Evaluation of CTA,time-resolved 4D CE-MRA and DSA in the follow-up of an intracranial aneurysm treated with a flow diverter stent: Experience from a single case

Abstract

Endovascular treatment of giant, fusiform and dissecting aneurysms with flow diverter stents is becoming more and more popular. However, very few studies on the follow-up have been published. We describe a patient with a dissecting aneurysm of the right vertebral artery treated with flow diverter stent placement. The patient was followed up with CT angiography (CTA), time-resolved contrast-enhanced MR angiography (CE-MRA) and digital subtraction angiography (DSA). CTA had false negative results in two instances, whereas time-resolved CE-MRA and DSA were the most accurate in depicting the residual flow in the aneurysmal sac. However, in the case of DSA the demonstration of residual flow proved quite difficult and required a very thorough examination with oblique projections. Our 2.5-year experience with this patient led us to believe that time-resolved CE-MRA is a valuable tool in the follow-up of flow diverter-treated stents.

Keywords

Intracranial aneurysm flow diverter digital subtraction angiography CT angiography contrast-enhanced MR angiography

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References

Cirillo

Dall'olio

Princiotta

. The use of flow-diverting stents in the treatment of giant cerebral aneurysms: preliminary results. Neuroradiol J 2010; 23(2): 220–224.

Leonardi

Cirillo

Toni

. Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience. Interv Neuroradiol 2011; 17(3): 306–315.

Agid

Schaaf

Farb

. CE-MRA for follow-up of aneurysms post stent-assisted coiling. Interv Neuroradiol. 2012; 18(3): 275–283.

Toni

Marliani

Cirillo

. 3T MRI in the evaluation of brain aneurysms treated with flow-diverting stents: preliminary experience. Neuroradiol J 2009; 22(5): 588–599.

Boddu SR, Tong FC, Dehkharghani S. Contrast-enhanced time-resolved MRA for follow-up of intracranial aneurysms treated with the Pipeline embolization device. Am J Neuroradiol. 2014. doi: 10.3174/ajnr.A4008. [Epub ahead of print]. doi: 10.3174/ajnr.A4008.

Majoie

Sprengers

van Rooij

. MR angiography at 3T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils. Am J Neuroradiol 2005; 26(6): 1349–1356.

Lubicz

levivier

Sadeghi

. Immediate intracranial aneurysm occlusion after embolization with detachable coils: a comparison between MR angiography and intra-arterial digital subtraction angiography. J Neuroradiol 2007; 34(3): 190–197doi: 10.1016/j.neurad.2007.05.002.

Cirillo

Scomazzoni

Cirillo

. Comparison of 3D TOF-MRA and 3D CE-MRA at 3T for imaging of intracranial aneurysms. Eur J Radiol 2013; 82(12): e853–859doi: 10.1016/j.ejrad.2013.08.052.

Yamada

Hayashi

Murao

. Time-of-flight MR angiography targeted to coiled intracranial aneurysms is more sensitive to residual flow than is digital subtraction angiography. Am J Neuroradiol 2004; 25(7): 1154–1157.

10.

Agid

Willinsky

Lee

. Characterization of aneurysm remnants after endovascular treatment: contrast-enhanced MR angiography versus catheter digital subtraction angiography. Am J Neuroradiol 2008; 29(8): 1570–1574doi: 10.3174/ajnr.a1124.