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.

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.