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Determinants of intracranial aneurysm retreatment following embolization with a single flow-diverting stent.
Vranic, Justin E; Harker, Pablo; Stapleton, Christopher J; Regenhardt, Robert W; Dmytriw, Adam A; Alotaibi, Naif M; Gupta, Rajiv; Leslie-Mazwi, Thabele M; Koch, Matthew J; Raymond, Scott B; Mascitelli, Justin R; Patterson, T Tyler; Seinfeld, Joshua; White, Andrew; Case, David; Roark, Christopher; Gandhi, Chirag D; Al-Mufti, Fawaz; Cooper, Jared; Patel, Aman B.
Afiliación
  • Vranic JE; Department of Radiology, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Harker P; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Stapleton CJ; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Regenhardt RW; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Dmytriw AA; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Alotaibi NM; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Gupta R; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Leslie-Mazwi TM; Department of Radiology, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Koch MJ; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Raymond SB; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, USA.
  • Mascitelli JR; Department of Neurosurgery, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, USA.
  • Patterson TT; Department of Radiology, 2090University of Vermont Medical Center, University of Vermont Medical Center, USA.
  • Seinfeld J; Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Long School of Medicine, USA.
  • White A; Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Long School of Medicine, USA.
  • Case D; Department of Neurosurgery, University of Colorado, USA.
  • Roark C; Department of Neurosurgery, University of Colorado, USA.
  • Gandhi CD; Department of Neurosurgery, University of Colorado, USA.
  • Al-Mufti F; Department of Neurosurgery, University of Colorado, USA.
  • Cooper J; Department of Neurosurgery, 8138Westchester Medical Center, 8138Westchester Medical Center, USA.
  • Patel AB; Department of Neurosurgery, 8138Westchester Medical Center, 8138Westchester Medical Center, USA.
Neuroradiol J ; 35(4): 461-467, 2022 Aug.
Article en En | MEDLINE | ID: mdl-34747246
ABSTRACT

PURPOSE:

Flow diverting stents have revolutionized the treatment of intracranial aneurysms through endoluminal reconstruction of the parent vessel. Despite this, certain aneurysms require retreatment. The purpose of this study was to identify clinical and radiologic determinants of aneurysm retreatment following flow diversion.

METHODS:

A multicenter flow diversion database was evaluated to identify patients presenting with an unruptured, previously untreated aneurysm with a minimum of 12 months' clinical and angiographic follow-up. Univariate and multivariate logistic regression modeling was performed to identify determinants of retreatment.

RESULTS:

We identified 189 aneurysms treated in 189 patients with a single flow-diverting stent. Mean age was 54 years, and 89% were female. Complete occlusion was achieved in 70.3% and 83.6% of patients at six and 12 months, respectively. Aneurysm retreatment with additional flow-diverting stents occurred in 5.8% of cases. Univariate analysis revealed that dome diameter ≥10 mm (p = 0.012), pre-clinoid internal carotid artery location (p = 0.012), distal > proximal parent vessel diameter (p = 0.042), and later dual antiplatelet therapy (DAPT) discontinuation (p < 0.001) were predictive of retreatment. Multivariate analysis identified discontinuation of DAPT >12 months (p = 0.003) as a strong determinant of retreatment with dome diameter ≥10 mm trending toward statistical significance (p = 0.064). Large aneurysm neck diameter, presence of aneurysm branch vessels, patient age, smoking history, and hypertension were not determinant of retreatment on multivariate analysis.

CONCLUSIONS:

Prolonged DAPT is the most important determinant of aneurysm retreatment following single-device flow diversion. Abbreviating DAPT duration to only six months should be a consideration in this population, especially for patients with a large aneurysm dome diameter.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Aneurisma Intracraneal / Embolización Terapéutica / Procedimientos Endovasculares Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Neuroradiol J Año: 2022 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Aneurisma Intracraneal / Embolización Terapéutica / Procedimientos Endovasculares Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Neuroradiol J Año: 2022 Tipo del documento: Article