Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2021; 08(01): 052-056
DOI: 10.1055/s-0039-1693501
Brief Report

Periprocedural Management during Placement of Flow Diverters in Intracranial Aneurysms: A Clinical Report and Review of Literature

Rajeeb K. Mishra
1   Department of Neuroanaesthesiology and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
,
Charu Mahajan
2   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Indu Kapoor
2   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Hemanshu Prabhakar
2   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Placement of flow diverter (FD) is an endovascular technique where the flow to the aneurysm is directed away from the aneurysmal sac using a stent in the parent vessel. In this clinical report, the authors share their institutional experience pertaining to clinical course of patients with intracranial aneurysm requiring placement of FD.

Methods After approval from institute ethics committee (IEC), the authors retrospectively studied all patients who underwent placement of FD for intracranial aneurysms from January 2014 to December 2017. Data regarding patient demographics, presenting complaints, aneurysm details, anesthesia technique, and intra- and postprocedural complications were noted. Duration of hospital stay, neurological outcome as measured by Glasgow outcome scale (GOS) at discharge and at 6 months was noted. Data are presented as median (range) or number (%).

Results Over a period of 3 years, 22 patients underwent FD placement. Two patients had subarachnoid hemorrhage (SAH) at the time of presentation, and the rest had unruptured aneurysms. All patients received general anesthesia (GA) for the procedure, and intravenous propofol was used for induction of anesthesia. Majority of the patients received sevoflurane and nitrous oxide combination for maintenance of anesthesia (20/22 [91%]). Five patients were not extubated at the end of the procedure. The most common indication for mechanical ventilation was delayed reversal because of hypothermia. At 6 months of follow-up, GOS was 5 in 18 patients. None of the patients developed any delayed complications related to FD and were neurologically intact.

Conclusions The use of FD for the treatment of aneurysms is a safe option. GA was used for carrying out procedure in all patients. The neurological outcome was good in all patients who were followed at 6 months.

Keywords

flow diverter - anesthetic management - intracranial aneurysms


Publication History

Article published online:
04 August 2019

© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ. A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke 2007; 38 (08) 2346-2352
    CrossrefPubMedGoogle Scholar
  • 2 Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ. A second-generation, endoluminal, flow-disrupting device for treatment of saccular aneurysms. Am J Neuroradiol 2009; 30 (06) 1153-1158
    CrossrefPubMedGoogle Scholar
  • 3 Arrese I, Sarabia R, Pintado R, Delgado-Rodriguez M. Flow-diverter devices for intracranial aneurysms: systematic review and meta-analysis. Neurosurgery 2013; 73 (02) 193-199 ,discussion199–200
    CrossrefPubMedGoogle Scholar
  • 4 Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke 2013; 44 (02) 442-447
    CrossrefPubMedGoogle Scholar
  • 5 Cagnazzo F, di Carlo DT, Cappucci M, Lefevre PH, Costalat V, Perrini P. Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis. Am J Neuroradiol 2018; 39 (09) 1669-1675
    CrossrefPubMedGoogle Scholar
  • 6 Bhogal P, Martinez Moreno R, Ganslandt O, Bäzner H, Henkes H, Perez MA. Use of flow diverters in the treatment of unruptured saccular aneurysms of the anterior cerebral artery. J Neurointerv Surg 2017; 9 (03) 283-289
    CrossrefPubMedGoogle Scholar
  • 7 Briganti F, Leone G, Cirillo L, de Divitiis O, Solari D, Cappabianca P. Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center. Neurosurg Focus 2017; 42 (06) E3
    CrossrefPubMedGoogle Scholar
  • 8 Griessenauer CJ, Shallwani H, Adeeb N. et al. Conscious sedation versus general anesthesia for the treatment of cerebral aneurysms with flow diversion: a matched cohort study. World Neurosurg 2017; 102: 1-5
    CrossrefPubMedGoogle Scholar
  • 9 Zanaty M, Daou B, Chalouhi N. et al. Same-day discharge after treatment with the pipeline embolization device using monitored anesthesia care. World Neurosurg 2016; 96: 31-35
    CrossrefPubMedGoogle Scholar
  • 10 Rummel C, Zubler C, Schroth G. et al. Monitoring cerebral oxygenation during balloon occlusion with multichannel NIRS. J Cereb Blood Flow Metab 2014; 34 (02) 347-356
    CrossrefPubMedGoogle Scholar
  • 11 Rajah G, Narayanan S, Rangel-Castilla L. Update on flow diverters for the endovascular management of cerebral aneurysms. Neurosurg Focus 2017; 42 (06) E2
    CrossrefPubMedGoogle Scholar
  • 12 Chiu AH, Ramesh R, Wenderoth J, Davies M, Cheung A. Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms. J Neurointerv Surg 2017; 9 (05) e18
    CrossrefPubMedGoogle Scholar
  • 13 Girdhar G, Li J, Kostousov L, Wainwright J, Chandler WL. In-vitro thrombogenicity assessment of flow diversion and aneurysm bridging devices. J Thromb Thrombolysis 2015; 40 (04) 437-443
    CrossrefPubMedGoogle Scholar
  • 14 Al-Mufti F, Cohen ER, Amuluru K. et al. Bailout strategies and complications associated with the use of flow-diverting stents for treating intracranial aneurysms. Intervent Neurol 2019; 8: 38-54
    CrossrefPubMedGoogle Scholar
  • 15 Turk III AS, Martin RH, Fiorella D, Mocco J, Siddiqui A, Bonafe A. Flow diversion versus traditional endovascular coiling therapy: design of the prospective LARGE aneurysm randomized trial. Am J Neuroradiol 2014; 35 (07) 1341-1345
    CrossrefPubMedGoogle Scholar
  • 16 Hammoud D, Gailloud P, Olivi A, Murphy KJ. Acute vasogenic edema induced by thrombosis of a giant intracranial aneurys a cause of pseudostroke after therapeutic occlusion of the parent vessel. Am J Neuroradiol 2003; 24 (06) 1237-1239
    PubMedGoogle Scholar
  • 17 Berge J, Tourdias T, Moreau J-F, Barreau X, Dousset V. Perianeurysmal brain inflammation after flow-diversion treatment. Am J Neuroradiol 2011; 32 (10) 1930-1934
    CrossrefPubMedGoogle Scholar
  • 18 Saatci I, Yavuz K, Ozer C, Geyik S, Cekirge HS. Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. Am J Neuroradiol 2012; 33 (08) 1436-1446
    CrossrefPubMedGoogle Scholar
  • 19 Raymond J, Gentric JC, Darsaut TE. et al. Flow diversion in the treatment of aneurysms: a randomized care trial and registry. J Neurosurg 2017; 127 (03) 454-462
    CrossrefPubMedGoogle Scholar
  • 20 Rouchaud A, Brinjikji W, Lanzino G, Cloft HJ, Kadirvel R, Kallmes DF. Delayed hemorrhagic complications after flow diversion for intracranial aneurysms: a literature overview. Neuroradiology 2016; 58 (02) 171-177
    CrossrefPubMedGoogle Scholar