Journal article
Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience
World neurosurgery, Vol.109, pp.e164-e169
01/2018
DOI: 10.1016/j.wneu.2017.09.125
PMID: 28987840
Abstract
Treatment of ruptured posterior circulation dissecting aneurysms is technically challenging with potentially high morbidity and mortality. We sought to assess the safety and feasibility of using a flow-diversion device (FDD) and a specific acute antiplatelet aggregation protocol in the management of ruptured dissecting aneurysms.
Subjects with ruptured dissecting aneurysms treated during a 3-year period were retrospectively identified from a prospective registry. Intraoperative complications, morbidity, and mortality were recorded. Tirofiban maintenance infusion without bolus was administered intravenously immediately after deployment of the FDD, and almost all patients were loaded with dual antiplatelet (aspirin and clopidogrel) post procedure. Clinical follow-up evaluation and modified Rankin Scale were assessed.
Nine subjects with ruptured posterior circulation dissecting aneurysms were treated with an FDD: 5 vertebral artery, 2 basilar artery, and 2 posterior inferior cerebellar artery aneurysms. Average World Federation of Neurosurgical Societies score was 2 (range 1–5). Seven patients had external ventricular drain placed acutely for hydrocephalus. Eight patients received tirofiban infusion without bolus after FDD. No intraoperative complications occurred. Two subjects developed asymptomatic intraparenchymal hemorrhage found on surveillance noncontrast computed tomography. One subject suffered a major intraparenchymal hemorrhage and died a few days post intervention after additional anticoagulation was started for a left ventricular assist device. Follow-up modified Rankin Scale within 12 months was 0 in 3 subjects, 1 in 3 subjects, 2 in 1 subject, and 4 in 1.
Treatment of dissecting posterior circulation aneurysms with FDDs is feasible and a potential alternative to deconstructive techniques.
Details
- Title: Subtitle
- Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience
- Creators
- Waldo R Guerrero - Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USASantiago Ortega-Gutierrez - Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USAMinako Hayakawa - Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USAColin P Derdeyn - Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USAJames D Rossen - Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa, USADavid Hasan - Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USAEdgar A Samaniego - Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.109, pp.e164-e169
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.wneu.2017.09.125
- PMID
- 28987840
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Language
- English
- Date published
- 01/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Cardiovascular Medicine; Neurosurgery; Otolaryngology; Internal Medicine
- Record Identifier
- 9984020796402771
Metrics
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