Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents

Fellows’ Journal Club

The authors report their experience treating basilar apex aneurysms with flow-diverter stents and evaluate their efficacy and safety profile in this specific condition. Of the 175 aneurysms treated with flow-diverter stents at their institution, 5 patients received flow-diverter stents for basilar apex aneurysms. The mean follow-up after stent deployment was 21 months. They conclude that flow diversion is a feasible technique with an efficacy demonstrated at a midterm follow-up, especially in the case of basilar apex aneurysm recurrences after previous endovascular treatments.

Abstract

Figure 4 from paper
A, The initial DSA demonstrates a wide-neck, large BAA involving the origin of both PCAs and superior cerebellar arteries (B) treated with a stent-assisted coiling technique (Neuroform 3.5 mm × 20 mm). C, The 18-month DSA follow-up reveals an aneurysmal recurrence at the level of the neck. D, A Pipeline stent was used to treat the neck remnant with (E) adequate aneurysm occlusion at 15-month DSA follow-up (mRR class IIIa) demonstrated in the working projection. F, The compression test performed confirms the result.

BACKGROUND AND PURPOSE

The treatment of wide-neck, large basilar apex aneurysms is challenging with either an endovascular or a surgical approach. The aim of the present study was to report our experience treating basilar apex aneurysms with flow-diverter stents and to evaluate their efficacy and safety profile in this specific anatomic condition.

MATERIALS AND METHODS

We retrospectively analyzed data from all consecutive patients treated with flow-diverter stents at our institution between January 2011 and January 2015. Patients with large basilar apex aneurysms treated with a flow-diverter stent were included in the study. Clinical presentations, technical details, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a midterm follow-up.

RESULTS

Of the 175 aneurysms treated with flow-diverter stents at our institution, 5 patients (2 women and 3 men; age range, 44–58 years) received flow-diverter stent for basilar apex aneurysms. The mean follow-up after stent deployment was 21 months (range, 15–24 months). One patient died on day 31 from an early postprocedural midbrain hemorrhage. One patient had a right cerebellar hemispheric ischemic lesion with a transient cerebellar syndrome resolved within 24 hours without neurologic sequelae at the latest follow-up. The mRS was 0 in 4 patients and 6 in 1 patient at last follow-up.

CONCLUSIONS

Flow diversion is a feasible technique with an efficacy demonstrated at a midterm follow-up, especially in the case of basilar apex aneurysm recurrences after previous endovascular treatments. Concern about its safety profile still exists.

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Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.