Flow Diversion for ICA Aneurysms with Compressive Neuro-Ophthalmologic Symptoms: Predictors of Morbidity, Mortality, and Incomplete Aneurysm Occlusion

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Compressive Aneurysm study group - (Author)
  • Institute and Polyclinic of Diagnostic and Interventional Neuroradiology
  • University Hospital Carl Gustav Carus Dresden
  • TUD Dresden University of Technology
  • Université de Tours
  • Hôpital Maison Blanche
  • Ruhr University Bochum
  • Fresenius AG
  • University of Duisburg-Essen
  • University of Cologne
  • University of Göttingen
  • Otto von Guericke University Magdeburg
  • Center Hospitalo-Universitaire (CHU) de Toulouse
  • Université de Reims Champagne-Ardenne

Abstract

BACKGROUND AND PURPOSE: Flow diversion is an effective treatment for aneurysms of the ICA with compression-related neuro-ophthalmologic symptoms, especially when treatment is initiated early after symptom onset and aneurysm occlusion is complete. However, non-negligible complication rates have been reported. Our aim was to identify risk factors for morbidity/mortality and incomplete aneurysm occlusion. MATERIALS AND METHODS: We performed a secondary analysis of a previous publication, which included all patients treated with flow diversion for an unruptured aneurysm of the ICA with compression-related symptoms. RESULTS: Fifty-four patients with 54 aneurysms (48 women, 88.9%; mean age, 59.2 [SD, 15.9] years; range, 21–86 years) treated with flow diversion were included. We observed morbidity and mortality rates of 7.4% and 3.7%. Increasing age (OR per decade, 3.2; 95% CI, 1.23–8.49; P = .02) and dual-antiplatelet therapy with ticagrelor (OR, 13.9; 95% CI, 1.16–165.97; P = .04) were significantly associated with morbidity/mortality. After a median follow-up of 13.3 [SD, 10.5] months, the rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 74%, 14%, and 12%. Incomplete occlusion at follow-up was less frequently observed in aneurysms treated with additional coil embolization (OR, 0.1; 95% CI, 0.01–0.86; P = .04). CONCLUSIONS: Although a promising treatment for compressive ICA aneurysms, flow diversion carries a relevant risk for complications and incomplete aneurysm occlusion. Our results may help identify patients in which flow diversion may not be the ideal treatment method. Additional coil embolization increased the likelihood of complete aneurysm occlusion at follow-up.

Details

Original languageEnglish
Pages (from-to)998-1003
Number of pages7
JournalAmerican journal of neuroradiology
Volume43
Issue number7
Publication statusPublished - 1 Jul 2022
Peer-reviewedYes

External IDs

PubMed 35738674
ORCID /0000-0001-5258-0025/work/146644932