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Case series
Stent and flow diverter assisted treatment of acutely ruptured brain aneurysms
  1. José E Cohen1,2,
  2. J Moshe Gomori2,
  3. Ronen R Leker3,
  4. Sergey Spektor1,
  5. Hosni Abu El Hassan1,
  6. Eyal Itshayek4
  1. 1 Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  2. 2 Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  3. 3 Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  4. 4 Department of Neurosurgery, Rabin Medical Center, Petah Tikva, Israel
  1. Correspondence to Professor José E Cohen, Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; jcohenns{at}yahoo.com

Abstract

Objective We present our experience with stent techniques in the management of acutely ruptured aneurysms, focusing on aneurysm occlusion rates, intraprocedural complications, and late outcomes.

Methods We retrospectively reviewed the clinical records of patients treated by stent techniques during the early acute phase of aneurysmal rupture, from June 2011 to June 2016. Patients who underwent stenting for the management of unruptured aneurysms, or in a delayed fashion for a ruptured lesion, were excluded.

Results 47 patients met inclusion criteria, including 46 with subarachnoid hemorrhage (SAH). There were 27 men and 20 women, mean age 38 years (range 23–73). They harbored 71 aneurysms, including 56 treated in the acute phase. Aneurysmal dome and neck width averaged 4.7 mm (range 1.7–12.1) and 3.2 mm (range 1.5–7.1), respectively. Single stent techniques were used in 39 patients and dual stent techniques in 17. External ventricular drains (EVDs) were placed before embolization in 35 patients (92%) and after in 3. Intraprocedure thromboembolic complications due to a hyporesponse to antiplatlets in 4 patients (8.5%) were successfully managed with intra-arterial antiplatelet agents. In 45 surviving patients (96%), there was complete aneurysm occlusion at the 9–12 month follow-up in 26/29 aneurysms treated by stent-assisted coiling (90%), in 2/3 aneurysms treated by flow diverter-assisted coiling (66%), and in 19/22 aneurysms treated by flow diverter alone (86%); 42/45 patients (93%) presented with a modified Rankin Scale score of 0–2.

Conclusion Stenting techniques in ruptured aneurysms can be performed with good technical success; however, procedural thromboembolic complications related to the antiplatelet strategy merit investigation. EVD placement before stenting must be considered.

  • aneurysm
  • platelets
  • hemorrhage
  • device
  • subarachnoid

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Footnotes

  • Contributors Substantial contributions to the conception or design of the work: JEC, JMG, and RRL. Contribution to the acquisition, analysis, or interpretation of the data for the work: JEC, JMG, RRL, SS, HAEH, and EI. Drafting the work or revising it critically for important intellectual content: JEC, JMG, RRL, SS, HAEH, and EI. Final approval of the version to be published: JEC, JMG, RRL, SS, HAEH, and EI. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: JEC, JMG, RRL, SS, HAEH, and EI.

  • Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by Hadassah-Hebrew University Medical Center institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Please direct requests for unpublished data that are relevant to this study to the corresponding author, JEC.

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