Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Kemal Alpay, Tero Hinkka, Antti E. Lindgren, Juha Matti Isokangas, Rahul Raj, Riitta Parkkola, Matias Sinisalo, Jussi Numminen, Juha Pekka Pienimäki, Petri Saari, Janne Seppänen, Kari Palosaari, Riitta Rautio

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Abstract

Background: Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date. Methods: This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate. Results: 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102). Conclusions: FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.

Original languageEnglish
JournalJOURNAL OF NEUROINTERVENTIONAL SURGERY
Volume14
Issue number7
Early online dateJul 2021
DOIs
Publication statusPublished - 2022
Publication typeA1 Journal article-refereed

Keywords

  • Aneurysm
  • Flow Diverter
  • Hemorrhage
  • Stroke
  • Subarachnoid

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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