Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Looks like a lot of research needs to be done to prevent these complications. If we had a great stroke association  we could add this in the overall stroke recovery strategy.  BUT WE HAVE NO STROKE LEADERSHIP OR STRATEGY.

Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

 

1. http://orcid.org/0000-0002-8129-2273Kemal Alpay1,
2. Tero Hinkka2,
3. Antti E Lindgren3,4,5,
4. Juha-Matti Isokangas6,
5. http://orcid.org/0000-0003-4243-9591Rahul Raj7,
6. Riitta Parkkola1,8,
7. Matias Sinisalo1,
8. Jussi Numminen9,
9. Juha-Pekka Pienimäki2,
10. Petri Saari10,
11. Janne Seppänen2,
12. Kari Palosaari6,
13. http://orcid.org/0000-0001-8385-0622Riitta Rautio1,8

1. Correspondence to Dr Kemal Alpay, Department of Radiology, TYKS Turku University Hospital, Varsinais-Suomi, 20521 Turku, Finland; kemalp@utu.fi

Abstract

Background 

 Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date.

Methods 

This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate.

Results 

110 patients (64 females; mean age 55.7 years; range 12–82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0–2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102).

Conclusions  

FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.

Data availability statement

Data are not available for public, however upon a reasonable request it may be provided.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/neurintsurg-2021-017641

When Treating Brain Aneurysms, Two Isn’t Always Better Than One

Just in case you need factual data to question your doctor about your aneurysm. It joins the other options for handling aneurysms, coiling, surgery, mesh, and glue   being the others.
http://dgnews.docguide.com/when-treating-brain-aneurysms-two-isn-t-always-better-one?
The old adage about two being better than one doesn’t necessarily apply to brain surgery, according to a study published in the American Journal of Neuroradiology.
To reduce blood flow into aneurysms, surgeons often insert a flow diverter across the opening of an aneurysm. If the neck of an aneurysm is large, surgeons will sometimes overlap 2 diverters, to increase the density of the mesh over the opening. Another technique is to compress the diverter to increase the mesh density and block more blood flow. But which technique is better?
The current study points to the single, compressed diverter provided that it produces a mesh denser than the 2 overlapped diverters, and that it covers at least half of the aneurysm opening.
The research, which is ongoing, could eventually help doctors determine the best way to treat patients suffering from aneurysms.
“When doctors see the simulated blood flow in our models, they’re able to visualise it,” said Hui Meng, University at Buffalo, Buffalo, New York. “They see that they need to put more of the dense mesh here or there to diffuse the jets [of blood], because the jets are dangerous.”
The researchers used virtual models of 3 types of aneurysms -- fusiform, and medium and large saccular -- and applied engineering principles to model the pressure and speed of blood flowing through the vessels.
The engineers modelled 3 different diverter treatment methods -- single non-compacted, two overlapped, and single compacted -- and ran tests to determine how they would affect blood flow in and out of the aneurysm using computational fluid dynamics.
The models showed that compressing a diverter produced a dense mesh that covered 57% of a fusiform-shaped aneurysm. That proved more effective than overlapping 2 diverters.
The compacted diverter was less effective in saccular aneurysms. As diverters are compressed, they become wider and bump into the sides of the vessel, so they could not be compressed enough to cover a small opening of an aneurysm. Compression was more effective in a large necked saccular aneurysm, producing a dense mesh that covered 47% of the opening.
Complete coverage of an aneurysm using a solid diverter is not favourable because a porous scaffold is needed to allow cell and tissue growth around the neck of the aneurysm. In addition, the danger of blocking off smaller arteries prevents the use of solid diverters.
Next, the team wants to look back over hundreds of previous cases, to determine how blood flow was affected by the use of diverters. The idea is to build a database so that more definitive conclusions can be drawn.
SOURCE: University at Buffalo

Medical Edge: Brain Aneurysm - Flow Diverter

Another option to consult with your doctor about. It joins the options for handling aneurysms, coiling, surgery, mesh, and glue   being the others. I can't visualize how this is done and I can't find any images for it.
http://kaaltv.com/article/stories/S2677160.shtml?cat=10799
Untreated aneurysms, or ballooning of blood vessels, can grow and possibly rupture, causing brain damage or even death.

If an aneurysm ruptured, blood would pool in the brain causing a hemorrhagic stroke. That stroke would result in brain damage, or even death.

Aneurysms used to mean major surgery, but now there are less invasive options for many people. It's called a Flow Diverter, and it works by redirecting the blood flow away from the aneurysm.

"What we are doing is putting nothing else than a screen to change or redirect the flow away from the aneurysm,” said Dr. Ricardo Hanel, Mayo Clinic Neurosurgeon.

During the procedure, Dr. Hanel inserts a catheter and runs it up to the site of the aneurysm. He deploys the diverter device, which redirects blood flow. Over the next few months, the entrance to the aneurysm becomes clotted and closed off, creating a new vessel wall.

"We are just at the beginning of experience with this device -- but I expect to see over five, ten years that these aneurysms that were closed at six months, they'll remain closed for the rest of the life and they will never come back."

The Flow Diverter device is FDA approved for aneurysms 10 millimeters or larger.

Dr. Hanel suspects that soon, it will be approved for smaller ones as well.

The Neuro network posting with pictures below.
http://theneuronetwork.com/group/neurointerventional/forum/topics/flow-diverter-stents