Introduction: Fusiform intracranial aneurysms are difficult to treat due to the circumferential nature of the diseased segment. Treatments can be divided into deconstructive (surgical trapping or endovascular embolization) or reconstructive (surgical wrapping or endovascular flow diversion). Endovascular occlusion typically requires a long segment of coiling for complete cessation of flow. We report the use of a vascular plug for focal vessel occlusion in fusiform aneurysms.
Methods: We retrospectively reviewed patients treated with the Microvascular Plug (MVP, Medtronic, Dublin Ireland) for aneurysms. In addition, we located 6 control patients who underwent coiling alone for vertebral artery occlusion for aneurysm treatment. The number of implants and fluoroscopy time were compared using an unpaired t-test.
Results: 11 patients were identified with 12 vessel occlusions. 8 of these were for vertebral artery dissecting aneurysms. The remaining cases were: A1 dissecting aneurysm, giant ICA aneurysm, and basilar aneurysm. 8 presented with SAH, 2 with brainstem compression, and one incidental. In 6 arteries, the site of occlusion was distal to PICA, and all PICAs remained patent on immediate of follow-up imaging. Comparing only vertebral aneurysms, the mean number of implants (coils+MVP) was 7 in the MVP group(n=8) and 20 in the coiling group(n=6) (p=0.0016). Mean fluoroscopy time was 17.62 min in the MVP group compared to 24.2min in the coiling group (p=0.07). There were no technical failures. Two patients (both with SAH) developed medullary strokes.
Conclusions: Endovascular parent vessel occlusion for fusiform intracranial aneurysms can be performed with the MVP device, preserving surrounding branches. There was a significant reduction in number of coils and a trend toward decreased fluoroscopy time in the MVP group. This is an important tool for cerebrovascular surgeons, particularly in cases of ruptured dissecting vertebral aneurysms, due to risk of antiplatelets with flow diversion and more challenging surgical access.
Patient Care: The use of this device is a minimally invasive, low cost alternative to traditional approaches which can allow for better preservation of surrounding vessels and potentially decreased radiation exposure.
Learning Objectives: 1) Describe the challenges of endovascular parent vessel sacrifice
2) Describe the potential benefits of the MVP in treatment of fusiform ruptured aneurysms.