Flow diversion (FD) is a novel endovascular technique based on the profound alteration
of cerebrovascular hemodynamics, which emerged as a promising minimally invasive therapy for
intracranial aneurysms. However, delayed post-procedural stroke remains an unexplained concern.
A consistent follow-up-regimen has not yet been defined, but is required urgently to clarify the
underlying cause of delayed ischemia. In the last two years, 223 patients were treated with six
different FD devices in our center. We identified subacute, FD-induced segmental vasospasm (SV) in
36 patients as a yet unknown, delayed-type reaction potentially compromising brain perfusion to a
critical level. Furthermore, 86% of all patients revealed significant SV approximately four weeks after
treatment. In addition, 56% had SV with 25% stenosis, and 80% had additional neointimal hyperplasia.
Only 13% exhibited SV-related high-grade stenosis. One of those suffered stroke due to prolonged
SV, requiring neurocritical care and repeated intra-arterial (i.a.) biochemical angioplasty for seven
days to prevent territorial infarction. Five patients suffered newly manifested, transient hemicrania
accompanying a compensatorily increased ipsilateral leptomeningeal perfusion. One treated vessel
obliterated permanently. Hence, FD-induced SV is a frequent vascular reaction after FD treatment,
potentially causing symptomatic ischemia or even stroke, approximately one month post procedure.
A specifically early follow-up-strategy must be applied to identify patients at risk for ischemia,
requiring intensified monitoring and potentially anti-vasospastic treatment.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:84640 |
| Date | 06 April 2023 |
| Creators | Schob, Stefan, Richter, Cindy, Scherlach, Cordula, Lindner, Dirk, Planitzer, Uwe, Hamerla, Gordian, Ziganshyna, Svitlana, Werdehausen, Robert, Struck, Manuel Florian, Schob, Bernd, Gaber, Khaled, Meixensberger, Jürgen, Hoffmann, Karl-Titus, Quäschling, Ulf |
| Publisher | MDPI |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| 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 | 2077-0383, 1649 |
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