• World Neurosurg · Jul 2024

    Thromboembolic Events after the Coverage of Anterior Cerebral Artery with Flow Diversion: A Single Institution Series and Systematic Review.

    • Felipe Ramirez-Velandia, Alejandro Enriquez-Marulanda, Michael Young, Eduardo Orrego-González, Jean Filo, Thomas B Fodor, Daniel Sconzo, Max Shutran, Christopher S Ogilvy, and Philipp Taussky.
    • Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: felipegolframirez@gmail.com.
    • World Neurosurg. 2024 Jul 1; 187: e1040e1053e1040-e1053.

    BackgroundAdvances in the use of flow diversion (FD) now extend to bifurcation aneurysms; herein, we compare thromboembolic events in patients with internal carotid artery (ICA) aneurysms treated with and without exclusion of the anterior cerebral artery (ACA).MethodsRetrospective analysis of aneurysms in the terminal ICA treated with FD from 2013 to 2023 at a single-center study. Procedures were classified according to the coverage at the origin of the ACA and compared through bivariate-analysis. A review was also carried on PubMed, Web of Science, and EMBASE until April 2024, adhering to the PRISMA reporting guidelines.ResultsNinety-five patients harboring 113 aneurysms treated in 102 procedures were evaluated. Fifty-eight were treated covering the ACA origin. Dual antiplatelet regimens included aspirin-clopidogrel (50%), aspirin-ticagrelor (44.1%), and aspirin-prasugrel (4.9%). Thromboembolic events occurred in 6 patients (5.9%), all of which presented with large vessel occlusion of the ICA, but without reaching statistical difference in the 2 treated cohorts (P = 0.46). At a median clinical follow-up of 5.95 months, there were no differences in the functional outcomes in the 2 groups (P = 0.22). Contralateral angiographic runs post-treatment after covering the ACA origin demonstrated increase in the A1 (median: 0.45 mm; IQR = 0.4-1.2) and ICA diameter (median: 0.55 mm; IQR = 0.1-1.2). After pooling data from literature and our cohort, complete side branch occlusion after the coverage of ACA was seen in 25% of branches (95%CI = 0.16-0.36), and thromboembolic events were observed after 3% (95%CI = 0.01-0.04) of procedures.ConclusionsThromboembolic events can occur in distal ICA aneurysms treated with FD, but no significant association was seen with covering the ACA origin.Copyright © 2024 Elsevier Inc. All rights reserved.

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