title: Blood Flow Diversion as a Primary Treatment Method for Ruptured Brain Aneurysms-Concerns, Controversy, and Future Directions.
abstract: Flow diversion is a novel treatment for brain aneurysms that works by redirecting blood flow away from the aneurysm. Immediately after placement of the stent, blood flow stagnates within the aneurysm dome and it undergoes thrombosis. Over time, a new endothelium develops across the neck, thereby reconstructing the parent vessel and curing the aneurysm. The use of this treatment method for ruptured aneurysms has two specific concerns: 1) risk of hemorrhage from the aneurysm after treatment because of potential delayed aneurysm occlusion; and 2) hemorrhagic complications from antiplatelet use, which is required to prevent thromboembolic complications from the device. In this review, we explore these two concerns based on the emerging published literature. Optimal peri-procedural management of these issues in the neurocritical care setting is vital to improving outcomes. We also identify ongoing clinical trials of flow diversion for the treatment of ruptured aneurysms. Flow diversion is an alternative to clipping or coiling for many ruptured aneurysms and may be potentially more efficacious in certain aneurysm subtypes.
authors.affiliation: Department of Neurological Surgery, University of Southern California, USC Healthcare Center II, 1520 San Pablo St #3800, Los Angeles, CA, 90033, USA. brian.walcott@usc.edu.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.affiliation: Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Koch
authors.affiliation: Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stapleton
authors.affiliation: Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Aman B
authors.initials: AB
authors.lastname: Patel
mesh_terms: D017542:Aneurysm, Ruptured / Q000628:therapy*; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D015607:Stents; D013923:Thromboembolism / Q000517:prevention & control*
keywords: Cerebral blood flow; Intracranial aneurysm; Intracranial hemorrhage; Neurosurgery; Subarachnoid hemorrhage