RT Journal Article
SR Electronic
T1 Use of Flow-Diverting Devices in Fusiform Vertebrobasilar Giant Aneurysms: A Report on Periprocedural Course and Long-Term Follow-Up
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1346
OP 1352
DO 10.3174/ajnr.A3859
VO 35
IS 7
A1 Ertl, L.
A1 Holtmannspötter, M.
A1 Patzig, M.
A1 Brückmann, H.
A1 Fesl, G.
YR 2014
UL http://www.ajnr.org/content/35/7/1346.abstract
AB BACKGROUND AND PURPOSE: Fusiform vertebrobasilar giant aneurysms are a rare (<1% of all intracranial aneurysms) but challenging aneurysm subtype. Little data are available on the natural history of this aneurysm subtype and the impact of the use of flow-diverting stents on the long-term clinical and imaging follow-up. In this article, we present our experience with the treatment of fusiform vertebrobasilar giant aneurysms by flow diverting stents. We aim to stimulate a discussion of the best management paradigm for this challenging aneurysm subtype. MATERIALS AND METHODS: We retrospectively identified 6 patients with fusiform vertebrobasilar giant aneurysms who had been treated with flow-diverting stents between October 2009 and March 2012 in our center. The available data were re-evaluated. The modified Rankin Scale score was assessed before intervention, during the stay in hospital, and at discharge. RESULTS: Six patients were identified (all male; age range, 49–71 years; median age, 60 years). Handling of material was successful in all cases. No primary periprocedural complications occurred. The mean follow-up was 13 months (15 days to 29 months). During follow-up, 3 of 6 patients had recurrent cerebral infarctions, but no patient experienced SAH. Two patients presented with acute thrombotic stent occlusion. The modified Rankin Scale score was not higher than 3 in any of the cases before intervention, whereas the best mRS score at the last follow-up was 5. Four of 6 patients died during follow-up. CONCLUSIONS: Endovascular treatment of fusiform vertebrobasilar giant aneurysms with flow-diverting devices is feasible from a technical point of view; however, changes in hemodynamics with secondary thrombosis are not predictable. We currently do not intend to treat fusiform vertebrobasilar giant aneurysms with flow-diverting devices until we have further understanding of the pathophysiology, natural history, and hemodynamic effects of flow diversion. ASAacetylsalicylic acidFVBGAfusiform vertebrobasilar giant aneurysm