Editor’s Choice
July 2014
(3 of 3)
This article presents the authors’ experience and long-term follow-up of 6 patients with fusiform and giant aneurysms of the vertebrobasilar system treated with flow-diverting devices. Devices were deployed uneventfully with no periprocedural complications. One year later, 3 patients had recurrent cerebral infarctions and 2 had acute thrombotic in-stent occlusions. Four patients died during the follow-up period. The authors do not intend to treat any more patients in this fashion until they have a better understanding of flow-diverting devices in this setting.
Abstract
BACKGROUND AND PURPOSE
Fusiform vertebrobasilar giant aneurysms are a rare (<1% of all intracranial aneurysms) but challenging aneurysm subtype. Little data are available on the natural history of this aneurysm subtype and the impact of the use of flow-diverting stents on the long-term clinical and imaging follow-up. In this article, we present our experience with the treatment of fusiform vertebrobasilar giant aneurysms by flow diverting stents. We aim to stimulate a discussion of the best management paradigm for this challenging aneurysm subtype.
MATERIALS AND METHODS
We retrospectively identified 6 patients with fusiform vertebrobasilar giant aneurysms who had been treated with flow-diverting stents between October 2009 and March 2012 in our center. The available data were re-evaluated. The modified Rankin Scale score was assessed before intervention, during the stay in hospital, and at discharge.
RESULTS
Six patients were identified (all male; age range, 49–71 years; median age, 60 years). Handling of material was successful in all cases. No primary periprocedural complications occurred. The mean follow-up was 13 months (15 days to 29 months). During follow-up, 3 of 6 patients had recurrent cerebral infarctions, but no patient experienced SAH. Two patients presented with acute thrombotic stent occlusion. The modified Rankin Scale score was not higher than 3 in any of the cases before intervention, whereas the best mRS score at the last follow-up was 5. Four of 6 patients died during follow-up.
CONCLUSIONS
Endovascular treatment of fusiform vertebrobasilar giant aneurysms with flow-diverting devices is feasible from a technical point of view; however, changes in hemodynamics with secondary thrombosis are not predictable. We currently do not intend to treat fusiform vertebrobasilar giant aneurysms with flow-diverting devices until we have further understanding of the pathophysiology, natural history, and hemodynamic effects of flow diversion.
