AI Article Synopsis
- Flow diverter (FD) devices are effective for treating wide-necked intracranial aneurysms, but concerns exist about the health of arterial branches obstructed by the stent.
- A study followed 18 patients with jailed middle cerebral artery branches after FD treatment, finding that 65% of aneurysms were completely occluded after a median of 35 months.
- Magnetic resonance perfusion (MRP) data showed notable perfusion changes in jailed branches, although they were not usually linked to clinical symptoms, suggesting FD treatment is generally safe.
Article Abstract
Background: Flow diverter (FD) devices provide a safe and effective treatment option especially for wide-necked intracranial aneurysms. One of the main concerns in patients treated with FD devices is patency of arterial branches jailed by the stent. However, there are no long-term data from magnetic resonance perfusion (MRP) studies regarding jailed branches. In this study we aimed to reveal the MRP findings in patients with jailed middle cerebral artery (MCA) cortical branches during long-term follow-up after flow diversion.
Methods: Patients who underwent FD stent treatment for MCA aneurysms with a resulting jailed cortical branch were included. Follow-up clinical, angiographic, and MRP examination findings were recorded. Different MRP parameters were measured in the MCA territory regarding the jailed branches.
Results: Eighteen patients treated endovascularly with flow diversion for a total of 20 MCA aneurysms were included. At angiographic follow-up (median 35 months, range 7-95 months) complete occlusion was observed in 13 (65%) aneurysms and partial occlusion was observed in 6 (30%). The mean transit time (MTT) prolongation, MTT ratio, time-to peak (TTP) prolongation, and TTP ratio were 1.34, 1.20, 1.18, and 1.06 s, respectively, when compared with the contralateral side in the MCA territory. MTT, TTP, and cerebral blood volume values of the patients showed statistically significant differences compared with the contralateral side (P<0.05).
Conclusions: Flow diversion treatment of complex bifurcation aneurysms can be effective and safe. MRP examination may reveal perfusion changes in the territory vascularized via a jailed branch, and these changes are rarely accompanied by clinical findings.
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| http://dx.doi.org/10.1136/jnis-2023-020124 | DOI Listing |
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