Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm

被引:14
作者
Schob, Stefan [1 ]
Richter, Cindy [1 ]
Scherlach, Cordula [1 ]
Lindner, Dirk [2 ]
Planitzer, Uwe [2 ]
Hamerla, Gordian [1 ]
Ziganshyna, Svitlana [3 ]
Werdehausen, Robert [3 ]
Struck, Manuel Florian [3 ]
Schob, Bernd [4 ]
Gaber, Khaled [2 ]
Meixensberger, Juergen [2 ]
Hoffmann, Karl-Titus [1 ]
Quaeschling, Ulf [1 ]
机构
[1] Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany
[2] Univ Hosp Leipzig, Dept Neurosurg, D-04103 Leipzig, Germany
[3] Univ Hosp Leipzig, Dept Anaesthesiol, D-04103 Leipzig, Germany
[4] Tech Univ Chemnitz, Dept Lightweight Struct & Polymers, D-09126 Chemnitz, Germany
关键词
flow diversion; delayed ischemia; stroke; vasospasm; hemodynamic therapy; cerebral aneurysm; PIPELINE EMBOLIZATION DEVICE; STENT;
D O I
10.3390/jcm8101649
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Flow diversion (FD) is a novel endovascular technique based on the profound alteration of cerebrovascular hemodynamics, which emerged as a promising minimally invasive therapy for intracranial aneurysms. However, delayed post-procedural stroke remains an unexplained concern. A consistent follow-up-regimen has not yet been defined, but is required urgently to clarify the underlying cause of delayed ischemia. In the last two years, 223 patients were treated with six different FD devices in our center. We identified subacute, FD-induced segmental vasospasm (SV) in 36 patients as a yet unknown, delayed-type reaction potentially compromising brain perfusion to a critical level. Furthermore, 86% of all patients revealed significant SV approximately four weeks after treatment. In addition, 56% had SV with 25% stenosis, and 80% had additional neointimal hyperplasia. Only 13% exhibited SV-related high-grade stenosis. One of those suffered stroke due to prolonged SV, requiring neurocritical care and repeated intra-arterial (i.a.) biochemical angioplasty for seven days to prevent territorial infarction. Five patients suffered newly manifested, transient hemicrania accompanying a compensatorily increased ipsilateral leptomeningeal perfusion. One treated vessel obliterated permanently. Hence, FD-induced SV is a frequent vascular reaction after FD treatment, potentially causing symptomatic ischemia or even stroke, approximately one month post procedure. A specifically early follow-up-strategy must be applied to identify patients at risk for ischemia, requiring intensified monitoring and potentially anti-vasospastic treatment.
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页数:19
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