DOI QR코드

DOI QR Code

Retreatment of a recurrent giant aneurysm of the internal carotid artery after treatment with a flow-diverting stent

  • Ginam Kim (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Junhyung Kim (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sang Kyu Park (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Joonho Chung (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2022.06.15
  • Accepted : 2022.09.30
  • Published : 2023.06.30

Abstract

Flow-diverting stents (FDSs) have proven advantageous for the treatment of large, fusiform, and dissecting aneurysms that are otherwise difficult to treat. Retreatment strategies for recurrent large or giant aneurysms after FDSs are limited to overlapping implantation of an additional FDS or definitive occlusion of the parent vessel. We report a recurrent giant aneurysm that was initially treated with an FDS with coils and was successfully treated with an additional FDS. Visual symptoms due to the mass effect of the recurrent aneurysm were completely resolved, and follow-up digital subtraction angiography revealed complete obliteration of the aneurysm. Additional FDS implantation for the retreatment of incompletely occluded aneurysms after the initial FDS treatment may be feasible and safe. Further studies are required to validate these results.

Keywords

References

  1. Brinjikji W, Lanzino G, Cloft H, Siddiqui A, Boccardi E, Cekirge S, et al. Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms: results from the IntrePED study. Am J Neuroradiol. 2016 Sep;37(9):1673-8. 
  2. Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke. 2013;44(2):442-7. 
  3. Carneiro A, Rane N, Kuker W, Cellerini M, Corkill R, Byrne JV. Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents. Neuroradiology. 2014 Jan;56(1):51-8. 
  4. Daou B, Atallah E, Chalouhi N, Starke RM, Oliver J, Montano M, et al. Aneurysms with persistent filling after failed treatment with the pipeline embolization device. J Neurosurg. 2018 Apr;1-7. 
  5. Fang Y-B, Lin A, Kostynskyy A, Agid R, Tymianski M, Radovanovic I, et al. Endovascular treatment of intracranial vertebrobasilar artery dissecting aneurysms: parent artery occlusion versus flow diverter. Eur J Radiol. 2018 Feb;99:68-75. 
  6. Goertz L, Hesse N, Liebig T, Ahmad W, Abdullayev N, Krischek B, et al. Retreatment strategies for recurrent and residual aneurysms after treatment with flow-diverter devices. Neuroradiology. 2020 Aug;62(8):1019-28. 
  7. Halbach VV, Higashida RT, Dowd CF, Barnwell SL, Fraser KW, Smith TP, et al. The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg. 1994 Apr;80(4):659-66. 
  8. King B, Vaziri S, Singla A, Fargen KM, Mocco J. Clinical and angiographic outcomes after stent-assisted coiling of cerebral aneurysms with Enterprise and Neuroform stents: a comparative analysis of the literature. J Neurointerv Surg. 2015 Dec;7(12):905-9. 
  9. Lv X, Yang H, Liu P, Li Y. Flow-diverter devices in the treatment of intracranial aneurysms: a meta-analysis and systematic review. Neuroradiol J. 2016 Feb;29(1):66-71. 
  10. Muskens IS, Hertgers O, Lycklama a Nijeholt GJ, Broekman ML, Moojen WA. Outcomes of retreatment for intracranial aneurysms-a meta-analysis. Neurosurgery. 2019 Dec;85(6):750-61. 
  11. Oishi H, Teranishi K, Yatomi K, Fujii T, Yamamoto M, Arai H. Flow diverter therapy using a pipeline embolization device for 100 unruptured large and giant internal carotid artery aneurysms in a single center in a Japanese population. Neurol Med Chir (Tokyo). 2018 Nov;58(11):461. 
  12. Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, et al. Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke. 2010 Jan;41(1):110-5. 
  13. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003 Jun;34(6):1398-403. 
  14. Rouchaud A, Leclerc O, Benayoun Y, Saleme S, Camilleri Y, d'Argento F, et al. Visual outcomes with flow-diverter stents covering the ophthalmic artery for treatment of internal carotid artery aneurysms. Am J Neuroradiol. 2015 Feb;36(2):330-6. 
  15. Shapiro M, Becske T, Nelson PK. Learning from failure: persistence of aneurysms following pipeline embolization. J Neurosurg. 2017 Feb;126(2):578-85. 
  16. Zhu D, Yan Y, Zhao P, Duan G, Zhao R, Liu J, et al. Safety and efficacy of flow diverter treatment for blood blister-like aneurysm: a systematic review and meta-analysis. World Neurosurg. 2018 Oct;118:e79-86.