Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms

Flow diversion is a promising option in selected patients with acutely ruptured microaneurysms. In this article, we reviewed our experience. Patients with acute spontaneous subarachnoid hemorrhage (SAH) after rupture of a blister-like or saccular microaneurysm (≤2 mm maximal diameter) at a nonbranch...

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Autores principales:	José E. Cohen, Hans Henkes, John Moshe Gomori, Gustavo Rajz, Ronen Leker
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	blister aneurysm brain aneurysm flow diverter stent hemorrhagic stroke internal carotid artery microaneurysm Medicine R
Acceso en línea:	https://doaj.org/article/d01198cef90145e6adcba84473ca14fe
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spelling	oai:doaj.org-article:d01198cef90145e6adcba84473ca14fe2021-11-25T18:00:55ZStandalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms10.3390/jcm102252492077-0383https://doaj.org/article/d01198cef90145e6adcba84473ca14fe2021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5249https://doaj.org/toc/2077-0383Flow diversion is a promising option in selected patients with acutely ruptured microaneurysms. In this article, we reviewed our experience. Patients with acute spontaneous subarachnoid hemorrhage (SAH) after rupture of a blister-like or saccular microaneurysm (≤2 mm maximal diameter) at a nonbranching ICA site treated from January 2016 to June 2019 using flow diversion as standalone therapy were included in this study. An EVD was usually placed preventively. Antiplatelet effects of pre-procedure DAPT were evaluated (target PRU, 80–160). After the intervention, DAPT was continued for ≥6 months, aspirin—indefinitely. Angiographic controls were obtained. Fifteen patients (12 female; mean age, 46.4 years) with 15 ruptured ICA microaneurysms (mean diameter, 1.8 mm) were included. An EVD was placed in 12 patients (75%) before DAPT administration and stenting. PRU values immediately before FDS were 1–134 (mean, 72.1). One patient died 27 days after flow diversion due to a suspected fulminant pulmonary embolism. Aneurysms were completely occluded at the 6–12-month angiographic follow-up in 14/14 surviving patients, with no rebleeding at a mean of 14 months. Late mRS was 0–2 in 13/14 patients and 3 in one due to sequelae of the original hemorrhage. Flow diversion provided robust aneurysm rebleeding control. Angiographic follow-up confirmed complete aneurysm occlusion in all the cases.José E. CohenHans HenkesJohn Moshe GomoriGustavo RajzRonen LekerMDPI AGarticleblister aneurysmbrain aneurysmflow diverter stenthemorrhagic strokeinternal carotid arterymicroaneurysmMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5249, p 5249 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	blister aneurysm brain aneurysm flow diverter stent hemorrhagic stroke internal carotid artery microaneurysm Medicine R
spellingShingle	blister aneurysm brain aneurysm flow diverter stent hemorrhagic stroke internal carotid artery microaneurysm Medicine R José E. Cohen Hans Henkes John Moshe Gomori Gustavo Rajz Ronen Leker Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms
description	Flow diversion is a promising option in selected patients with acutely ruptured microaneurysms. In this article, we reviewed our experience. Patients with acute spontaneous subarachnoid hemorrhage (SAH) after rupture of a blister-like or saccular microaneurysm (≤2 mm maximal diameter) at a nonbranching ICA site treated from January 2016 to June 2019 using flow diversion as standalone therapy were included in this study. An EVD was usually placed preventively. Antiplatelet effects of pre-procedure DAPT were evaluated (target PRU, 80–160). After the intervention, DAPT was continued for ≥6 months, aspirin—indefinitely. Angiographic controls were obtained. Fifteen patients (12 female; mean age, 46.4 years) with 15 ruptured ICA microaneurysms (mean diameter, 1.8 mm) were included. An EVD was placed in 12 patients (75%) before DAPT administration and stenting. PRU values immediately before FDS were 1–134 (mean, 72.1). One patient died 27 days after flow diversion due to a suspected fulminant pulmonary embolism. Aneurysms were completely occluded at the 6–12-month angiographic follow-up in 14/14 surviving patients, with no rebleeding at a mean of 14 months. Late mRS was 0–2 in 13/14 patients and 3 in one due to sequelae of the original hemorrhage. Flow diversion provided robust aneurysm rebleeding control. Angiographic follow-up confirmed complete aneurysm occlusion in all the cases.
format	article
author	José E. Cohen Hans Henkes John Moshe Gomori Gustavo Rajz Ronen Leker
author_facet	José E. Cohen Hans Henkes John Moshe Gomori Gustavo Rajz Ronen Leker
author_sort	José E. Cohen
title	Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms
title_short	Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms
title_full	Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms
title_fullStr	Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms
title_full_unstemmed	Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms
title_sort	standalone flow diversion therapy effectively controls rebleeding of acutely ruptured internal carotid artery trunk (nonbranching) microaneurysms
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/d01198cef90145e6adcba84473ca14fe
work_keys_str_mv	AT joseecohen standaloneflowdiversiontherapyeffectivelycontrolsrebleedingofacutelyrupturedinternalcarotidarterytrunknonbranchingmicroaneurysms AT hanshenkes standaloneflowdiversiontherapyeffectivelycontrolsrebleedingofacutelyrupturedinternalcarotidarterytrunknonbranchingmicroaneurysms AT johnmoshegomori standaloneflowdiversiontherapyeffectivelycontrolsrebleedingofacutelyrupturedinternalcarotidarterytrunknonbranchingmicroaneurysms AT gustavorajz standaloneflowdiversiontherapyeffectivelycontrolsrebleedingofacutelyrupturedinternalcarotidarterytrunknonbranchingmicroaneurysms AT ronenleker standaloneflowdiversiontherapyeffectivelycontrolsrebleedingofacutelyrupturedinternalcarotidarterytrunknonbranchingmicroaneurysms
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Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms

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