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Effect of Flow Diversion Treatment on Very Small Ruptured Aneurysms

Kulcsár, Zsolt MD; Wetzel, Stephan G. MD; Augsburger, Luca PhD; Gruber, Andreas MD, PhD; Wanke, Isabel MD, PhD; Andre Rüfenacht, Daniel MD, PhD

doi: 10.1227/01.NEU.0000372920.39101.55
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BACKGROUND: Ruptured aneurysms of < 2 mm are not amenable to endovascular coiling and therefore pose a significant treatment challenge.

OBJECTIVE: To test recently introduced flow diverters that allow endovascular reconstruction via another method and may represent a new treatment option for such lesions.

PATIENTS AND METHODS: Three female patients presented with acute subarachnoid hemorrhage. An aneurysm of < 2 mm was identified in all patients as the cause of bleeding. The aneurysms were located at the C2 segment of the internal carotid in 2 patients and on the basilar bifurcation in the other. All patients had failed early endovascular treatment attempts. Flow diversion with the SILK flow diverter was offered as an alternative in each patient.

RESULTS: SILK deployment successfully eliminated the aneurysms in all 3 instances. One of the aneurysms was excluded from contrast material visualization immediately after stent deployment. Transient thrombotic complication was observed in the case of the basilar artery aneurysm. It resolved with the administration of intraarterial tirofiban. There was no treatment-related morbidity, and none of the aneurysms reruptured after SILK implantation during a clinical follow-up of at least 4 months (range, 4–10 months). Imaging follow-up showed complete vessel remodeling in all cases.

CONCLUSION: Flow diversion treatment prevented rebleeding during the follow-up period. Reverse remodeling of the concerned vascular segment with delayed disappearance of the aneurysm was observed in each case.

BACKGROUND: Ruptured aneurysms of < 2 mm are not amenable to endovascular coiling. OBJECTIVE: To test recently introduced flow diverters that allow endovascular reconstruction as an alternate method to treat these aneurysms. PATIENTS AND METHODS: Three female patients presented with subarachnoid hemorrhage. An aneurysm of < 2 mm was identified as the cause of bleeding. The aneurysms were located at the C2 segment of the internal carotid in 2 patients and on the basilar bifurcation in the other. All patients had failed early endovascular treatment attempts. Flow diversion with the SILK flow diverter was offered as an alternative in each patient. RESULTS: SILK deployment successfully eliminated all the aneurysms. There was no treatment-related morbidity, and none of the aneurysms reruptured after SILK implantation during a clinical follow-up of at least 4 months (range, 4–10 months). Imaging follow-up showed complete vessel remodeling in all cases. CONCLUSION: Flow diversion treatment prevented rebleeding during the follow-up period.

Department of Neuroradiology, Hirslanden Clinic, Zurich, Switzerland (Kulcsár) (Wanke) (Rüfenacht)

Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland (Wetzel)

Laboratory of Hemodynamics and Cardiovascular Technology, Federal Institute of Technology, Lausanne, Switzerland (Augsburger)

Department of Neurosurgery, University of Vienna, Vienna, Austria (Gruber)

Department of Neuroradiology, University of Essen, Essen, Germany (Wanke)

Reprint requests: Zsolt Kulcsár, MD, Neuroradiologie, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland. E-mail: kulcsarzsolt22@gmail.com

Received, July 28, 2009.

Accepted, January 20, 2010.

Copyright © by the Congress of Neurological Surgeons