Evaluation of flow diverter use in acutely ruptured vertebral artery dissecting Aneurysms: A focus on safety and efficacy for rapid Aneurysm obliteration

• Published in: Clinical neurology and neurosurgery 2024-07, Vol.242, p.108345, Article 108345
• Main Authors: Duangprasert, Gahn, Sukhor, Sasikan, Ratanavinitkul, Warot, Tantongtip, Dilok
• Format: Article
• Language: English
• Subjects: Aneurysm; Aneurysms; Aspirin; Catheters; Dissecting Aneurysms; Embolization; Flow diversion; Flow diverter; Hemorrhage; Ischemia; Kappa coefficient; Medical imaging; Morphology; Occlusion; Patients; Rupture; Statistical analysis; Stents; Subarachnoid hemorrhage; Thrombosis; Tomography; Vertebrae; Vertebral artery
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2024.108345

Flow diverter device (FDD) has emerged as the reconstruction technique for treating ruptured dissecting vertebral artery Aneurysms (VADA), but data on feasibility regarding re-rupture risk and timing of Aneurysm obliteration following FDD treatment is still limited. Therefore, this study aimed to evaluate the safety and efficacy of FDD in the treatment of VADAs presenting with subarachnoid hemorrhage (SAH). We retrospectively reviewed patients with ruptured VADA presenting with subarachnoid hemorrhage who underwent FDD placement at our institution between 2015 and 2023. Patient demographic data, Aneurysm configuration, and occlusion status were analyzed. Thirteen patients with SAH from VADA rupture underwent FDD implantation. The average size of the largest diameter of the Aneurysm was 11.2 mm (range 6.5–21 mm). Eight of 13 (61.5 %) patients had their Aneurysms completely obliterated within 2 weeks after the procedure. The small dissecting Aneurysm (d = 0.636, p = 0.002) and degree of intra-Aneurysmal contrast stasis (d = 0.524, p = 0.026) were associated with rapid Aneurysm occlusion, according to the Somer’s d coefficient. There were no ischemic or hemorrhagic complications at the average clinical follow-up of 28.4 months (range 5–67 months) and average angiographic follow-up of 20.1 months (range 3–60 months). A favorable outcome (mRS 0–2) was achieved in 12 patients (92.3 %). FDD is safe and effective for the reconstruction of acutely ruptured VADAs. In addition, our study emphasizes that small dissecting Aneurysms tend to be rapidly obliterated after flow diversion, which eliminates the risk of re-rupture during the acute phase of subarachnoid hemorrhage. •The flow diverter is safe and effective in acutely ruptured VADAs.•Small dissecting Aneurysm tends to be rapidly obliterated after flow diversion.•A relatively large cohort of ruptured VADA patients with flow diverter.•Flow diverter provides favorable long-term outcomes in treating ruptured VADAs.