RT Journal Article
SR Electronic
T1 Intra-Aneurysmal Thrombosis as a Possible Cause of Delayed Aneurysm Rupture after Flow-Diversion Treatment
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 20
OP 25
DO 10.3174/ajnr.A2370
VO 32
IS 1
A1 Z. Kulcsár
A1 E. Houdart
A1 A. Bonafé
A1 G. Parker
A1 J. Millar
A1 A.J.P. Goddard
A1 S. Renowden
A1 G. Gál
A1 B. Turowski
A1 K. Mitchell
A1 F. Gray
A1 M. Rodriguez
A1 R. van den Berg
A1 A. Gruber
A1 H. Desal
A1 I. Wanke
A1 D.A. Rüfenacht
YR 2011
UL http://www.ajnr.org/content/32/1/20.abstract
AB BACKGROUND AND PURPOSE: FD technology enables reconstructive repair of otherwise difficult-to-treat intracranial aneurysms. These stentlike devices may induce progressive aneurysm thrombosis without additional implants and may initiate complete reverse vessel remodeling. The associated vascular biologic processes are as yet only partially understood. MATERIALS AND METHODS: From 12 different centers, 13 cases of delayed postprocedural aneurysm rupture were recorded and analyzed. Symptom, aneurysm location and morphology, and the time elapsed from treatment until rupture were analyzed. RESULTS: There were 10 internal carotid and 3 basilar artery aneurysms. Mean aneurysm diameter was 22 ± 6 mm. Eleven patients were symptomatic before treatment. A single FD was used for all saccular aneurysms, while fusiform lesions were treated by using multiple devices. A supplementary loose coiling of the aneurysm was performed in 1 patient only. Ten patients developed early aneurysm rupture after FD treatment (mean, 16 days; range, 2–48 days); in 3 patients, rupture occurred 3–5 months after treatment. In all cases, most of the aneurysm cavity was thrombosed before rupture. The biologic mechanisms predisposing to rupture under these conditions are reviewed and discussed CONCLUSIONS: FDs alone may modify hemodynamics in ways that induce extensive aneurysm thrombosis. Under specific conditions, however, instead of reverse remodeling and cicatrization, aggressive thrombus-associated autolysis of the aneurysm wall may result in delayed rupture. AAAabdominal aortic aneurysmapprox.approximateARaspect ratioCCFcarotid cavernous fistulaDSAdigital subtraction angiographyFDflow diverterHEhematoxylin-eosinICAinternal carotid arteryLleftMax.maximumNAnot applicablePAOparent artery occlusionRright