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. 2022 Jul;14(7):699-703.
doi: 10.1136/neurintsurg-2021-017641. Epub 2021 Jul 15.

Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Kemal Alpay  1 , Tero Hinkka  2 , Antti E Lindgren  3   4   5 , Juha-Matti Isokangas  6 , Rahul Raj  7 , Riitta Parkkola  8   9 , Matias Sinisalo  8 , Jussi Numminen  10 , Juha-Pekka Pienimäki  2 , Petri Saari  11 , Janne Seppänen  2 , Kari Palosaari  6 , Riitta Rautio  8   9
Affiliations

Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Kemal Alpay et al. J Neurointerv Surg. 2022 Jul.

Abstract

Background: Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date.

Methods: This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate.

Results: 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102).

Conclusions: FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.

Keywords: Aneurysm; Flow Diverter; Hemorrhage; Stroke; Subarachnoid.

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Conflict of interest statement

Competing interests: KA has received personal research grants from Turku University Foundation and Maire Taponen Foundation. RRaj has received personal research grants from Finska Läkaresällskapet and Medicinska Understödsföreningen Liv & Hälsä. RR is consultant for Microvention, Stryker and Medtronic.

Figures

Figure 1
Figure 1
NECT image showing diffuse SAH (A). Three-dimensional rotational image and DSA showing a 1×2 mm ruptured blister-like aneurysm in right ICA (B, C). DSA captured during the deployment of FRED 4.0/18/12 mm (D). Dyna-CT showing good opposition of FD (E). DSA image showing complete occlusion of the aneurysm 4 months after the treatment (F). DSA, digital subtraction angiography; FD, flow diverter; FRED, flow re-direction endoluminal device; ICA, internal carotid artery; NECT, non-enhanced CT, SAH, subarachnoid hemorrhage
See this image and copyright information in PMC

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