Experience of implantation of flow-diverter in the acute period of aneurismatic intracranial hemorrhage

Abstract

In the period from 2013 to 2019 at the Scientific and Practical Center for Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine, implantation of flow-diverter in the acute period of aneurysmal intracranial hemorrhage was performed in six patients (4 (66.7 %) men and 2 (33.3 %) women. The average age was 50 years). Hemorrhage was diagnosed using multispiral computed tomography, aneurysm was verified using cerebral subtraction angiography according to Seldinger. In 3 cases the aneurysm was located on the internal carotid artery, in 2 cases – on V4-segment of the vertebral artery, in1 case – on A1-segment of the anterior cerebral artery. Five patients received a loading dose of double antiplatelet therapy before implantation of a flow-diverter (300 mg clopidogrel and 300 mg acetylsalicylic acid). One patient received dual antiplatelet therapy (75 mg clopidogrel and 75 mg acetylsalicylic acid) in five days before stent implantation. All patients after implantation of a flow-diverter received double antiplatelet therapy in a standard dose (75 mg clopidogrel and 75 mg acetylsalicylic acid). In five cases a FRED (Microvention - Terumo) flow-diverter was used and in one case – Pipeline (Medtronic). The diameter and length of the stent depended on the angioantomy of the aneurysm and the bearing artery. In two cases the implantation of a flow-diverter was accompanied by the implantation of micro coils into the cavity of the aneurysm, in four cases – as a single endovascular treatment technique. There were no complications in the early or late postoperative period. At the time of discharge on the Glasgow modified exit scale (GOSE) five patients had more than 5 points, one patient died (1 point) for reasons not related to the underlying disease. A control examination in the period from 6 to 12 month after implantation passed three patients, in all cases of aneurysm from the blood circulation is totally excluded.