Flow Diversion after Aneurysmal Subarachnoid Hemorrhage

Sabareesh K Natarajan; Hussain Shallwani; Vernard S Fennell; Jeffrey S Beecher; Hakeem J Shakir; Jason M Davies; Kenneth V Snyder; Adnan H Siddiqui; Elad I Levy

doi:10.1016/j.nec.2017.02.011

Flow Diversion after Aneurysmal Subarachnoid Hemorrhage

Neurosurg Clin N Am. 2017 Jul;28(3):375-388. doi: 10.1016/j.nec.2017.02.011.

Authors

Sabareesh K Natarajan¹, Hussain Shallwani¹, Vernard S Fennell¹, Jeffrey S Beecher¹, Hakeem J Shakir², Jason M Davies², Kenneth V Snyder³, Adnan H Siddiqui⁴, Elad I Levy⁵

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Gates Vascular Institute, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; University at Buffalo, State University of New York, 875 Ellicott Street, 5th Floor, Buffalo, NY 14203, USA; Neurosurgical Stroke Service, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 3435 Main Street, Buffalo, NY 14214, USA; Neuroendovascular Services, Gates Vascular Institute, Kaleida Health, Buffalo, 100 High Street, Buffalo, NY, USA.
² Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Gates Vascular Institute, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; University at Buffalo, State University of New York, 875 Ellicott Street, 5th Floor, Buffalo, NY 14203, USA; Neurosurgical Stroke Service, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; The Jacobs Institute, 875 Ellicott Street, 5th Floor, Buffalo, NY 14203, USA; Toshiba Stroke & Vascular Research Center, University at Buffalo, State University of New York, 875 Ellicott Street, Buffalo, NY 14214, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 3435 Main Street, Buffalo, NY 14214, USA; Neuroendovascular Services, Gates Vascular Institute, Kaleida Health, Buffalo, 100 High Street, Buffalo, NY, USA.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Gates Vascular Institute, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; University at Buffalo, State University of New York, 875 Ellicott Street, 5th Floor, Buffalo, NY 14203, USA; Neurosurgical Stroke Service, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; Toshiba Stroke & Vascular Research Center, University at Buffalo, State University of New York, 875 Ellicott Street, Buffalo, NY 14214, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 3435 Main Street, Buffalo, NY 14214, USA; Neuroendovascular Services, Gates Vascular Institute, Kaleida Health, Buffalo, 100 High Street, Buffalo, NY, USA.
⁴ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Gates Vascular Institute, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; University at Buffalo, State University of New York, 875 Ellicott Street, 5th Floor, Buffalo, NY 14203, USA; Neurosurgical Stroke Service, Kaleida Health, 100 High Street, Buffalo, NY 14203, USA; The Jacobs Institute, 875 Ellicott Street, 5th Floor, Buffalo, NY 14203, USA; Toshiba Stroke & Vascular Research Center, University at Buffalo, State University of New York, 875 Ellicott Street, Buffalo, NY 14214, USA.
⁵ Toshiba Stroke & Vascular Research Center, University at Buffalo, State University of New York, 875 Ellicott Street, Buffalo, NY 14214, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 3435 Main Street, Buffalo, NY 14214, USA; Neuroendovascular Services, Gates Vascular Institute, Kaleida Health, Buffalo, 100 High Street, Buffalo, NY, USA. Electronic address: elevy@ubns.com.

PMID: 28600012
DOI: 10.1016/j.nec.2017.02.011

Abstract

Flow diversion after aneurysmal subarachnoid hemorrhage (SAH) is the last treatment option for aneurysm occlusion when other methods of aneurysm treatment cannot be used because of the need for dual antiplatelet therapy. The authors' general protocol for treatment selection after aneurysmal SAH is provided to share with readers our approach to securing the aneurysm before embarking flow diversion for primary treatment or delayed adjunctive treatment to primary coiling. The authors' experience with flow diversion after aneurysmal SAH, review of pertinent literature, and the future of flow diversion after aneurysmal SAH are discussed.

Keywords: Cerebral aneurysm; Flow diversion; Pipeline Embolization Device; Subarachnoid hemorrhage.

Publication types

Review

MeSH terms

Aged
Aneurysm, Ruptured / surgery*
Endovascular Procedures / instrumentation
Endovascular Procedures / methods*
Female
Humans
Intracranial Aneurysm / physiopathology
Intracranial Aneurysm / surgery*
Male
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use
Regional Blood Flow
Subarachnoid Hemorrhage / physiopathology
Subarachnoid Hemorrhage / surgery*
Young Adult

Substances

Platelet Aggregation Inhibitors