Subscribe to RSS
Periprocedural Management during Placement of Flow Diverters in Intracranial Aneurysms: A Clinical Report and Review of Literature
Background Placement of flow diverter (FD) is an endovascular technique where the flow to the aneurysm is directed away from the aneurysmal sac using a stent in the parent vessel. In this clinical report, the authors share their institutional experience pertaining to clinical course of patients with intracranial aneurysm requiring placement of FD.
Methods After approval from institute ethics committee (IEC), the authors retrospectively studied all patients who underwent placement of FD for intracranial aneurysms from January 2014 to December 2017. Data regarding patient demographics, presenting complaints, aneurysm details, anesthesia technique, and intra- and postprocedural complications were noted. Duration of hospital stay, neurological outcome as measured by Glasgow outcome scale (GOS) at discharge and at 6 months was noted. Data are presented as median (range) or number (%).
Results Over a period of 3 years, 22 patients underwent FD placement. Two patients had subarachnoid hemorrhage (SAH) at the time of presentation, and the rest had unruptured aneurysms. All patients received general anesthesia (GA) for the procedure, and intravenous propofol was used for induction of anesthesia. Majority of the patients received sevoflurane and nitrous oxide combination for maintenance of anesthesia (20/22 [91%]). Five patients were not extubated at the end of the procedure. The most common indication for mechanical ventilation was delayed reversal because of hypothermia. At 6 months of follow-up, GOS was 5 in 18 patients. None of the patients developed any delayed complications related to FD and were neurologically intact.
Conclusions The use of FD for the treatment of aneurysms is a safe option. GA was used for carrying out procedure in all patients. The neurological outcome was good in all patients who were followed at 6 months.
04 August 2019 (online)
© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 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 (08) 2346-2352
- 2 Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ. A second-generation, endoluminal, flow-disrupting device for treatment of saccular aneurysms. Am J Neuroradiol 2009; 30 (06) 1153-1158
- 3 Arrese I, Sarabia R, Pintado R, Delgado-Rodriguez M. Flow-diverter devices for intracranial aneurysms: systematic review and meta-analysis. Neurosurgery 2013; 73 (02) 193-199 ,discussion199–200
- 4 Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke 2013; 44 (02) 442-447
- 5 Cagnazzo F, di Carlo DT, Cappucci M, Lefevre PH, Costalat V, Perrini P. Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis. Am J Neuroradiol 2018; 39 (09) 1669-1675
- 6 Bhogal P, Martinez Moreno R, Ganslandt O, Bäzner H, Henkes H, Perez MA. Use of flow diverters in the treatment of unruptured saccular aneurysms of the anterior cerebral artery. J Neurointerv Surg 2017; 9 (03) 283-289
- 7 Briganti F, Leone G, Cirillo L, de Divitiis O, Solari D, Cappabianca P. Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center. Neurosurg Focus 2017; 42 (06) E3
- 8 Griessenauer CJ, Shallwani H, Adeeb N. et al. Conscious sedation versus general anesthesia for the treatment of cerebral aneurysms with flow diversion: a matched cohort study. World Neurosurg 2017; 102: 1-5
- 9 Zanaty M, Daou B, Chalouhi N. et al. Same-day discharge after treatment with the pipeline embolization device using monitored anesthesia care. World Neurosurg 2016; 96: 31-35
- 10 Rummel C, Zubler C, Schroth G. et al. Monitoring cerebral oxygenation during balloon occlusion with multichannel NIRS. J Cereb Blood Flow Metab 2014; 34 (02) 347-356
- 11 Rajah G, Narayanan S, Rangel-Castilla L. Update on flow diverters for the endovascular management of cerebral aneurysms. Neurosurg Focus 2017; 42 (06) E2
- 12 Chiu AH, Ramesh R, Wenderoth J, Davies M, Cheung A. Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms. J Neurointerv Surg 2017; 9 (05) e18
- 13 Girdhar G, Li J, Kostousov L, Wainwright J, Chandler WL. In-vitro thrombogenicity assessment of flow diversion and aneurysm bridging devices. J Thromb Thrombolysis 2015; 40 (04) 437-443
- 14 Al-Mufti F, Cohen ER, Amuluru K. et al. Bailout strategies and complications associated with the use of flow-diverting stents for treating intracranial aneurysms. Intervent Neurol 2019; 8: 38-54
- 15 Turk III AS, Martin RH, Fiorella D, Mocco J, Siddiqui A, Bonafe A. Flow diversion versus traditional endovascular coiling therapy: design of the prospective LARGE aneurysm randomized trial. Am J Neuroradiol 2014; 35 (07) 1341-1345
- 16 Hammoud D, Gailloud P, Olivi A, Murphy KJ. Acute vasogenic edema induced by thrombosis of a giant intracranial aneurys a cause of pseudostroke after therapeutic occlusion of the parent vessel. Am J Neuroradiol 2003; 24 (06) 1237-1239
- 17 Berge J, Tourdias T, Moreau J-F, Barreau X, Dousset V. Perianeurysmal brain inflammation after flow-diversion treatment. Am J Neuroradiol 2011; 32 (10) 1930-1934
- 18 Saatci I, Yavuz K, Ozer C, Geyik S, Cekirge HS. Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. Am J Neuroradiol 2012; 33 (08) 1436-1446
- 19 Raymond J, Gentric JC, Darsaut TE. et al. Flow diversion in the treatment of aneurysms: a randomized care trial and registry. J Neurosurg 2017; 127 (03) 454-462
- 20 Rouchaud A, Brinjikji W, Lanzino G, Cloft HJ, Kadirvel R, Kallmes DF. Delayed hemorrhagic complications after flow diversion for intracranial aneurysms: a literature overview. Neuroradiology 2016; 58 (02) 171-177