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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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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. |
format | Online Article Text |
id | pubmed-9209683 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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