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

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 stu...

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Autores principales: Alpay, Kemal, Hinkka, Tero, Lindgren, Antti E, Isokangas, Juha-Matti, Raj, Rahul, Parkkola, Riitta, Sinisalo, Matias, Numminen, Jussi, Pienimäki, Juha-Pekka, Saari, Petri, Seppänen, Janne, Palosaari, Kari, Rautio, Riitta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209683/
https://www.ncbi.nlm.nih.gov/pubmed/34266906
http://dx.doi.org/10.1136/neurintsurg-2021-017641
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author Alpay, Kemal
Hinkka, Tero
Lindgren, Antti E
Isokangas, Juha-Matti
Raj, Rahul
Parkkola, Riitta
Sinisalo, Matias
Numminen, Jussi
Pienimäki, Juha-Pekka
Saari, Petri
Seppänen, Janne
Palosaari, Kari
Rautio, Riitta
author_facet Alpay, Kemal
Hinkka, Tero
Lindgren, Antti E
Isokangas, Juha-Matti
Raj, Rahul
Parkkola, Riitta
Sinisalo, Matias
Numminen, Jussi
Pienimäki, Juha-Pekka
Saari, Petri
Seppänen, Janne
Palosaari, Kari
Rautio, Riitta
author_sort Alpay, Kemal
collection PubMed
description 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.
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spelling pubmed-92096832022-07-08 Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms Alpay, Kemal Hinkka, Tero Lindgren, Antti E Isokangas, Juha-Matti Raj, Rahul Parkkola, Riitta Sinisalo, Matias Numminen, Jussi Pienimäki, Juha-Pekka Saari, Petri Seppänen, Janne Palosaari, Kari Rautio, Riitta J Neurointerv Surg Hemorrhagic Stroke 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. BMJ Publishing Group 2022-07 2021-07-15 /pmc/articles/PMC9209683/ /pubmed/34266906 http://dx.doi.org/10.1136/neurintsurg-2021-017641 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://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/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Hemorrhagic Stroke
Alpay, Kemal
Hinkka, Tero
Lindgren, Antti E
Isokangas, Juha-Matti
Raj, Rahul
Parkkola, Riitta
Sinisalo, Matias
Numminen, Jussi
Pienimäki, Juha-Pekka
Saari, Petri
Seppänen, Janne
Palosaari, Kari
Rautio, Riitta
Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms
title Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms
title_full Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms
title_fullStr Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms
title_full_unstemmed Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms
title_short Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms
title_sort finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms
topic Hemorrhagic Stroke
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209683/
https://www.ncbi.nlm.nih.gov/pubmed/34266906
http://dx.doi.org/10.1136/neurintsurg-2021-017641
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