Geniş boyunlu paraoftalmik anevrizmaların akım çevirici stent implantasyonu ile endovasküler tedavisi

Hamit Güzeldağ; Bilen Onan; Ferhat Can Pişkin; Sinan Sözütok

doi:10.17826/cumj.977944

EN TR

Endovascular treatment of wide-necked paraophthalmic aneurysms with flow diverter stent implantation

Abstract

Purpose: The aim of this study was to present early and mid-term clinical results of flow diverter stents used for the treatment of wide-necked paraophthalmic aneurysms. Materials and Methods: Between January October 2008-January 2020, the data of 87 patients treated with flow diverter stent due to a wide-necked aneurysm located in the paraophthalmic segment of the internal carotid artery were retrospectively analyzed. Results: In this study, a total of 87 patients, 66 of whom (75.8%) were women, with an average age of 51.1 ± 8 were involved. A total of 100 paraophthalmic segment aneurysms were treated with flow diverter stents. For forty (40%) paraophthalmic segment aneurysms, embolization was performed using a flow diverter stent with coil. All stents were placed in the desired location (technical success 100%). In one patient, death due to intracranial bleeding occurred on the fifth day after treatment (mortality rate: 1.1%). During long-term follow-up, 3 patients developed critical stent stenosis (narrowing of the stent lumen by more than 50%) and required treatment. Patients were followed for an average of 29.8 ± 3 months. In follow-up at 3th-6th moth and after 6th moth, 77 (81.9%) and 88 (92.6%) aneurysms were total occluded. Conclusion: Flow diverter stent implantation alone or in combination with coil embolization is a safety and effective method for endovascular treatment of paraophthalmic aneurysms.

Keywords

intracranial aneurysm , Paraophthalmic , Flow diverter , Stent , endovascular embolization , Endovascular Treatment.

Geniş boyunlu paraoftalmik anevrizmaların akım çevirici stent implantasyonu ile endovasküler tedavisi

Öz

Amaç: Bu çalışmada, amacımız geniş boyunlu paraoftalmik anevrizmaların tedavisi için kullanılan akım çevirici stentlerin erken ve orta dönem klinik sonuçlarını sunmak idi. Gereç ve Yöntem: Hastanemizin girişimsel radyoloji ünitesinde Ekim 2008-Ocak 2020 tarihleri arasında internal karotid arterin paraoftalmik segmentinde yer alan geniş boyunlu anevrizma nedeniyle akım çevirici stent ile tedavi edilen toplam 87 hastanın verileri retrospektif olarak analiz edildi. Bulgular: Bu çalışmada yaş ortalaması 51,1 ± 8 olan 66’sı (% 75,8) kadın toplam 87 hasta yer aldı. Otuz dört (% 39) hastada birden fazla olmak üzere, toplam 100 paraoftalmik segment yerleşimli anevrizma, akım çevirici stentler ile tedavi edildi. Kırk (% 40) paraoftalmik segment anevrizmanın tedavisi için akım çevirici stente ek olarak koil embolizasyonu da yapıldı. Tüm stentler istenilen lokalizasyona yerleştirildi (Teknik başarı % 100). Bir hastada tedaviden sonra 5. günde intrakraniyal kanama nedeniyle ölüm gerçekleşti (Mortalite oranı: % 1,1). Uzun dönem takiplerde 3 hastada ileri düzeyde (stent lümenin %50 nin üzerinde daralaması) stent stenozu gelişti ve tedavi gerektirdi. Hastalar ortalama 29,8 ± 3 ay takip edildi. Yapılan kontrollerde ilk 3-6. ayda 77 (%81,9) anevrizma ve 6. ay sonrası kontrollerde 88 (%92,6) anevrizma kapalı idi. Sonuç: Paraoftalmik anevrizmaların endovasküler tedavisinde akım çevirici stent implantasyonu tek başına veya koil embolizasyonu ile birlikte güvenilir ve etkin bir yöntemdir.

Anahtar Kelimeler

İntrakraniyal anevrizma , Paraoftalmik , Akım çevirici , Stent , Endovasküler embolizasyon , Endovasküler tedavi.

References

1. Tateshima S, Duckwiler G. Vascular Diseases of the Nervous System. 2012; 1070-1083.
2. Weir B. Unruptured intracranial aneurysms: a review. J Neurosurg 2002; 96:3-42.
3. Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29:251-6.
4. Wiebers DO, Whisnant JP, O’Fallon WM. The natural history of unruptured intracranial aneurysms. N Engl J Med 1981; 304:696-8.
5. Kandarpa K, Aruny JE. Handbook of interventional Radiologic Procedures. 3rd edition, Philadelphia: Lippincott Williams& Wilkins 2002; 532-535,578-579.
6. Ismail Alhothi A, Qi T, Guo S, Shi Z, Liang F, YangL, et al. Neuroform stent– assisted coil embolization New treatment strategy for complex intracranial aneurysms with midtermresults. Romanian Neurosurgery 2010; 2:147-157.
7. Zhang Y, Chong W, Qian Y. Investigation of intracranial aneurysm hemodynamics following flow diverter stent treatment. Med Eng Phys 2013;35:608-15.
8. Fiorella D, Kelly ME, Albuquerque FC, Nelson PK. Curative reconstruction of a giant midbasillar trunk aneurysm with the pipeline embolization device. Neurosurgery 2009; 64:212-217.
9. Byrne J, Beletchi R, Yarnold J. The SILK registry: Intracranial aneurysm treatments with a new flow diverter. 10th congress of World Federation of Interventional and Thereapeutic Neuroradiology June 29th-July 3rd 2009;112.
10. Chapot R, Stracke P, Meyn H, Heddier M. Experience with Silk in 25 aneurysms. 10th congress of World Federation of Interventional and Thereapeutic Neuroradiology. June 29th-July 3rd 2009;112.

11. Mohlenbruch MA, Herweh C, Jestaedt L, Stampfl S, Schonenberger S, Ringleb PA, et al. The FRED flow-diverter stent for intracranial aneurysms: clinical study toassess safety and efficacy. AJNR Am J Neuroradiol 2015; 36:1155-1161.
12. Ley D, Mühl-Benninghaus R, Yilmaz U, Körner H, Cattaneo G, Mailänder W, et al. The Derivo embolization device, a second-generation flow diverter for the treatment of intracranial aneurysms, evaluated in an elastase-induced aneurysm model. Clinical neuroradiology. 2017; 27: 335-343.
13. Ricardo J. Komotar MD, J Mocco MD, Robert A. Solomon MD: Guidelines for the Surgical Treatment of Unruptured Intracranial Aneurysms. In. Edited by University C. New York, NY.
14. Tanriover N, Kawashima M, Rhoton AL Jr, Ulm AJ, Mericle RA. Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg. 2003;98:1277-90.
15. Bhogal P, Hellstern V, Bäzner H, Ganslandt O, Henkes H, Pérez MA. The Use of Flow Diverting Stents to Treat Para-Ophthalmic Aneurysms, 2017;8:381.
16. Laziono G. Coil embolization of very small aneurysms. J Neurosurg 2010;112:549–550.
17. Lanzino G, Brinjikji W. Embolization of middle cerebral artery aneurysms: ready for prime time? J Neurosurg. 2010;112:701-702.
18. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34(6):1398-403.
19. Cirillo L LM, Dall’olio M, Princiotta C, Stafa A, Simonetti L, Toni F, et al. Complications in the treatment of intracranial aneurysms with silk stents: an analysis of 30 consecutive patients. Interv Neuroradiol. Interventional Neuroradiology. 2012; 18:413-25.
20. Lubicz B, Collignon L, Raphaeli G, Jean-Pierre P, Michae ̈l Bruneau, Olivier De W, et al. Flow-diverter stent for the endovascular treatment of intracranial aneurysms: a prospective study in 29 patients with 34 aneurysms. Stroke 2010; 41: 2247-53.
21. Zanaty M, Chalouhi N, Tjoumakaris SI, Rosenwasser RH, Gonzalez LF, Jabbour P. Flow diversion panacea or poison? Front Neurol 2014;5:21.
22. Leung GK TA, Lui WM. Pipeline embolization device for intracranial aneurysm: a systematic review. Clin Neuroradiol. Clinical Neuroradiology. 2012; 22:295-303.
23. Kocer N, Islak C, Kizilkilic O, Kocak B, Saglam M, Tureci E. Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results. J Neurosurg. 2014; 120:1158-71.
24. Malatesta E, Nuzzi NP, Divenuto I, Fossaceca R, Lombardi M, Cerini P, et al. Endovascular treatment of intracranial aneurysms with flow diverter stents: preliminary single-centre experience. Radiol med 2013;118:971–983.
25. Giacomini L, Piske RL, Baccin CE, Barroso M, Joaquim AF, Tedeschi H. Neurovascular reconstruction with flow diverter stents fort he treatment of 87 intracranial aneurysms: Clinical results. Interv Neuroradiol. 2015; 21:292-9.
26. Murthy SB, Shah S, Shastri A, Venkatasubba Rao CP, Bershad EM, Suarez JI. The SILK flow diverter in the treatment of intracranial aneurysms. J Clin Neurosci. 2014; 21:203-6.
27. Trivelato FP, Abud DG, Ulhôa AC, Waihrich ES, Abud TG, Castro Afonso LH, et al. Derivo Embolization Device for the Treatment of Intracranial Aneurysms. Stroke. 2019;50:2351-2358.
28. Lee DH, Arat A, Morsi H, Shaltoni H, Harris JR, Mawad ME. Dual antiplatelet therapy monitoring for neuro-interventional procedures using a point-of-care platelet function test: a single-center experience. AJNR. American journal of neuroradiology. 2008; 29:1389-94.
29. Turowski B, Macht S, Kulcsár Z, Hänggi D, Stummer W. Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts? Neuroradiology. 2011;53:37-41.
30. Klisch J, Turk A, Turner R, Woo HH, Fiorella D. Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. AJNR Am J Neuroradiol. 2011;32:627-32.
31. Lozen A, Manjila S, Rhiew R, Fessler R. Y-stent-assisted coil embolization for the management of unruptured cerebral aneurysms: report of six cases. Acta Neurochir (Wien) 2009;151:1663-72. 32. Berge J, Biondi A, Machi P. Flow-diverter Silk stent for the treatment of intracranial aneurysms: 1- year follow-up in a multi-center study. AJNR Am J Neuroradiol 2012; 33:1150-55.

Details

Primary Language

Turkish

Subjects

Clinical Sciences

Journal Section

Research Article

Authors

Hamit Güzeldağ
0000-0002-6258-0771
Türkiye

Bilen Onan
0000-0002-1486-2782
Türkiye

Ferhat Can Pişkin ^*
0000-0003-4092-1077
Türkiye

Sinan Sözütok
0000-0003-3626-2312
Türkiye

Publication Date

December 30, 2021

Submission Date

August 3, 2021

Acceptance Date

October 24, 2021

Published in Issue

Year 2021 Volume: 46 Number: 4

DOI

https://doi.org/10.17826/cumj.977944

IZ

https://izlik.org/JA96DX23WY

MLA

Güzeldağ, Hamit, et al. “Geniş Boyunlu Paraoftalmik Anevrizmaların Akım çevirici Stent Implantasyonu Ile Endovasküler Tedavisi”. Cukurova Medical Journal, vol. 46, no. 4, Dec. 2021, pp. 1666-74, doi:10.17826/cumj.977944.

This journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Endovascular treatment of wide-necked paraophthalmic aneurysms with flow diverter stent implantation

Abstract

Keywords

Geniş boyunlu paraoftalmik anevrizmaların akım çevirici stent implantasyonu ile endovasküler tedavisi

Öz

Anahtar Kelimeler

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

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