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Flow Diverter Implantation for Intracranial Aneurysm with Concomitant Cerebral Infarction in the Chronic Phase: A
Li-Xin Huang1,2,3, Xiao-Bing Wu2, Hui Wang1
1Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Insights
Flow diverters safely treat intracranial aneurysms in patients with chronic cerebral infarction. This approach balances bleeding and rupture risks, showing favorable outcomes with careful antiplatelet management.
Area of Science:
- Neurology
- Interventional Neuroradiology
Background:
- Intracranial aneurysms (IAs) and chronic cerebral infarction (CI) pose treatment challenges due to conflicting antiplatelet therapy needs.
- Existing evidence on flow diverter (FD) safety and efficacy in patients with coexisting CI is limited.
Purpose of the Study:
- To evaluate the safety and efficacy of flow diverter implantation for an unruptured IA in a patient with chronic-phase CI.
Main Methods:
- A case report of a 56-year-old man with subacute CI and an unruptured IA.
- Initiation of dual antiplatelet therapy (DAPT) followed by FD implantation during the chronic infarction phase (Day 25).
- Postoperative management included 6 months of DAPT, followed by single antiplatelet therapy.
Main Results:
- Successful FD implantation without peri- or post-procedural complications.
- Complete aneurysm obliteration confirmed at 12 and 36 months.
- Full recovery of neurological deficits and no recurrent ischemic or hemorrhagic events.
Conclusions:
- Flow diverter implantation is a safe and effective treatment for unruptured intracranial aneurysms in the context of chronic cerebral infarction.
- Strategic timing of intervention during the chronic phase and tailored antiplatelet regimens are crucial for balancing risks and outcomes.
- Further investigation is needed to establish the broader applicability of this treatment strategy.
Abstract:
BACKGROUND Intracranial aneurysms (IAs) coexisting with chronic-phase cerebral infarction (CI) present unique therapeutic challenges. Antiplatelet therapy for infarction increases bleeding risks during aneurysm treatment, whereas delayed intervention may raise rupture risks. Flow diverters (FDs) have transformed IA management, but evidence regarding their safety and efficacy in patients with concomitant chronic CI remains scarce. CASE REPORT A 56-year-old man presented with slurred speech and right-sided weakness caused by subacute CI in the left basal ganglia. Imaging identified a small, unruptured IA (2.50×1.74×1.54 mm) in the left internal carotid artery ophthalmic segment. The aneurysm was asymptomatic, without corresponding neurological deficits or headaches. Dual antiplatelet therapy (DAPT: aspirin 100 mg/day and clopidogrel 75 mg/day) and atorvastatin (20 mg/day) were initiated on Day 1. By Day 25 (chronic infarction phase, ≥21 days post-onset, with stabilized neurological symptoms), an FD (Pipeline™ Flex, 4.25×16 mm; Medtronic, USA) was implanted. Postoperatively, DAPT was maintained for 6 months to mitigate FD-related thromboembolic risk and prevent CI recurrence, after which single antiplatelet therapy (aspirin 100 mg/day) was continued. Follow-up at 12 and 36 months demonstrated complete aneurysm obliteration and full recovery of motor and speech functions without recurrent ischemia or hemorrhage. CONCLUSIONS FD implantation was safely performed and resulted in favorable outcomes for an unruptured IA in a patient with chronic-phase CI. Appropriate timing during the chronic phase and individualized antiplatelet management appeared to balance infarction control and aneurysm occlusion. Further research is warranted to determine broader applicability of these findings.
