Flow Diversion for Intracranial Aneurysms in Patients with Hematologic Disorders

Flow diverting stents are a mainstay treatment of intracranial aneurysms (IA). They rely on reduction of intra-aneurysmal blood flow velocity along with endothelialization to induce thrombus formation and promote occlusion. Patients with hematologic disorders (HDs) can have abnormal fluid dynamics and blood cell/metal interactions that can affect the mechanism of action of flow diversion (FD). We sought to determine the outcomes of patients with various HD after receiving FD treatment for IA.

This retrospective chart review examined 11 patients with various HD who received FD for their IAs. HD were classified as either coagulopathies (e.g., factor deficiencies, von Willebrand disease) or hemoglobinopathies (e.g., sickle cell disease [SCD]). Patient outcomes were assessed clinically and radiographically, with radiographic outcomes based on O'Kelly-Marotta (OKM) scores from follow-up angiograms.

The total sample included 11 patients with 29 IAs. The median age was 50 years and 81.8% were female. All patients were on pre-procedural dual antiplatelet therapy. Out of the 29 total aneurysms, 17 were treated with FD and 15 originated from the paraophthalmic segment. Seven patients received surface modified stents. The median number of deployed stents during initial treatment was 2. The average aneurysm diameter was 5.03 mm (standard deviation: 3.88 mm). Patients with SCD were the only group to experience complications, with 2 out of 3 patients suffering a post-operative stroke. Seven patients with 8 treated aneurysms experienced complete occlusion at last follow-up with a mean time to OKMD score of 16.8 months.

Despite a small sample size, this series raises concern for the use of FD in patients with SCD. While FD still resulted in adequate rates of aneurysm occlusion, treatment methodology must be tailored for patients with HD.