E-065 Flow diversion for pediatric intracranial aneurysms: preliminary clinical and radiological data from a pediatric tertiary university hospital
Notice bibliographique
Résumé
Introduction and Purpose Flow diversion is a well-established endovascular therapy for treating intracranial aneurysms in adults. Although most pediatric intracranial aneurysms are effectively treated by deconstructive techniques, sometimes this is not feasible or safe. We aim to share our experience in treating complex intracranial aneurysms with flow-diverting stents. Materials and Methods We conducted a retrospective analysis of consecutive patients aged 17 or younger who underwent treatment with flow diversion for intracranial aneurysms at a pediatric tertiary university center between March 2018 and May 2023. Demographic, clinical, and radiological characteristics at presentation and long-term follow-up were collected and analyzed. Pre-procedural and post-procedural antiplatelet medication administration was also documented. Safety was defined as ischemic/hemorrhagic events and mortality, while efficacy was measured by complete occlusion at final follow-up. Angiographic occlusion was assessed according to the O’Kelly-Marotta classification. Results Five patients (4 females, 1 male) were included with a mean age at treatment of 11.2 years (range: 6–15). One patient had sickle cell disease and another had a suprasellar adenoma. One patient presented with subarachnoid hemorrhage, while one each presented with third nerve palsy, recurrent transient ischemic attacks and interval growth, and one was iatrogenic secondary to a neurosurgical procedure. Four patients failed balloon occlusion tests and no test was performed in one patient. Aneurysms were located in the internal carotid artery (n=3), middle cerebral artery (n=1), and posterior cerebral artery (n=1). Aneurysm types included saccular (n=2), traumatic/pseudoaneurysm (n=1), dissecting/dysplastic (n=1), and blister-like (n=1). All patients received weight-based dual antiplatelet premedication: aspirin and clopidogrel (n=2), aspirin and ticagrelor (n=1), and aspirin and eptifibatide (n=2); platelet testing was not available. A total of nine flow diverters were deployed, including Pipeline Flex (n=3), Pipeline Vantage (n=4), Silk Vista Baby (n=1), and Surpass Evolve (n=1). Optical coherence tomography was used in one case to acutely evaluate the stent apposition. Two patients underwent adjuvant coiling. One patient needed angioplasty after stent deployment. There were no immediate intraprocedural complications. Two patients developed symptomatic ischemic complications at 48 hours and 3 months post-treatment and one patient had an asymptomatic infarct on 24 hours post-procedure MRI. Dual antiplatelet medication was maintained for 6 months (n=3) and 12 months (n=2) based on imaging features and prior thrombotic events. The last follow-up imaging, including CT/MR Angiography and/or catheter angiography (mean: 17.6 months; range: 7–30) revealed complete occlusion of all aneurysms. One patient developed asymptomatic complete occlusion of the flow diverter construct with interval development of extensive pial collateralization 12 months after treatment. Conclusion Initial short-term observations indicate that flow diversion is a feasible technique for well-selected pediatric intracranial aneurysms that cannot be effectively deconstructed. However, the risk of ischemic complications is significant, and extended monitoring is essential to better understand potential long-term risks and complications. Disclosures C. Parra-Farinas: None. S. Chowdhury: None. V. Rea: None. S. Bickford: None. J. Quon: None. A. Kulkarni: None. V. Pereira: None. J. Spears: None. T. Marotta: None. L. Brandao: None. P. Dirks: None. P. Muthusami: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».