Abstract
Flow diversion is a relatively new technique used for the treatment of intracranial aneurysms. The introduction of flow diverters (FDs) dates back to 2007. Nowadays, several types of FDs are available on the market of neurointerventional devices. Indications for flow diverter use are unruptured large or giant saccular wide-neck or fusiform intracranial aneurysms. However, the number of published studies regarding the off-label use of FDs in the setting of acute aneurysmal subarachnoid hemorrhage (SAH) is increasing [1–4].
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References
Walcott BP, Koch MJ, Stapleton CJ, Patel AB. Blood flow diversion as a primary treatment method for ruptured brain aneurysms-concerns, controversy, and future directions. Neurocrit Care. 2017;26(3):465–73.
Cruz JP, O’Kelly C, Kelly M, et al. Pipeline embolization device in aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2013;34(2):271–6.
de Barros Faria M, Castro RN, Lundquist J, et al. The role of the pipeline embolization device for the treatment of dissecting intracranial aneurysms. AJNR Am J Neuroradiol. 2011;32(11):2192–5.
Duman E, Coven I, Yildirim E, Yilmaz C, Pinar HU. Endovascular treatment of wide necked ruptured Saccular aneurysms with flow-diverter stent. Turk Neurosurg. 2017;27(3):362–7.
Madaelil TP, Moran CJ, Cross DT 3rd, Kansagra AP. Flow diversion in ruptured intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol. 2017;38(3):590–5.
Cagnazzo F, di Carlo DT, Cappucci M, Lefevre PH, Costalat V, Perrini P. Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2018;39(9):1669–75.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.
McAuliffe W, Wenderoth JD. Immediate and midterm results following treatment of recently ruptured intracranial aneurysms with the pipeline embolization device. AJNR Am J Neuroradiol. 2012;33(3):487–93.
Goertz L, Dorn F, Kraus B, et al. Safety and efficacy of the Derivo Embolization Device for the treatment of ruptured intracranial aneurysms. J Neurointerv Surg. 2019;11(3):290–5.
Linfante I, Mayich M, Sonig A, Fujimoto J, Siddiqui A, Dabus G. Flow diversion with Pipeline Embolic Device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature. J Neurointerv Surg. 2017;9(1):29–33.
Aydin K, Arat A, Sencer S, et al. Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg. 2015;7(3):202–9.
Cerejo R, Bain M, John S, et al. Flow diverter treatment of cerebral blister aneurysms. Neuroradiology. 2017;59(12):1285–90.
Chalouhi N, Zanaty M, Whiting A, et al. Treatment of ruptured intracranial aneurysms with the pipeline embolization device. Neurosurgery. 2015;76(2):165–172; discussion 172.
Chan RS, Mak CH, Wong AK, Chan KY, Leung KM. Use of the pipeline embolization device to treat recently ruptured dissecting cerebral aneurysms. Interv Neuroradiol. 2014;20(4):436–41.
Lin N, Brouillard AM, Keigher KM, et al. Utilization of pipeline embolization device for treatment of ruptured intracranial aneurysms: US multicenter experience. J Neurointerv Surg. 2015;7(11):808–15.
Lozupone E, Piano M, Valvassori L, et al. Flow diverter devices in ruptured intracranial aneurysms: a single-center experience. J Neurosurg. 2018;128(4):1037–43.
Mahajan A, Das B, Narang KS, et al. Surpass flow diverter in the treatment of ruptured intracranial aneurysms-a single-center experience. World Neurosurg. 2018;120:e1061–70.
Maus V, Mpotsaris A, Dorn F, et al. The use of flow diverter in ruptured, dissecting intracranial aneurysms of the posterior circulation. World Neurosurg. 2018;111:e424–33.
Mokin M, Chinea A, Primiani CT, et al. Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerv Surg. 2018;10(11):1074–8.
Natarajan SK, Shallwani H, Fennell VS, et al. Flow diversion after aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2017;28(3):375–88.
Parthasarathy R, Gupta V, Gupta A. Safety of Prasugrel loading in ruptured blister like aneurysm treated with a pipeline device. Br J Radiol. 2018;91(1086):20170476.
Ryan RW, Khan AS, Barco R, Choulakian A. Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy. Neurosurg Focus. 2017;42(6):E11.
Yang C, Vadasz A, Szikora I. Treatment of ruptured blood blister aneurysms using primary flow-diverter stenting with considerations for adjunctive coiling: a single-centre experience and literature review. Interv Neuroradiol. 2017;23(5):465–76.
Lindgren A, Vergouwen MD, van der Schaaf I, et al. Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2018;8:Cd003085.
Fiorella D, Arthur AS, Chiacchierini R, Emery E, Molyneux A, Pierot L. How safe and effective are existing treatments for wide-necked bifurcation aneurysms? Literature-based objective performance criteria for safety and effectiveness. J Neurointerv Surg. 2017;9(12):1197–201.
Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke. 2013;44(2):442–7.
Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(8):2315–21.
Funding
No specific funding from either commercial or non-commercial organizations was received for the research and writing of this chapter.
BoxWhat is known?
Flow diversion as treatment for recently ruptured aneurysms seems to yield a high complete occlusion rate. Two meta-analysis about this topic, with overlapping study population but different inclusion criteria, reported fairly high rates of favorable clinical outcome. Reporting of (treatment-related) varies considerably among published studies.
What is new?
Only (very) low quality evidence regarding the use of flow diverters in the acute SAH phase is available. Publication and selection bias seem to be important types of bias distorting the final results of meta-analyses, with larger series tending to report especially more negative results regarding clinical outcome.
Consequences for clinical practice
Flow diversion should be considered last resort option in the treatment of recently ruptured aneurysms. When no other treatment option is deemed feasible, the use of FDs can be considered. However the high rate of complications should be kept in mind. Rationale behind choice for FD treatment in this setting should be documented properly and should be subject of future research.
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ten Brinck, M.F.M., de Vries, J. (2019). Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysms: The Scientific Base for Flow Diverters. In: Bartels, R., Rovers, M., Westert, G. (eds) Evidence for Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16323-5_7
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DOI: https://doi.org/10.1007/978-3-030-16323-5_7
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