E-150 Anterior cerebral artery flow diversion: 10 years' experience. (23rd July 2022)

• Record Type: Journal Article
• Authors: Mahady, K; Coulthard, A
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A156
• Page End: A156
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.261
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Anterior cerebral and anterior communicating artery aneurysms are common and can be challenging to safely treat either endovascularly or surgically. Endovascular treatment strategy has evolved with flow diversion increasing in accessibility and diversity. We present our single centre experience over ten years, alongside outcomes and complications. Materials and Methods: All patients undergoing flow diversion as complete or part of treatment for anterior cerebral or anterior communicating artery aneurysm at Royal Brisbane and Women's Hospital (RBWH) between January 2012 and January 2022 were retrospectively identified from an interventional neuroradiology database. Demographic information as well as pre-operative medication prescription, Verify Now platelet responsiveness results (PRU) and technical data including access and stent type were collected. Procedural and routine follow up cross sectional or formal angiographic imaging performed at 3, 12 and 24 months as well as most recent imaging available in January 2022 was reviewed. Patients were contacted by telephone to assess current clinical status and modified Rankin score (mRs). Results: 354 anterior cerebral artery aneurysms in 317 patients with a median age of 57 years were treated at RBWH over 10 years. Of those, 79 were treated with stent assistance, and of those, 58 (73%) underwent flow diversion, with an early peak followed by reduction in incidence of flow diversion in the early phase of the study, and later growth after the introduction of newer devices. Occlusion rates at 2 years of follow up have not significantly changed over 10 years, with an average rate of 74% for complete occlusion and 13% partial occlusion. Our complication rate remains less than 5%. One patient died. Complications include silent caudate head infarct affecting approximately 1 in 3 patients, unchanged over time, and other ACA territory infarct (silent or symptomatic) affecting approximately 2% of patients. Inaccessible aneurysms have reduced in frequency over time, and procedural complexity has increased as collective operator experience has grown. Conclusion: Flow diversion remains a safe and effective option for treatment of anterior cerebral artery aneurysms, cognisant of an associated high rate of clinically 'silent' caudate head infarct. Disclosures: K. Mahady: None. A. Coulthard: None.