Branch vessel occlusion in aneurysm treatment with flow diverter stent
Keywords:
aneurysm, branch vessel, patency, Side branches occlusion, flow diversion, flow diverter stentAbstract
Flow diverter placement for treatment of intracranial aneurysms gained growing consensus in the past years. A major concern among professionals is the side branch coverage which leads in some cases to vessel occlusion. However, the lost vessel patency only infrequently is accompanied by a new onset of neurological deficits secondary to ischaemic lesions. A retrospective analysis of all patients treated with flow diversion at our hospital was aimed to better understand this phenomenon in order to formulate a hypothesis about the causes. We concluded that vessel occlusion occurs due to a reduced blood pressure gradient in those vessels with a strong collateral or anastomotic vascularization that refurnishes the same distal vascular territories. Indeed, we detected no new brain infarction since blood flow was always guaranteed.
References
Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A, et al. Endovascular treatment of cerebral aneurysms using flow-diverter devices: a systematic review. Neuroradiol J. 2015; 28:365-375.
Briganti F, Leone G, Ugga L, Marseglia M, Solari D, Caranci F, et al. Safety and efficacy of flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms: a single center experience. Acta Neurochir (Wien). 2016;158: 1745-1755.
Briganti F, Leone G, Ugga L, Marseglia M, Macera A, Manto A, et al. Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience. J Neurointerventional Surg. 2017;9:70-76.
Maimon S, Gonen L, Nossek E, Strauss I, Levite R, Ram Z. Treatment of intra-cranial aneurysms with the SILK flow diverter: 2 years’
experience with 28 patients at a single center. Acta Neurochir (Wien). 2012;154:979-987.
Wagner A, Cortsen M, Hauerberg J, Romner B, Wagner MP. Treatment of intracranial aneurysms. Reconstruction of the parent artery with flowdiverting (Silk) stent. Neuroradiology. 2012;54: 709-718.
De Vries J, Boogaarts J, Van Norden A, Wakhloo AK. New generation of flow diverter (surpass) for unruptured intracranial aneurysms: a prospective single-center study in 37 patients. Stroke. 2013;44:1567-1577.
Wakhloo AK, Lylyk P, de Vries J, Taschner C, Lundquist J, Biondi A, et al. Surpass flow diverter in the treatment of intracranial aneurysms: a prospective multicenter study. Am J Neuroradiol. 2015;36:98-107.
Mpotsaris A, Skalej M, Beuing O, Eckert B, Behme D, Weber W. Long-term occlusion results with SILK flow diversion in 28 aneurysms: do
recanalizations occur during follow-up? Interv Neuroradiol. 2015;21:300-310.
Berge J, Biondi A, Machi P, Brunel H, Pierot L, Gabrillargues J, et al. Flow-diverter silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study. AJNR Am J Neuroradiol. 2012;33:1150-1155.
Lubicz B, Van der Elst O, Collignon L, Mine B, Alghamdi F. Silk flow-diverter stent for the treatment of intracranial aneurysms: a series of 58 patients with emphasis on long-term results. AJNR Am J Neuroradiol. 2015;36:542-546.
Strauss I, Maimon S. Silk flow diverter in the treatment of complex intracranial aneurysms: a single-center experience with 60 patients. Acta Neurochir (Wien). 2016; 158:247-254.
O’Kelly CJ, Spears J, Chow M, Wong J, Boulton M, Weill A, et al. Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2013;34:381-387.
Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bäzner H, et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012; 54:369-382.
Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ. A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke. 2007;38:2346–2352.
Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ. A second-generation, endoluminal, flow-disrupting device for treatment of saccular aneurysms. AJNR Am J Neuroradiol. 2009;30:1153–1158.
D'Urso PI, Lanzino G, Cloft HJ, Kallmes DF. Flow diversion for intracranial aneurysms: a review. Stroke. 2011;42(8):2363‐2368. doi:10.1161/STROKEAHA.111.620328
Augsburger L, Farhat M, Reymond P, Fonck E, Kulcsar Z, Stergiopulos N, et al. Effect of flow diverter porosity on intraaneurysmal blood flow. Klin Neuroradiol. 2009;19:204–214.
Lieber BB, Livescu V, Hopkins LN, Wakhloo AK. Particle image velocimetry assessment of stent design influence on intra-aneurysmal flow. Ann Biomed Eng. 2002;30:768–777
Lieber BB, Stancampiano AP, Wakhloo AK. Alteration of hemodynamics in aneurysm models by stenting: Influence of stent porosity. Ann Biomed Eng. 1997;25:460–469
Trager AL, Sadasivan C, Seong J, Lieber BB. Correlation between angiographic and particle image velocimetry quantifications of flow diverters inaninvitromodelofelastase-inducedrabbitaneurysms. J Biomech Eng. 2009;131:034506
Cagnazzo F, Lefevre PH, Mantilla D, et al. Patency of the supraclinoid internal carotid artery branches after flow diversion treatment. A meta-analysis. J Neuroradiol. 2019;46(1):9‐14. doi:10.1016/j.neurad.2018.07.006
Rangel-Castilla L, Munich SA, Jaleel N, et al. Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases. J Neurosurg. 2017;126(4):1064‐1069. doi:10.3171/2016.4.JNS16147
Bhogal P, Ganslandt O, Bäzner H, Henkes H, Pérez MA. The Fate of Side Branches Covered by Flow Diverters-Results from 140 Patients. World Neurosurg. 2017;103:789‐798. doi:10.1016/j.wneu.2017.04.092
Raymond SB, Koch MJ, Rabinov JD, et al. The Role of Collateral Circulation in Branch Vessel Occlusion After Flow Diversion [published online ahead of print, 2018 Dec 26]. World Neurosurg. 2018;S1878-8750(18)32887-0. doi:10.1016/j.wneu.2018.12.064
Wu X, Tian Z, Li W, et al. Patency of Branch Vessels After Pipeline Embolization: Comparison of Various Branches. Front Neurol. 2019;10:838. Published 2019 Aug 7. doi:10.3389/fneur.2019.00838
Gascou G, Lobotesis K, Brunel H, et al. Extra-aneurysmal flow modification following pipeline embolization device implantation: focus on regional branches, perforators, and the parent vessel. AJNR Am J Neuroradiol. 2015;36(4):725‐731. doi:10.3174/ajnr.A4191
Kadirvel R, Ding YH, Dai D, Rezek I, Lewis DA, Kallmes DF. Cellular mechanisms of aneurysm occlusion after treatment with a flow diverter. Radiology. 2014;270(2):394‐399. doi:10.1148/radiol.13130796
Cebral JR, Raschi M, Mut F, et al. Analysis of flow changes in side branches jailed by flow diverters in rabbit models. Int J Numer Method Biomed Eng. 2014;30(10):988‐999. doi:10.1002/cnm.2640
Cagnazzo F, Lefevre PH, Mantilla D, et al. Patency of the supraclinoid internal carotid artery branches after flow diversion treatment. A meta-analysis. J Neuroradiol. 2019;46(1):9‐14. doi:10.1016/j.neurad.2018.07.006
Appanaboyina Sunil MF, Lohner Rainald, Scrivano Esteban, Miranda Carlos, Lylyk Pedro, Putman Christopher, et al. Computational modelling of bloos flow in side arterial branches after stenting of cerebral aneurysm. Int J Comput Fluid Dynamics. 2008;22:669–676. 24.
Seong J, Wakhloo AK, Lieber BB. In vitro evaluation of flow divertors in an elastase-induced saccular aneurysm model in rabbit. J Biomech Eng. 2007;129:863–872
Daou B, Valle-Giler EP, Chalouhi N, et al. Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device. J Neurosurg. 2017;126(2):564‐569. doi:10.3171/2016.2.JNS152544
Brinjikji W, Kallmes DF, Cloft HJ, Lanzino G: Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol 36:537–541, 2015
Vedantam A, Rao VY, Shaltoni HM, Mawad ME: Incidence and clinical implications of carotid branch occlusion following treatment of internal carotid artery aneurysms with the pipeline embolization device. Neurosurgery 76:173–178, 2015
Raz E, Shapiro M, Becske T, Zumofen DW, Tanweer O, Potts MB, et al: Anterior choroidal artery patency and clinical follow-up after coverage with the pipeline embolization device. AJNR Am J Neuroradiol 36:937–942, 2015
Brinjikji W, Lanzino G, Cloft HJ, Kallmes DF: Patency of the posterior communicating artery after flow diversion treatment of internal carotid artery aneurysms. Clin Neurol Neurosurg 120:84–88, 2014
Vedantam A, Rao VY, Shaltoni HM, Mawad ME: Incidence and clinical implications of carotid branch occlusion following treatment of internal carotid artery aneurysms with the pipeline embolization device. Neurosurgery 76:173–178, 2015
Dimmick SJ, Faulder KC. Normal variants of the cerebral circulation at multidetector CT angiography. Radiographics. 2009;29(4):1027‐1043. doi:10.1148/rg.294085730
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.