Article Figures & Data
Figures
- Fig 1.
A 66-year-old woman presenting with an unruptured left vertebral artery aneurysm measuring 5 mm in maximum diameter. A, Lateral view of a left vertebral artery digital subtraction angiogram. B, Rotational 3D reconstruction. C, Angiogram post-FRED placement (arrows show the proximal and distal ends of the flow diverter). D, Stasis in the aneurysm after flow-diverter placement. E, Conebeam CT with contrast 1 month after stent placement shows complete occlusion of the aneurysm. F, Confirmation of aneurysm occlusion at 1 year.
- Fig 2.
A 68-year-old male patient who had an SAH with a Hunt and Hess score of 3 (left). Diagnostic angiography reveals a 3-mm dissecting aneurysm of the basilar artery at the origin of the anterior inferior cerebellar artery (middle). Implantation of a FRED into the basilar artery with good wall apposition and complete coverage of the aneurysm neck and anterior inferior cerebellar artery origin was achieved. The patient was administered tirofiban for the first 24 hours after implantation (right). During recovery, the patient presented with cranial nerve IX to XII palsies and slight hemiparesis on the left. MR imaging showed only minimal DWI lesions in both cerebellar hemispheres (MRI not shown). Diagnostic angiography 7 days after the primary intervention revealed occlusion of the aneurysm and occlusion of the anterior inferior cerebellar artery. The patient recovered to a mRS 2 after 3 months.
Tables
Parameter No. No. of patients 84 No. of aneurysms 84 Females 42 (50.0%) Median age (range) (yr) 54 (15–81) Pretreatment mRS of patients without SAH 58 0 53 (91.4%) 1 4 (6.9%) 2 1 (1.7%) 3–5 0 (0.0%) Index aneurysm presentation Acute SAH (within 48 hours) 12 (14.3%) <2 weeks since SAH 6 (7.1%) >2 weeks since SAH 7 (8.3%) Stroke 2 (2.4%) Brain stem compression 5 (6.0%) Brain stem infarction 2 (2.4%) Incidental 38 (45.2%) Othera 12 (14.3%) Aneurysm location Vertebral artery (intradural) 42 (50%) Basilar artery 22 (26.1%) Posterior cerebral artery 7 (8.3%) Superior cerebellar artery 4 (4.8%) Vertebral artery (extradural) 4 (4.8%) Posterior inferior cerebellar artery 3 (3.6%) Vertebrobasilar junction 2 (2.4%) Aneurysm morphology Saccular 34 (40.5%) Fusiform 21 (25.0%) Dissecting 19 (22.6%) Blister/pseudoaneurysm 10 (11.9%) Index aneurysm pretreatedb 7 (8.3%) Aneurysm size (median) (range) (mm) 7 (2–67) Intra-aneurysmal thrombus 7 (8.3%) Parameter No. No. of FREDs per aneurysm 1 FRED 80 (95.2%) 2 FREDs 3 (3.6%) 4 FREDs 1 (1.2%) Adjunctive coiling required 14 (16.7%) Platelet function testing 80 (95.2%) Antiplatelet regimen changed after testing 2 (2.4%) Postprocedural antiplatelet regimen ASA + clopidogrel 62 (73.8%) Tirofiban loading followed by ASA + clopidogrel 11 (13.1%) ASA + ticagrelor 6 (7.1%) Prasugrel 3 (3.6%) ASA + prasugrel 1 (1.2%) ASA + tirofiban + ticagrelor 1 (1.2%) Thromboembolic infarction due to procedure 11 (13.1%) Symptomatic thromboembolic complication 8 (9.5%) Location of infarction Cerebellum 7 (8.3%) Brain stem 2 (2.4%) Posterior cerebral artery territory 1 (1.2%) Thalamus 1 (1.2%) Hemorrhagic complications 0 (0.0%) Other complications 3 (3.6%) Parent artery occlusion 2 (2.4%) Time of radiographic follow-up (median) (range) (mo)a 24 (0.03–72) Occlusion status last imaging follow-upa Complete occlusion (100%) 61 (78.2%) Near-complete occlusion (>90%) 7 (9%) Incomplete occlusion (<90%) 10 (12.8%) Imaging techniqueb MRA 34 (50%) DSA 31 (45.6%) Conebeam CT with IV contrast 2 (2.9%) CTA 1 (1.5%) Retreatmentc 6 (7.1%) Time of functional outcome follow-up (median) (range) (mo)d 27 (0.03–72) Functional outcomee mRS 0–2 78 (94%) mRS 3–5 0 mRS 6 5 (6%)
