AI Article Synopsis
- Thromboembolic (TE) events, which can arise even with proper dual antiplatelet therapy, are serious complications following flow diversion (FD) procedures used to treat aneurysms, leading to significant morbidity and mortality.
- A study was conducted on 651 FD procedures in 591 patients from 2013 to 2023, revealing a TE event rate of 5.8%, with permanent deficits in 20 patients and 4 fatalities linked to vascular occlusions.
- Factors such as aspirin resistance, age, and aneurysm characteristics were identified as predictors for the occurrence of TE events, particularly highlighting the high morbidity associated with large-vessel occlusions in the middle cerebral artery.
Article Abstract
Objective: Thromboembolic (TE) events are among the most feared complications after flow diversion (FD) and have been reported to occur even with adequate dual antiplatelet therapy. Herein, the authors characterize thrombotic and embolic events that developed after FD, focusing on the morbidity of each of these events and the predisposing factors associated with their development.
Methods: A retrospective analysis of aneurysms treated with FD at a single institution in the US between 2013 and 2023 was performed. The authors documented the emergence of intraprocedural and postoperative TE events. A survival analysis and a Cox regression model was conducted to identify predictors associated with these events.
Results: The authors included 651 procedures performed in 591 patients to treat 746 aneurysms. TE events occurred in 38 of the procedures performed (5.8%), causing permanent deficit in 20 patients and death in 4 patients. Eleven cases presented with acute stent thrombosis, 11 with large-vessel occlusion, and 9 with perforator strokes. At a median follow-up of 9.5 months, 73.0% of patients with an ischemic event had a modified Rankin Scale score ≤ 2. Three of the deaths were secondary to occlusion at the basilar trunk and vertebral artery. In patients with TE events in the anterior circulation, 7 of 11 patients with middle cerebral artery occlusion and 9 of 12 patients with internal carotid artery occlusion achieved independence. Time-to-event Cox regression analysis demonstrated that TE events were more frequent in patients exhibiting aspirin resistance (hazard ratio 2.66; 95% CI 1.10-6.70).
Conclusions: TE events after FD result from multiple factors, including age, aneurysm characteristics, aneurysm location, antiplatelet resistance, and procedural factors. In our cohort, we found the highest morbidity for patients with TE events presenting with large-vessel occlusion at the middle cerebral artery, and vertebrobasilar system.
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| http://dx.doi.org/10.3171/2024.5.JNS24476 | DOI Listing |
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