfavorable Morphology for Coiling
F. Cagnazzo, I. Derraz, C. Dargazanli, P.-H. Lefevre, I. Coelho Ferreira, G. Gascou, C. Riquelme, A. Fanti, R. Ahmed, J. Frandon, A. Bonafe, V. Costalat
American Journal of Neuroradiology Jun 2021, 42 (6) 1087-1092; DOI: 10.3174/ajnr.A7125

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Flow-Diversion Treatment for Unruptured ICA Bifurcation Aneurysms with Unfavorable Morphology for Coiling
F. Cagnazzo, I. Derraz, C. Dargazanli, P.-H. Lefevre, I. Coelho Ferreira, G. Gascou, C. Riquelme, A. Fanti, R. Ahmed, J. Frandon, A. Bonafe, V. Costalat
American Journal of Neuroradiology Jun 2021, 42 (6) 1087-1092; DOI: 10.3174/ajnr.A7125
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