Treatment of Extracranial Dissecting Pseudoaneurysms with Flow Diverters: A Single Center Experience

Andreas Simgen*, Umut Yilmaz, Christian Roth, Panagiotis Papanagiotou, Philipp Dietrich, Ruben Mühl-Benninghaus, Wolfgang Reith and Michael Kettner

Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany

^*Correspondance to: Andreas Simgen 

 PDF  Full Text DOI: 10.25107/2474-1647.3440

Abstract

Purpose: Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past decade. Despite the growing experience, treatment of extracranial dissection Pseudoaneurysms (PA) remains an off-label use and is limited to small case series in literature. Methods: Fourteen patients with 15 dissecting PA of the extracranial Internal Carotid Artery (ICA) and vertebral artery who were treated with FDs between 2011 and 2018 were examined retrospectively. Aneurysm occlusion, procedural complications, and clinical outcome were evaluated. Results: Angiographic follow-up was available for all patients with a mean long-term follow-up time of 17.4 ± 14.5 months. Aneurysms were located in the anterior (86.7%, n=13) and posterior (13.3%, n=2) circulation. Of the ICA, the C1 segment was predominant (53.3%, n=8). Aneurysm morphology was saccular (86.7%, n=13) and fusiform (13.3%, n=2). Adequate aneurysm occlusion (Kamran grade 3 and 4) at long-term follow-up was achieved in 93.3% (n=14). Symptoms of patients were: Headache (42.9%, n=6); Stroke (21.4%, n=3); Horner’s-Syndrome (7.1%, n=1); Vertigo (7.1%, n=1). Reported etiologies were spontaneous (71.4%, n=10), traumatic (21.4%, n=3) and iatrogenic (7.1%, n=1). Underlying dissecting stenosis was observed in 21.4% (n=3) with a mean of 69.1 ± 16.8% and decreased significantly at long-term follow-up (12.1 ± 21.0%; p=0.022). Asymptomatic thromboembolic event occurred in 7.1% (n=1). Retreatment was performed in 7.1% (n=1). There was no procedural morbidity or mortality. Conclusion: Treatment of extracranial dissection pseudoaneurysms using FDs is effective and safe. Further studies with larger case numbers are necessary to establish this treatment method in selected patients.

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Cite the article

Simgen A, Yilmaz U, Roth C, Papanagiotou P, Dietrich P, Mühl- Benninghaus R, et al. Treatment of Extracranial Dissecting Pseudoaneurysms with Flow Diverters: A Single Center Experience. Clin Surg. 2022; 7: 3440..