title: Flow diverter devices in ruptured intracranial aneurysms: a single-center experience.
abstract: OBJECTIVE In this single-center series, the authors retrospectively evaluated the effectiveness, safety, and midterm follow-up results of ruptured aneurysms treated by implantation of a flow diverter device (FDD). METHODS The records of 17 patients (12 females, 5 males, average World Federation of Neurosurgical Societies score = 2.9) who presented with subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm treated with an FDD were retrospectively reviewed. Of 17 ruptured aneurysms, 8 were blood blister-like aneurysms and the remaining 9 were dissecting aneurysms. The mean delay between SAH and treatment was 4.2 days. Intraprocedural and periprocedural morbidity and mortality were recorded. Clinical and angiographic follow-up evaluations were conducted between 6 and 12 months after the procedure. RESULTS None of the ruptured aneurysms re-bled after endovascular treatment. The overall mortality rate was 12% (2/17), involving 2 patients who died after a few days because of complications of SAH. The overall morbidity rate was 12%: 1 patient experienced intraparenchymal bleeding during the repositioning of external ventricular drainage, and 1 patient with a posterior inferior cerebellar artery aneurysm developed paraplegia due to a spinal cord infarction after 2 weeks. The angiographic follow-up evaluations showed a complete occlusion of the aneurysm in 12 of 15 surviving patients; of the 3 remaining cases, 1 patient showed a remnant of the aneurysm, 1 patient was retreated due to an enlargement of the aneurysm, and 1 patient was lost at the angiographic follow-up. CONCLUSIONS FDDs can be used in patients with ruptured aneurysms, where conventional neurosurgical or endovascular treatments can be challenging.
authors.affiliation: 1Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan; and.
authors.forename: Emilio
authors.initials: E
authors.lastname: Lozupone
authors.affiliation: 1Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan; and.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Piano
authors.affiliation: 1Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan; and.
authors.forename: Luca
authors.initials: L
authors.lastname: Valvassori
authors.affiliation: 1Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan; and.
authors.forename: Luca
authors.initials: L
authors.lastname: Quilici
authors.affiliation: 1Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan; and.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Pero
authors.affiliation: 2Department of Radiology, Policlinico Universitario "Agostino Gemelli," Rome,Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Visconti
authors.affiliation: 1Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan; and.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Boccardi
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002533:Cerebral Angiography; D002648:Child; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010264:Paraplegia / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: ACA = anterior cerebral artery; ASA = acetylsalicylic acid; BBA = blood blister–like aneurysm; DSA = digital subtraction angiography; EVD = external ventricular drainage; FDD = flow diverter device; ICA = internal carotid artery; MCA = middle cerebral artery; PCA = posterior cerebral artery; PED = Pipeline Embolization Device; PICA = posterior inferior cerebellar artery; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurological Societies; blood blister–like aneurysm; dissecting fusiform aneurysm; flow diverter device; interventional neurosurgery; mRS = modified Rankin Scale; ruptured aneurysm; subarachnoid hemorrhage; vascular disorders