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Revolutionary impact of flow diversion/modification on treatment of certain aneuryms


Friday, 30 Sep 2011 11:45
Saruhan Çekirge
Saruhan Çekirge


Saruhan Çekirge, professor, Hacettepe University Hospitals, Ankara,Turkey, told delegates at the European Society of Minimally Invasive Neurological Therapy congress (ESMINT) held in Nice, France, that the impact of flow diversion/modification on the endovascular treatment of aneurysms with an important branch originating from the aneurysm sac was a “revolutionary change”.


He also told delegates: “In endovascular aneurysm treatment with flow diverters, there has been a strong consideration regarding the side branch or perforator patency. There have been anecdotal cases reporting perforating injury in the literature. In our experience, covering a segment, with branches coming off, with flow diverters especially with a single device, does not result in clinical consequence. If there is a flow demand, the vessel stays open; if not, it may close or become hypoplastic. This is most interesting that if there is a flow demand it stays open, so there is very intelligent behaviour.”


“Control studies have shown that flow diversion/modification treatment provides revolutionary changes not only for aneurysms which are large/giant and fusiform, for very small, difficult or impossible- to-coil ones and also for aneurysms with an important vessel coming off the sac which used to be the major limitation for endovascular treatment,” he added.


In the Hacettepe FD Pipeline/Silk series of 269 aneurysms in 211 patients, there was a subgroup of 46 aneurysms with a vessel originating from the aneurysm sac. In this group of 46 aneurysms with a vessel originating from the aneurysm sac, 23 aneurysms were in the internal carotid-anterior choroidal artery, 11 in the posterior communicating, four in the posterior inferior coronary artery, two in the distal anterior cerebral artery, one in the distal posterior communicating artery and five in the middle cerebral artery with important side branches originating .

 

“In 33 of these 46 aneurysms, six months and/or one year follow-up DSA was obtained. Investigators found that out of these 33 aneurysms which were controlled, all but one vessel (posterior communicating artery) originating from the aneurysm sac stayed open. Twenty aneurysms closed with perfect reconstruction and 13 aneurysm sacs were remodeled back. No clinical consequences developed except for one patient with an internal carotid-anterior choroidal aneurysm who stopped using clopidogrel after one week and had a transient ischaemic attack with a very small diffusion MR lesion in the territory. This patient returned to normal in 24 hours and a six-month control DSA revealed complete aneurysm occlusion with patency of the artery,” said Çekirge.




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