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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...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
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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 |
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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 |
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