Introduction: Devastating intraparenchymal hemorrhage has been associated with the use of flow-diverting stents (FDS) for the treatment of intracranial aneurysms. One hypothesized mechanism is the rapid reduction of hemodynamic capacitance caused by FDS placement. The objective of this study was to evaluate whether treatment utilizing FDS leads to altered intracranial arterial pressure dynamics.
Methods: Data were prospectively collected on consecutive patients undergoing FDS treatment of un-ruptured internal carotid artery (ICA) aneurysms involving the cavernous through communicating segments. Arterial pressures were obtained from 3 peri-aneurysmal locations through microcatheter pressure measurements before and after FDS deployment. Peripheral arterial pressures were simultaneously obtained to control for systemic blood pressure variations.
Results: Measurements of arterial pressures were successful in all 14 patients; mean aneurysm size was 10±4 mm. Following FDS deployment, the change in pressure across the aneurysm neck (delta p) significantly decreased as evaluated by systolic pressure, pulse pressure, and mean arterial pressure (all p<0.05). Larger aneurysm size was correlated with a greater delta p of both systolic pressure and pulse pressure after FDS placement (Spearman’s rho 0.49 and 0.45, p<0.10 respectively). Despite these intracranial pressure changes, no significant systemic pressure fluctuations were detected.
Conclusions: Aneurysm treatment with FDS was associated with significant alterations in ICA hemodynamics. The decreased pressure differential across the aneurysm neck following FDS placement suggests diminished hemodynamic capacitance, which may lead to capillary hyperperfusion and increased risk of intraparenchymal hemorrhage.
Patient Care: Understand and diagnose the risk factors for intraparenchymal hemorrhage following flow-diverting stent treatment.
Learning Objectives: To better understand the intracranial hemodynamics following flow-diverting stent therapy