Variation of Mass Effect After Using a Flow Diverter With Adjunctive Coil Embolization for Symptomatic Unruptured Large and Giant Intracranial Aneurysms.

Zhongxiao Wang,Kun Wang,Xinjian Yang,Mingqi Zhang,Wei Zhu,Jian Liu,Zhongbin Tian,Ying Zhang,Wenqiang Li,Yisen Zhang,Jiejun Wang

doi:10.3389/fneur.2019.01191

Abstract

Background: Mass effect associated with large or giant aneurysms is an intractable problem for traditional endovascular treatments. Preventing recurrence of aneurysms requires dense coiling, which may aggravate the mass effect. However, the flow diverter (FD) is a new device that avoids the need for dense coiling. This study was performed to investigate whether use of FDs with adjunctive coil embolization can relieve the aneurysmal mass effect and to explore the factors that affect the variation of compressional symptoms.Methods: We retrospectively evaluated patients with compressional symptoms caused by unruptured aneurysms who underwent endovascular treatment with an FD with adjunctive coil embolization at our center from January 2015 to December 2017. Imaging follow-up included digital subtraction angiography (DSA) ranging from 11 to 14 months and magnetic resonance imaging (MRI) ranging from 24 to 30 months; the former was used to evaluate the intracavitary volume, and the latter was used to measure the variation of the mass effect. Follow-up physical examinations were performed to observe variations of symptoms.Results: In total, 22 patients with 22 aneurysms were treated by an FD combined with coil embolization. All 22 patients underwent the last clinical follow-up. Regarding compressional symptoms, 12 (54.54%) patients showed improvement, 6 (27.27%) were fully recovered, and 6 (27.27%) showed improvement but with incomplete cranial palsy. However, five (22.72%) patients showed no change, four (18.18%) showed worsening symptoms compared with their preoperative state, and one (4.55%) died of delayed rupture. Seventeen of the 22 patients underwent MRI. Of these 17 patients, the aneurysm shrank in 13 (76.47%) and no significant change occurred in 4 (23.53%). In the multivariate analysis, a short duration from symptom occurrence to treatment (p = 0.03) and younger patient age (p = 0.038) were statistically significant factors benefiting symptom improvement, and shrinkage of the aneurysm was associated with favorable clinical outcomes (p = 0.006).Conclusions: Use of the FD with adjunctive loose coil embolization might help to alleviate the compressional symptoms caused by intracranial aneurysms. Shrinkage of the aneurysm, a short duration of symptoms, and younger patient age might contribute to favorable outcomes of mass effect-related symptoms.

Highlights

Intracranial aneurysms are abnormal bulges of brain arteries that may rupture and bleed, leading to subarachnoid hemorrhage [1]
Patients were included in this study if their symptoms were related to mass effect caused by a saccular aneurysm of the anterior circulation and they had objective neurological signs, the symptomatic aneurysm did not rupture before treatment, they received interventional treatment by a Pipeline embolization device (PED) with adjunctive coil embolization, and their radiographic records included digital subtraction angiography (DSA)
We identified 227 patients who underwent endovascular treatment with a PED with adjunctive coil embolization for intracranial aneurysms from September 2015 to December 2017, among whom 22 patients with 22 aneurysms causing compressional symptoms were included in the present study (Table 1)

Summary

Introduction

Intracranial aneurysms are abnormal bulges of brain arteries that may rupture and bleed, leading to subarachnoid hemorrhage [1]. The classic intervention relies on coils for dense embolization in the aneurysmal sac, promoting thrombosis; if complete occlusion is achieved, the cranial palsy caused by the mass effect may become aggravated. FDs are woven stents constructed with high mesh density They promote aneurysm occlusion by endoluminal reconstruction of the parent artery and redirection of blood flow away from the aneurysm [5, 6]. This study was performed to determine whether aneurysms can shrink after treatment with a PED with adjunctive coil embolization and identify the predictive factors for recovery of compressional symptoms. This study was performed to investigate whether use of FDs with adjunctive coil embolization can relieve the aneurysmal mass effect and to explore the factors that affect the variation of compressional symptoms

Methods

Results

Conclusion