Cargando…

Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm

Flow diversion (FD) is a novel endovascular technique based on the profound alteration of cerebrovascular hemodynamics, which emerged as a promising minimally invasive therapy for intracranial aneurysms. However, delayed post-procedural stroke remains an unexplained concern. A consistent follow-up-r...

Descripción completa

Detalles Bibliográficos
Autores principales: Schob, Stefan, Richter, Cindy, Scherlach, Cordula, Lindner, Dirk, Planitzer, Uwe, Hamerla, Gordian, Ziganshyna, Svitlana, Werdehausen, Robert, Struck, Manuel Florian, Schob, Bernd, Gaber, Khaled, Meixensberger, Jürgen, Hoffmann, Karl-Titus, Quäschling, Ulf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832548/
https://www.ncbi.nlm.nih.gov/pubmed/31658743
http://dx.doi.org/10.3390/jcm8101649
_version_ 1783466198898311168
author Schob, Stefan
Richter, Cindy
Scherlach, Cordula
Lindner, Dirk
Planitzer, Uwe
Hamerla, Gordian
Ziganshyna, Svitlana
Werdehausen, Robert
Struck, Manuel Florian
Schob, Bernd
Gaber, Khaled
Meixensberger, Jürgen
Hoffmann, Karl-Titus
Quäschling, Ulf
author_facet Schob, Stefan
Richter, Cindy
Scherlach, Cordula
Lindner, Dirk
Planitzer, Uwe
Hamerla, Gordian
Ziganshyna, Svitlana
Werdehausen, Robert
Struck, Manuel Florian
Schob, Bernd
Gaber, Khaled
Meixensberger, Jürgen
Hoffmann, Karl-Titus
Quäschling, Ulf
author_sort Schob, Stefan
collection PubMed
description Flow diversion (FD) is a novel endovascular technique based on the profound alteration of cerebrovascular hemodynamics, which emerged as a promising minimally invasive therapy for intracranial aneurysms. However, delayed post-procedural stroke remains an unexplained concern. A consistent follow-up-regimen has not yet been defined, but is required urgently to clarify the underlying cause of delayed ischemia. In the last two years, 223 patients were treated with six different FD devices in our center. We identified subacute, FD-induced segmental vasospasm (SV) in 36 patients as a yet unknown, delayed-type reaction potentially compromising brain perfusion to a critical level. Furthermore, 86% of all patients revealed significant SV approximately four weeks after treatment. In addition, 56% had SV with 25% stenosis, and 80% had additional neointimal hyperplasia. Only 13% exhibited SV-related high-grade stenosis. One of those suffered stroke due to prolonged SV, requiring neurocritical care and repeated intra-arterial (i.a.) biochemical angioplasty for seven days to prevent territorial infarction. Five patients suffered newly manifested, transient hemicrania accompanying a compensatorily increased ipsilateral leptomeningeal perfusion. One treated vessel obliterated permanently. Hence, FD-induced SV is a frequent vascular reaction after FD treatment, potentially causing symptomatic ischemia or even stroke, approximately one month post procedure. A specifically early follow-up-strategy must be applied to identify patients at risk for ischemia, requiring intensified monitoring and potentially anti-vasospastic treatment.
format Online
Article
Text
id pubmed-6832548
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-68325482019-11-25 Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm Schob, Stefan Richter, Cindy Scherlach, Cordula Lindner, Dirk Planitzer, Uwe Hamerla, Gordian Ziganshyna, Svitlana Werdehausen, Robert Struck, Manuel Florian Schob, Bernd Gaber, Khaled Meixensberger, Jürgen Hoffmann, Karl-Titus Quäschling, Ulf J Clin Med Article Flow diversion (FD) is a novel endovascular technique based on the profound alteration of cerebrovascular hemodynamics, which emerged as a promising minimally invasive therapy for intracranial aneurysms. However, delayed post-procedural stroke remains an unexplained concern. A consistent follow-up-regimen has not yet been defined, but is required urgently to clarify the underlying cause of delayed ischemia. In the last two years, 223 patients were treated with six different FD devices in our center. We identified subacute, FD-induced segmental vasospasm (SV) in 36 patients as a yet unknown, delayed-type reaction potentially compromising brain perfusion to a critical level. Furthermore, 86% of all patients revealed significant SV approximately four weeks after treatment. In addition, 56% had SV with 25% stenosis, and 80% had additional neointimal hyperplasia. Only 13% exhibited SV-related high-grade stenosis. One of those suffered stroke due to prolonged SV, requiring neurocritical care and repeated intra-arterial (i.a.) biochemical angioplasty for seven days to prevent territorial infarction. Five patients suffered newly manifested, transient hemicrania accompanying a compensatorily increased ipsilateral leptomeningeal perfusion. One treated vessel obliterated permanently. Hence, FD-induced SV is a frequent vascular reaction after FD treatment, potentially causing symptomatic ischemia or even stroke, approximately one month post procedure. A specifically early follow-up-strategy must be applied to identify patients at risk for ischemia, requiring intensified monitoring and potentially anti-vasospastic treatment. MDPI 2019-10-10 /pmc/articles/PMC6832548/ /pubmed/31658743 http://dx.doi.org/10.3390/jcm8101649 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schob, Stefan
Richter, Cindy
Scherlach, Cordula
Lindner, Dirk
Planitzer, Uwe
Hamerla, Gordian
Ziganshyna, Svitlana
Werdehausen, Robert
Struck, Manuel Florian
Schob, Bernd
Gaber, Khaled
Meixensberger, Jürgen
Hoffmann, Karl-Titus
Quäschling, Ulf
Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm
title Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm
title_full Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm
title_fullStr Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm
title_full_unstemmed Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm
title_short Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm
title_sort delayed stroke after aneurysm treatment with flow diverters in small cerebral vessels: a potentially critical complication caused by subacute vasospasm
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832548/
https://www.ncbi.nlm.nih.gov/pubmed/31658743
http://dx.doi.org/10.3390/jcm8101649
work_keys_str_mv AT schobstefan delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT richtercindy delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT scherlachcordula delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT lindnerdirk delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT planitzeruwe delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT hamerlagordian delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT ziganshynasvitlana delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT werdehausenrobert delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT struckmanuelflorian delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT schobbernd delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT gaberkhaled delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT meixensbergerjurgen delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT hoffmannkarltitus delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm
AT quaschlingulf delayedstrokeafteraneurysmtreatmentwithflowdivertersinsmallcerebralvesselsapotentiallycriticalcomplicationcausedbysubacutevasospasm