title: Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms: a report on periprocedural course and long-term follow-up.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: From the Department of Neuroradiology (L.E., M.P., H.B., G.F.), Institute of Clinical Radiology, Grosshadern Campus, University of Munich, Munich, Germany lorenz.ertl@med.uni-muenchen.de.
authors.forename: L
authors.initials: L
authors.lastname: Ertl
authors.affiliation: From the Department of Neuroradiology (L.E., M.P., H.B., G.F.), Institute of Clinical Radiology, Grosshadern Campus, University of Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Holtmannspötter
authors.affiliation: Center for Diagnostic Radiology (M.H.), Department of Neuroradiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Patzig
authors.affiliation: From the Department of Neuroradiology (L.E., M.P., H.B., G.F.), Institute of Clinical Radiology, Grosshadern Campus, University of Munich, Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Brückmann
authors.affiliation: From the Department of Neuroradiology (L.E., M.P., H.B., G.F.), Institute of Clinical Radiology, Grosshadern Campus, University of Munich, Munich, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Fesl
mesh_terms: D000368:Aged; D002548:Cerebral Revascularization / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*