Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Background And Objectives: Data regarding radiographic occlusion rates after repeat flow diversion after initial placement of a flow diverter (FD) in large intracranial aneurysms are limited. We report clinical and angiographic outcomes on 7 patients who required retreatment with overlapping FDs after initial flow diversion for large intracranial aneurysms.
Methods: We performed a retrospective review of a prospectively maintained database of cerebrovascular procedures performed at our institution from 2017 to 2021. We identified patients who underwent retreatment with overlapping FDs for large (>10 mm) cerebral aneurysms after initial flow diversion. At last angiographic follow-up, occlusion grade was evaluated using the O'Kelly-Marotta (OKM) grading scale.
Results: Seven patients (median age 57 years) with cerebral aneurysms requiring retreatment were identified. The most common aneurysm location was the ophthalmic internal carotid artery (n = 3) and basilar trunk (n = 3). There were 4 fusiform and 3 saccular aneurysms. The median aneurysm width was 18 mm; the median neck size for saccular aneurysms was 7 mm; and the median dome-to-neck ratio was 2.8. The median time to retreatment was 9 months, usually due to symptomatic mass effect. After retreatment, the median clinical follow-up was 36 months, MRI/magnetic resonance angiography follow-up was 15 months, and digital subtraction angiography follow-up was 14 months. Aneurysm occlusion at last angiographic follow-up was graded as OKM A (total filling, n = 1), B (subtotal filling, n = 2), C (early neck remnant, n = 3), and D (no filling, n = 0). All patients with symptomatic improvement were OKM C, whereas patients with worsened symptom burden were OKM A or B. Two patients required further open surgical management for definitive management of the aneurysm remnant.
Conclusion: Although most patients demonstrated a decrease in aneurysm remnant size, many had high-grade persistent filling (OKM grades A or B) in this subset of mostly large fusiform aneurysms. Larger studies with longer follow-up are warranted to optimize treatment strategies for atypical aneurysm remnants after repeat flow diversion.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1227/ons.0000000000001056 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Endovascular Treatment for Fungal Internal Carotid Artery Aneurysm.
Cureus
August 2025
Department of Neurosurgery, The University of Osaka Graduate School of Medicine, Suita, JPN.
Fungal cerebral aneurysms, particularly those resulting from direct invasion by fungal sinusitis, are rare and often fatal when involving the cavernous segment of the internal carotid artery (ICA). We present a case of a ruptured fungal ICA aneurysm caused by sinusitis, successfully treated with parent artery occlusion (PAO). In this case, an 80-year-old woman presented with right ptosis, facial pain, and cranial nerve III, IV, and VI palsies.
View Article and Find Full Text PDFEfficacy of flow diversion in blister-like intracranial aneurysms during acute subarachnoid hemorrhage: a single-arm meta-analysis.
J Neurointerv Surg
September 2025
Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Background: Blister-like intracranial aneurysms are rare fragile lesions with a high risk of rupture leading to acute subarachnoid hemorrhage (aSAH) and significant morbidity. Flow diversion (FD) has emerged as a promising endovascular treatment, particularly for complex cases unsuitable for clipping or coiling, but evidence in ruptured settings remains limited due to challenges such as the risks of dual antiplatelet therapy. This study aimed to evaluate the efficacy and safety of FD in ruptured blister-like aneurysms during aSAH through a systematic review and meta-analysis.
View Article and Find Full Text PDFRadial-first to wrist-first: Transulnar arterial access for diagnostic cerebral angiography and neurovascular intervention.
Clin Neurol Neurosurg
September 2025
Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA. Electronic address:
Purpose: Although transradial arterial access has been increasingly used in neurointerventional procedures, anatomical variations, vasospasm, or radial artery occlusion can preclude safe access to the radial artery. This study evaluates the feasibility and safety of transulnar artery access as an alternative route for diagnostic cerebral angiography and neurovascular interventions.
Materials And Methods: A retrospective review was conducted at a high-volume academic neurovascular center.
A Successful Treatment of Hemifacial Spasm After Flow Diverter Stent Placement for Ipsilateral Internal Carotid Artery Saccular Aneurysm.
J Med Cases
August 2025
Department of Anatomy, Faculty of Medicine, European University of Lefke, Mersin 10, Lefke 99728, Northern Cyprus, Turkey.
Hemifacial spasm (HFS) is a neurological disorder characterized by involuntary, paroxysmal contractions of the muscles innervated by the facial nerve on one side of the face. While primary HFS is most often caused by vascular compression at the root exit zone (REZ) of the facial nerve, secondary causes such as tumors, arteriovenous malformations, and intracranial aneurysms are rare. The management of HFS due to aneurysmal compression remains challenging, and the literature on endovascular treatment, particularly with flow diverter stents, is limited.
View Article and Find Full Text PDFDelayed Cerebral Ischemia and Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Impact of Stents and Dual Antiplatelet Therapy.
Neurosurgery
July 2025
Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Background And Objectives: As stent-assisted coiling and flow diversion permeate the treatment armamentarium for appropriately selected ruptured aneurysms, the effect of dual antiplatelet therapy (DAPT) on hemorrhagic complications is primarily scrutinized. However, the effect of DAPT and the presence of a stent on vasospasm and delayed cerebral ischemia (DCI) is less well studied.
Methods: Our prospectively maintained institutional database of intracranial aneurysms was queried for DCI and postaneurysmal subarachnoid hemorrhage (aSAH) vasospasm among patients undergoing stent coiling/flow diversion with subsequent usage of DAPT (S-DAPT).