Flow-diverting stents allow efficient treatment of unruptured,intradural dissecting aneurysms of the vertebral artery: An explanatory approach using in vivo flow analysis

Abstract

Object

Our study aimed to evaluate the efficiency of flow-diverting stents (FDS) in treating unruptured, intradural dissecting aneurysms of the vertebral artery (VADAs). Additionally, the effect of FDS on the aneurysmal flow pattern was investigated by performing in vivo flow analysis using parametric color coding (PCC).

Methods

We evaluated 11 patients with unruptured, intradural VADAs, treated with FDS. Pre- and postinterventional DSA-series were postprocessed by PCC, and time-density curves were calculated. The parameters aneurysmal inflow-velocity, outflow-velocity and relative time-to-peak (rTTP) were calculated. Pre- and postinterventional values were compared and correlated with the occlusion rate after six months.

Results

Follow-up DSA detected 10 aneurysms occluded, meaning an occlusion rate of 91%. No procedure-related morbidity and mortality was found. Flow analyses revealed a significant reduction of aneurysmal inflow- velocity and prolongation of rTTP after FDS deployment. Concerning aneurysm occlusion, the postinterventional outflow-velocity turned out to be a marginally statistically significant predictor. A definite threshold value (–0.7 density change/s) could be determined for the outflow-velocity that allows prediction of complete aneurysm occlusion with high sensitivity and specificity (100%).

Conclusions

Using FDS can be considered an efficient and safe therapy option in treating unruptured, intradural VADA. From in vivo flow analyses the postinterventional aneurysmal outflow-velocity turned out to be a potential predictor for later complete aneurysm occlusion. Here, it might be possible to determine a threshold value that allows prediction of aneurysm occlusion with high specificity and sensitivity. As fast, applicable and easy-to-handle tool, PCC could be used for procedural monitoring and might contribute to further treatment optimization.

Keywords

Cerebral aneurysm treatment flow-diverting stents vascular disease image postprocessing

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References

Sasaki

Ogawa

Kioke

. A clinicopathologic study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 1991; 75: 874–882.

Luo

Chang

Teng

. Endovascular treatment of ruptured vertebral dissecting aneurysms with electrodetachable coils. J Chin Med Assoc 2005; 68: 578–584.

Naito

Iwai

Sasaki

. Management of intracranial vertebral artery dissections initially presenting without subarachnoid haemorrhage. Neurosurgery 2002; 51: 930–937.

Flemming

Wiebers

Brown

Jr . The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovasc Dis 2005; 20: 270–279.

Yamaura

Watanabe

Saeki

. Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 1990; 72: 183–188.

Peluso

van Rooij

Sluzewski

. Endovascular treatment of symptomatic intradural vertebral dissecting aneurysms. AJNR Am J Neuroradiol 2008; 29: 102–106.

Kashiwazaki

Ushikoshi

Asano

. Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection. Neuroradiology 2013; 55: 201–206.

de Barros Faria

Castro

Lundquist

. The role of the pipeline embolization device for the treatment of dissecting intracranial aneurysms. AJNR Am J Neuroradiol 2011; 32: 2192–2195.

Yeung

Lai

Lau

. Long-term outcome of endovascular reconstruction with the Pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 2012; 116: 882–887.

10.

Ducruet

Crowley

Albuquerque

. Reconstructive endovascular treatment of a ruptured vertebral artery dissecting aneurysm using the Pipeline embolization device. J Neurointerv Surg 2013; 5: e20.

11.

Narata

Yilmaz

Schaller

. Flow-diverting stent for ruptured intracranial dissecting aneurysm of vertebral artery. Neurosurgery 2012; 70: 982–988. discussion 988–989.

12.

Strother

Bender

Deuerling-Zheng

. Parametric color coding of digital subtraction angiography. AJNR Am J Neuroradiol 2010; 31: 919–924.

13.

Struffert

Deuerling-Zheng

Engelhorn

. Monitoring of balloon test occlusion of the internal carotid artery by parametric color coding and perfusion imaging within the angio suite: First results. Clin Neuroradiol 2013; 23: 285–292.

14.

Gölitz

Struffert

Lücking

. Parametric color coding of digital subtraction angiography in the evaluation of carotid cavernous fistulas. Clin Neuroradiol 2013; 23: 113–120.

15.

Sönmez

Brinjikji

Murad

. Deconstructive and reconstructive techniques in treatment of vertebrobasilar dissecting aneurysms: A systematic review and meta-analysis. AJNR Am J Neuroradiol 2015; 36: 1293–1298.

16.

Dabus

Lin

Linfante

. Endovascular treatment of fusiform intracranial vertebral artery aneurysms using reconstructive techniques. J Neurointerv Surg 2014; 6: 589–594.

17.

Struffert

Ott

Kowarschik

. Measurement of quantifiable parameters by time-density curves in the elastase-induced aneurysm model: First results in the comparison of a flow diverter and a conventional aneurysm stent. Eur Radiol 2013; 23: 521–527.

18.

Gölitz

Struffert

Rösch

. Cerebral aneurysm treatment using flow-diverting stents: In-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: Preliminary results. Eur Radiol 2015; 25: 428–435.

19.

Kono

Shintani

Fujimoto

. Stent-assisted coil embolization and computational fluid dynamics simulations of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage: Case report. Neurosurgery 2012; 71: E1192–E1200. discussion E1200–E1201.