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Flow diversion of fusiform intracranial aneurysms

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Abstract

Fusiform aneurysms are less common than saccular aneurysms, but have higher associated mortality and rebleeding rates. Recently, flow diversion has emerged as a possible treatment option. The purpose of this study was to determine the safety and efficacy of the Pipeline Embolization Device (PED) for the treatment of ruptured and unruptured fusiform aneurysms. This was a retrospective analysis of patients with fusiform intracranial aneurysms treated with a PED at a quaternary care center between January 2012 and September 2019. Occlusion rates, neurologic morbidity/mortality, and other clinical variables were analyzed. Twenty-nine patients with 30 fusiform aneurysms were treated with a PED. Sixteen aneurysms (53%) were located in the anterior circulation and 14 aneurysms (47%) were in the posterior circulation. The mean maximal diameter of the aneurysms was 10.1 ± 5.6 mm (range 2.3–25 mm). Angiographic and clinical follow-up were available for 28 aneurysms (93%). The median follow-up was 17.4 months (IQR 4.8 to 28 months) and occlusion rates were graded according to the O’Kelly-Marotta (OKM) scale. Of patients with DSA follow-up, 15 aneurysms (60%) were completely occluded (OKM D) and 19 aneurysms (76%) had a favorable occlusion result (OKM C1-3 and D). The overall complication rate was 26.7% with a neurological morbidity rate of 6.7% and neurological mortality rate of 3.4%. Flow diversion can be an effective treatment for both ruptured and unruptured fusiform aneurysms. Nevertheless, complete occlusion rates are lower than for saccular aneurysms. Therefore, flow diversion should be considered only if other more direct treatment options, such as clipping or stent/coiling are not applicable. Flow diversion should be used cautiously in patients presenting with rupture.

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Authors and Affiliations

  1. Department of Neurosurgery, Duke University Medical Center, Box 3807, Erwin Road, Durham, NC, 27710, USA

    Andrew Griffin, Emily Lerner, Adam Zuchowski, Ali Zomorodi, L. Fernando Gonzalez & Erik F. Hauck

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  1. Andrew Griffin
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  2. Emily Lerner
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  3. Adam Zuchowski
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  4. Ali Zomorodi
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Correspondence to Andrew Griffin.

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Ethical approved

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Duke University approved this study.

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Informed consent is not applicable as this is a retrospective study. Due to the nature of this retrospective study, it is not feasible to obtain informed consent from study subjects. Subjects to be included may no longer be receiving medical care at Duke University Health System or have current contact information on file at Duke. Further, this study may include deceased subjects, from whom it is not possible to obtain informed consent.

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Griffin, A., Lerner, E., Zuchowski, A. et al. Flow diversion of fusiform intracranial aneurysms. Neurosurg Rev 44, 1471–1478 (2021). https://doi.org/10.1007/s10143-020-01332-0

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  • DOI: https://doi.org/10.1007/s10143-020-01332-0

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