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Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience.

Publication ,  Journal Article
Guerrero, WR; Ortega-Gutierrez, S; Hayakawa, M; Derdeyn, CP; Rossen, JD; Hasan, D; Samaniego, EA
Published in: World Neurosurg
January 2018

OBJECTIVE: Treatment of ruptured posterior circulation dissecting aneurysms is technically challenging with potentially high morbidity and mortality. We sought to assess the safety and feasibility of using a flow-diversion device (FDD) and a specific acute antiplatelet aggregation protocol in the management of ruptured dissecting aneurysms. METHODS: Subjects with ruptured dissecting aneurysms treated during a 3-year period were retrospectively identified from a prospective registry. Intraoperative complications, morbidity, and mortality were recorded. Tirofiban maintenance infusion without bolus was administered intravenously immediately after deployment of the FDD, and almost all patients were loaded with dual antiplatelet (aspirin and clopidogrel) post procedure. Clinical follow-up evaluation and modified Rankin Scale were assessed. RESULTS: Nine subjects with ruptured posterior circulation dissecting aneurysms were treated with an FDD: 5 vertebral artery, 2 basilar artery, and 2 posterior inferior cerebellar artery aneurysms. Average World Federation of Neurosurgical Societies score was 2 (range 1-5). Seven patients had external ventricular drain placed acutely for hydrocephalus. Eight patients received tirofiban infusion without bolus after FDD. No intraoperative complications occurred. Two subjects developed asymptomatic intraparenchymal hemorrhage found on surveillance noncontrast computed tomography. One subject suffered a major intraparenchymal hemorrhage and died a few days post intervention after additional anticoagulation was started for a left ventricular assist device. Follow-up modified Rankin Scale within 12 months was 0 in 3 subjects, 1 in 3 subjects, 2 in 1 subject, and 4 in 1. CONCLUSIONS: Treatment of dissecting posterior circulation aneurysms with FDDs is feasible and a potential alternative to deconstructive techniques.

Duke Scholars

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

January 2018

Volume

109

Start / End Page

e164 / e169

Location

United States

Related Subject Headings

  • Vertebral Artery Dissection
  • Subarachnoid Hemorrhage
  • Retrospective Studies
  • Intracranial Aneurysm
  • Humans
  • Follow-Up Studies
  • Feasibility Studies
  • Equipment Design
  • Endovascular Procedures
  • Embolization, Therapeutic
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Guerrero, W. R., Ortega-Gutierrez, S., Hayakawa, M., Derdeyn, C. P., Rossen, J. D., Hasan, D., & Samaniego, E. A. (2018). Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience. World Neurosurg, 109, e164–e169. https://doi.org/10.1016/j.wneu.2017.09.125
Guerrero, Waldo R., Santiago Ortega-Gutierrez, Minako Hayakawa, Colin P. Derdeyn, James D. Rossen, David Hasan, and Edgar A. Samaniego. “Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience.World Neurosurg 109 (January 2018): e164–69. https://doi.org/10.1016/j.wneu.2017.09.125.
Guerrero WR, Ortega-Gutierrez S, Hayakawa M, Derdeyn CP, Rossen JD, Hasan D, et al. Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience. World Neurosurg. 2018 Jan;109:e164–9.
Guerrero, Waldo R., et al. “Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience.World Neurosurg, vol. 109, Jan. 2018, pp. e164–69. Pubmed, doi:10.1016/j.wneu.2017.09.125.
Guerrero WR, Ortega-Gutierrez S, Hayakawa M, Derdeyn CP, Rossen JD, Hasan D, Samaniego EA. Endovascular Treatment of Ruptured Vertebrobasilar Dissecting Aneurysms Using Flow Diversion Embolization Devices: Single-Institution Experience. World Neurosurg. 2018 Jan;109:e164–e169.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

January 2018

Volume

109

Start / End Page

e164 / e169

Location

United States

Related Subject Headings

  • Vertebral Artery Dissection
  • Subarachnoid Hemorrhage
  • Retrospective Studies
  • Intracranial Aneurysm
  • Humans
  • Follow-Up Studies
  • Feasibility Studies
  • Equipment Design
  • Endovascular Procedures
  • Embolization, Therapeutic