Document Detail


Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment.
MedLine Citation:
PMID:  21071538     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: FD technology enables reconstructive repair of otherwise difficult-to-treat intracranial aneurysms. These stentlike devices may induce progressive aneurysm thrombosis without additional implants and may initiate complete reverse vessel remodeling. The associated vascular biologic processes are as yet only partially understood.
MATERIALS AND METHODS: From 12 different centers, 13 cases of delayed postprocedural aneurysm rupture were recorded and analyzed. Symptom, aneurysm location and morphology, and the time elapsed from treatment until rupture were analyzed.
RESULTS: There were 10 internal carotid and 3 basilar artery aneurysms. Mean aneurysm diameter was 22 ± 6 mm. Eleven patients were symptomatic before treatment. A single FD was used for all saccular aneurysms, while fusiform lesions were treated by using multiple devices. A supplementary loose coiling of the aneurysm was performed in 1 patient only. Ten patients developed early aneurysm rupture after FD treatment (mean, 16 days; range, 2-48 days); in 3 patients, rupture occurred 3-5 months after treatment. In all cases, most of the aneurysm cavity was thrombosed before rupture. The biologic mechanisms predisposing to rupture under these conditions are reviewed and discussed
CONCLUSIONS: FDs alone may modify hemodynamics in ways that induce extensive aneurysm thrombosis. Under specific conditions, however, instead of reverse remodeling and cicatrization, aggressive thrombus-associated autolysis of the aneurysm wall may result in delayed rupture.
Authors:
Z Kulcsár; E Houdart; A Bonafé; G Parker; J Millar; A J P Goddard; S Renowden; G Gál; B Turowski; K Mitchell; F Gray; M Rodriguez; R van den Berg; A Gruber; H Desal; I Wanke; D A Rüfenacht
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Publication Detail:
Type:  Journal Article     Date:  2010-11-11
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  32     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  20-5     Citation Subset:  IM    
Affiliation:
Department of Neuroradiology, Swiss Neuro Institute Hirslanden, Clinic Hirslanden, Zurich, Switzerland. zsolt.kulcsar@hirslanden.ch
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Comment In:
AJNR Am J Neuroradiol. 2011 Jan;32(1):26   [PMID:  21071535 ]

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