Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting
with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality,
especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel
is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive
options include stent-assisted coiling and flow diversion (FD). The latter is technically less
challenging and does not require catheterization of the fragile aneurysm. Our study aims
to report a multicentric experience with FD for reconstruction of DA in acute SAH.
Materials and Methods: This retrospective study investigated 31 patients (age: 30–78
years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA.
The patients were treated between 2010 and 2020 in one of the following German
neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG
Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical
history, imaging, implanted devices, and outcomes were reviewed for the study.
Results: Reconstruction with flow-diverting stents was performed in all cases. The
p64 was implanted in 14 patients; one of them required an additional balloon expandable stent to reconstruct severe stenosis in the target segment. One case
demanded additional liquid embolization after procedural rupture, and in one case,
p64 was combined with a PED. Further 13 patients were treated exclusively with
the PED. The p48MW-HPC was used in two patients, one in combination with two
additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB,
one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of
death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary
artery, and delayed parenchymal hemorrhage. The remaining three patients died in the
acute–subacute phase related to the severity of the initial hemorrhage and associated
comorbidities. One patient became apallic (GOS 2), whereas two patients had severe
disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a
complete recovery (GOS 5).
Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a
promising approach. However, the severity of the condition is reflected by high overall
morbi-mortality, even despite technically successful endovascular treatment.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:84338 |
| Date | 27 March 2023 |
| Creators | Maybaum, Jens, Henkes, Hans, Aguilar-Pérez, Marta, Hellstern, Victoria, Gihr, Georg Alexander, Härtig, Wolfgang, Reisberg, André, Mucha, Dirk, Schüngel, Marie-Sophie, Brill, Richard, Quäschling, Ulf, Hoffmann, Karl-Titus, Schob, Stefan |
| Publisher | Frontiers Research Foundation |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English, German |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 1664-2295, 700164 |
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