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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
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Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Richter, Cindy
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Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Scherlach, Cordula
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Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Lindner, Dirk
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Univ Hosp Leipzig, Dept Neurosurg, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Planitzer, Uwe
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Univ Hosp Leipzig, Dept Neurosurg, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Hamerla, Gordian
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Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Ziganshyna, Svitlana
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Univ Hosp Leipzig, Dept Anaesthesiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Werdehausen, Robert
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Univ Hosp Leipzig, Dept Anaesthesiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Struck, Manuel Florian
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Univ Hosp Leipzig, Dept Anaesthesiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Schob, Bernd
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机构:
Tech Univ Chemnitz, Dept Lightweight Struct & Polymers, D-09126 Chemnitz, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Gaber, Khaled
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机构:
Univ Hosp Leipzig, Dept Neurosurg, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Meixensberger, Juergen
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h-index: 0
机构:
Univ Hosp Leipzig, Dept Neurosurg, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Hoffmann, Karl-Titus
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Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany

Quaeschling, Ulf
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h-index: 0
机构:
Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany Univ Hosp Leipzig, Dept Neuroradiol, D-04103 Leipzig, Germany
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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Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Dept Neurol, Glostrup, Denmark Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Danish Headache Ctr, Glostrup, Denmark

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Olinger, Anne Christine Rye
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Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Danish Headache Ctr, Glostrup, Denmark
Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Dept Neurol, Glostrup, Denmark Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Danish Headache Ctr, Glostrup, Denmark

de Koning, Patrick J. H.
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Leiden Univ, Med Ctr, Dept Radiol, Div Image Proc, Leiden, Netherlands Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Danish Headache Ctr, Glostrup, Denmark

Larsson, Henrik B. W.
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Univ Copenhagen, Fac Hlth & Med Sci, Rigshosp, Funct Imaging Unit,Dept Clin Physiol Nucl Med & P, Glostrup, Denmark Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Danish Headache Ctr, Glostrup, Denmark

Ashina, Messoud
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Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Danish Headache Ctr, Glostrup, Denmark
Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Dept Neurol, Glostrup, Denmark Univ Copenhagen, Rigshosp Glostrup, Fac Hlth & Med Sci, Danish Headache Ctr, Glostrup, Denmark
[10]
Is there an association between flow diverter fish mouthing and delayed-type hypersensitivity to metals?-a case-control study
[J].
Kocer, Naci
;
Mondel, Prabath Kumar
;
Yamac, Elif
;
Kavak, Ayse
;
Kizilkilic, Osman
;
Islak, Civan
.
NEURORADIOLOGY,
2017, 59 (11)
:1171-1178

Kocer, Naci
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Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey

Mondel, Prabath Kumar
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Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey

Yamac, Elif
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Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey

Kavak, Ayse
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机构:
Bakirkoy Dr Sadi Konuk Training & Res Hosp, Dept Dermatol, Tevfik Saglam Cad 11,Zuhuratbaba Mah, TR-34147 Bakirkoy Istanbul, Turkey Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey

Kizilkilic, Osman
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Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey

Islak, Civan
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h-index: 0
机构:
Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey Istanbul Univ, Cerrahpasa Med Fac, Div Neuroradiol, Dept Radiol, TR-34098 Istanbul, Turkey