Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study

Jose Danilo Bengzon Diestro; Nimer Adeeb; Mahmoud Dibas; William Boisseau; Pablo Harker; Waleed Brinjikji; Sishi Xiang; Evan Joyce; Maksim Shapiro; Eytan Raz; Carmen Parra-Farinas; Gwynedd Pickett; Naif M. Alotaibi; Robert W. Regenhardt; Joshua D. Bernstock; Julian Spears; Christoph J. Griessenauer; Jan Karl Burkhardt; Muhammad U. Hafeez; Peter Kan; Ramesh Grandhi; Philipp Taussky; Erez Nossek; Tao Hong; Hongqi Zhang; Lorenzo Rinaldo; Giuseppe Lanzino; Christopher J. Stapleton; James D. Rabinov; Aman B. Patel; Thomas R. Marotta; Daniel Roy; Adam A. Dmytriw

doi:10.1093/neuros/nyab365

Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study

Jose Danilo Bengzon Diestro, Nimer Adeeb, Mahmoud Dibas, William Boisseau, Pablo Harker, Waleed Brinjikji, Sishi Xiang, Evan Joyce, Maksim Shapiro, Eytan Raz, Carmen Parra-Farinas, Gwynedd Pickett, Naif M. Alotaibi, Robert W. Regenhardt, Joshua D. Bernstock, Julian Spears, Christoph J. Griessenauer, Jan Karl Burkhardt, Muhammad U. Hafeez, Peter KanRamesh Grandhi, Philipp Taussky, Erez Nossek, Tao Hong, Hongqi Zhang, Lorenzo Rinaldo, Giuseppe Lanzino, Christopher J. Stapleton, James D. Rabinov, Aman B. Patel, Thomas R. Marotta, Daniel Roy, Adam A. Dmytriw

Radiology

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Open surgery has traditionally been preferred for the management of bifurcationmiddle cerebral artery (MCA) aneurysms. Flow diverting stents present a novel endovascular strategy for aneurysm treatment. OBJECTIVE: To add to the limited literature describing the outcomes and complications in the use of flow diverters for the treatment of these complex aneurysms. METHODS:This is amulticenter retrospective review ofMCAbifurcation aneurysmsundergoing flow diversion.We assessed post-treatment radiological outcomes and both thromboembolic and hemorrhagic complications. RESULTS: We reviewed the outcomes of 54 aneurysms treated with flow diversion. Four (7.4%) of the aneurysms had a history of rupture (3 remote and 1 acute). Fourteen (25.9%) of the aneurysms already underwent either open surgery or coiling prior to flowdiversion. A total of 36 out of the 45 aneurysms (80%) with available follow-up data had adequate aneurysm occlusion with a median follow-up time of 12 mo. There were no hemorrhagic complications but 16.7% (9/54) had thromboembolic complications. CONCLUSION: Flow diverting stents may be a viable option for the endovascular treatment of complex bifurcationMCAaneurysms. However, compared to published series on the open surgical treatment of this subset of aneurysms, flow diversion has inferior outcomes and are associated with a higher rate of complications.

Original language	English (US)
Pages (from-to)	1112-1121
Number of pages	10
Journal	Neurosurgery
Volume	89
Issue number	6
DOIs	https://doi.org/10.1093/neuros/nyab365
State	Published - Dec 1 2021

Keywords

Endovascular
Flow diversion
Intracranial aneurysm
Middle cerebral artery
Pipeline

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1093/neuros/nyab365

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Diestro, J. D. B., Adeeb, N., Dibas, M., Boisseau, W., Harker, P., Brinjikji, W., Xiang, S., Joyce, E., Shapiro, M., Raz, E., Parra-Farinas, C., Pickett, G., Alotaibi, N. M., Regenhardt, R. W., Bernstock, J. D., Spears, J., Griessenauer, C. J., Burkhardt, J. K., Hafeez, M. U., ... Dmytriw, A. A. (2021). Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study. Neurosurgery, 89(6), 1112-1121. https://doi.org/10.1093/neuros/nyab365

Diestro, JDB, Adeeb, N, Dibas, M, Boisseau, W, Harker, P, Brinjikji, W, Xiang, S, Joyce, E, Shapiro, M, Raz, E, Parra-Farinas, C, Pickett, G, Alotaibi, NM, Regenhardt, RW, Bernstock, JD, Spears, J, Griessenauer, CJ, Burkhardt, JK, Hafeez, MU, Kan, P, Grandhi, R, Taussky, P, Nossek, E, Hong, T, Zhang, H, Rinaldo, L, Lanzino, G, Stapleton, CJ, Rabinov, JD, Patel, AB, Marotta, TR, Roy, D & Dmytriw, AA 2021, 'Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study', Neurosurgery, vol. 89, no. 6, pp. 1112-1121. https://doi.org/10.1093/neuros/nyab365

@article{968a62d297d14c3395681dafd908396f,

title = "Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study",

abstract = "BACKGROUND: Open surgery has traditionally been preferred for the management of bifurcationmiddle cerebral artery (MCA) aneurysms. Flow diverting stents present a novel endovascular strategy for aneurysm treatment. OBJECTIVE: To add to the limited literature describing the outcomes and complications in the use of flow diverters for the treatment of these complex aneurysms. METHODS:This is amulticenter retrospective review ofMCAbifurcation aneurysmsundergoing flow diversion.We assessed post-treatment radiological outcomes and both thromboembolic and hemorrhagic complications. RESULTS: We reviewed the outcomes of 54 aneurysms treated with flow diversion. Four (7.4%) of the aneurysms had a history of rupture (3 remote and 1 acute). Fourteen (25.9%) of the aneurysms already underwent either open surgery or coiling prior to flowdiversion. A total of 36 out of the 45 aneurysms (80%) with available follow-up data had adequate aneurysm occlusion with a median follow-up time of 12 mo. There were no hemorrhagic complications but 16.7% (9/54) had thromboembolic complications. CONCLUSION: Flow diverting stents may be a viable option for the endovascular treatment of complex bifurcationMCAaneurysms. However, compared to published series on the open surgical treatment of this subset of aneurysms, flow diversion has inferior outcomes and are associated with a higher rate of complications.",

keywords = "Endovascular, Flow diversion, Intracranial aneurysm, Middle cerebral artery, Pipeline",

author = "Diestro, {Jose Danilo Bengzon} and Nimer Adeeb and Mahmoud Dibas and William Boisseau and Pablo Harker and Waleed Brinjikji and Sishi Xiang and Evan Joyce and Maksim Shapiro and Eytan Raz and Carmen Parra-Farinas and Gwynedd Pickett and Alotaibi, {Naif M.} and Regenhardt, {Robert W.} and Bernstock, {Joshua D.} and Julian Spears and Griessenauer, {Christoph J.} and Burkhardt, {Jan Karl} and Hafeez, {Muhammad U.} and Peter Kan and Ramesh Grandhi and Philipp Taussky and Erez Nossek and Tao Hong and Hongqi Zhang and Lorenzo Rinaldo and Giuseppe Lanzino and Stapleton, {Christopher J.} and Rabinov, {James D.} and Patel, {Aman B.} and Marotta, {Thomas R.} and Daniel Roy and Dmytriw, {Adam A.}",

note = "Publisher Copyright: {\textcopyright} Congress of Neurological Surgeons 2021.",

year = "2021",

month = dec,

day = "1",

doi = "10.1093/neuros/nyab365",

language = "English (US)",

volume = "89",

pages = "1112--1121",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "6",

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TY - JOUR

T1 - Flow Diversion for Middle Cerebral Artery Aneurysms

T2 - An International Cohort Study

AU - Diestro, Jose Danilo Bengzon

AU - Adeeb, Nimer

AU - Dibas, Mahmoud

AU - Boisseau, William

AU - Harker, Pablo

AU - Brinjikji, Waleed

AU - Xiang, Sishi

AU - Joyce, Evan

AU - Shapiro, Maksim

AU - Raz, Eytan

AU - Parra-Farinas, Carmen

AU - Pickett, Gwynedd

AU - Alotaibi, Naif M.

AU - Regenhardt, Robert W.

AU - Bernstock, Joshua D.

AU - Spears, Julian

AU - Griessenauer, Christoph J.

AU - Burkhardt, Jan Karl

AU - Hafeez, Muhammad U.

AU - Kan, Peter

AU - Grandhi, Ramesh

AU - Taussky, Philipp

AU - Nossek, Erez

AU - Hong, Tao

AU - Zhang, Hongqi

AU - Rinaldo, Lorenzo

AU - Lanzino, Giuseppe

AU - Stapleton, Christopher J.

AU - Rabinov, James D.

AU - Patel, Aman B.

AU - Marotta, Thomas R.

AU - Roy, Daniel

AU - Dmytriw, Adam A.

PY - 2021/12/1

Y1 - 2021/12/1

N2 - BACKGROUND: Open surgery has traditionally been preferred for the management of bifurcationmiddle cerebral artery (MCA) aneurysms. Flow diverting stents present a novel endovascular strategy for aneurysm treatment. OBJECTIVE: To add to the limited literature describing the outcomes and complications in the use of flow diverters for the treatment of these complex aneurysms. METHODS:This is amulticenter retrospective review ofMCAbifurcation aneurysmsundergoing flow diversion.We assessed post-treatment radiological outcomes and both thromboembolic and hemorrhagic complications. RESULTS: We reviewed the outcomes of 54 aneurysms treated with flow diversion. Four (7.4%) of the aneurysms had a history of rupture (3 remote and 1 acute). Fourteen (25.9%) of the aneurysms already underwent either open surgery or coiling prior to flowdiversion. A total of 36 out of the 45 aneurysms (80%) with available follow-up data had adequate aneurysm occlusion with a median follow-up time of 12 mo. There were no hemorrhagic complications but 16.7% (9/54) had thromboembolic complications. CONCLUSION: Flow diverting stents may be a viable option for the endovascular treatment of complex bifurcationMCAaneurysms. However, compared to published series on the open surgical treatment of this subset of aneurysms, flow diversion has inferior outcomes and are associated with a higher rate of complications.

AB - BACKGROUND: Open surgery has traditionally been preferred for the management of bifurcationmiddle cerebral artery (MCA) aneurysms. Flow diverting stents present a novel endovascular strategy for aneurysm treatment. OBJECTIVE: To add to the limited literature describing the outcomes and complications in the use of flow diverters for the treatment of these complex aneurysms. METHODS:This is amulticenter retrospective review ofMCAbifurcation aneurysmsundergoing flow diversion.We assessed post-treatment radiological outcomes and both thromboembolic and hemorrhagic complications. RESULTS: We reviewed the outcomes of 54 aneurysms treated with flow diversion. Four (7.4%) of the aneurysms had a history of rupture (3 remote and 1 acute). Fourteen (25.9%) of the aneurysms already underwent either open surgery or coiling prior to flowdiversion. A total of 36 out of the 45 aneurysms (80%) with available follow-up data had adequate aneurysm occlusion with a median follow-up time of 12 mo. There were no hemorrhagic complications but 16.7% (9/54) had thromboembolic complications. CONCLUSION: Flow diverting stents may be a viable option for the endovascular treatment of complex bifurcationMCAaneurysms. However, compared to published series on the open surgical treatment of this subset of aneurysms, flow diversion has inferior outcomes and are associated with a higher rate of complications.

KW - Endovascular

KW - Flow diversion

KW - Intracranial aneurysm

KW - Middle cerebral artery

KW - Pipeline

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DO - 10.1093/neuros/nyab365

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AN - SCOPUS:85121990987

SN - 0148-396X

VL - 89

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JO - Neurosurgery

JF - Neurosurgery

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ER -

Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study

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