RT Journal Article
SR Electronic
T1 Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: which stent placement strategy should ‘I’ use? A single center experience
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1118
OP 1122
DO 10.1136/neurintsurg-2019-014858
VO 11
IS 11
A1 Igor Pagiola
A1 Cristian Mihalea
A1 Jildaz Caroff
A1 Léon Ikka
A1 Vanessa Chalumeau
A1 Thomas Yasuda
A1 Joaquin Marenco de la Torre
A1 Marta Iacobucci
A1 Augustin Ozanne
A1 Sophie Gallas
A1 Marcio Chaves Marques
A1 Henrique Carrete
A1 Michel Eli Frudit
A1 Jacques Moret
A1 Laurent Spelle
YR 2019
UL http://jnis.bmj.com/content/11/11/1118.abstract
AB Background Aneurysms of the anterior communicating artery (ACoA) are difficult to treat with coiling or clipping because of the anatomical variation in this region. Flow diversion represents a feasible treatment, but no consensus exists as to which stent deployment technique is more suitable.Methods All patients with ACoA aneurysms treated with flow diverters between April 2014 and November 2018 were retrospectively analyzed. Aneurysm characteristics, follow-up results, and clinical outcome data were recorded, and a new classification comparing the diameters of both A1 segments is proposed: H1=same diameters; H2=<50% difference in diameters; H3= ≥50% difference; and Y=no A1 segment.Results We analyzed 30 procedures in 30 patients with ACoA aneurysms, including 16 ruptured aneurysms treated with coiling embolization and 4 previously unruptured aneurysms (two Medina and two Woven EndoBridge devices). Adequate aneurysm occlusion occurred in 86.9%; one patient (3.3%) experienced symptomatic ischemic stroke. The global thromboembolic complications for each group were 17.6% (H1), 25% (H2), and 60% (H3).Conclusion Flow diversion treatment in this region is safe, feasible, and effective. The most suitable anatomical configuration for flow diverter treatment seems to be the H1 configuration where the ‘I technique’ is suitable (from an A1 segment to the ipsilateral A2). There is a tendency that the H3 configuration is not a good indication for flow diverter treatment. However, further studies are needed to evaluate the feasibility of this anatomical classification and the reproducibility of our findings.