E5029. A CTA Pictorial Review of Devices Used in the Endovascular Treatment of Cerebral Aneurysms
Authors
Felipe Barreras Galindo ;
San Juan Bautista School of Medicine
Juan Gonzalez Ramos-; ;
Recinto de Ciencias Medicas
Pablo Barreras Galindo-; ;
San Juan Bautista School of Medicine
Fabianna Himet Coll;
San Juan Bautista School of Medicine
Mario Polo Asenjo;
Hospital Menonita; San Juan Bautista School of Medicine
Background
During the past few decades, the percentage of cerebral aneurysms treated with endovascular techniques has grown exponentially. This has been due, in large part, to the wide variety of endovascular devices available, including stents, flow-diverters, endo-saccular devices, and even liquid embolic agents. Radiologists will frequently encounter these devices in CTA ordered to follow up treated aneurysms. In other cases, thromboembolic complications related to these endovascular devices may be identified on CT. Correctly diagnosing these potential complications will aid in promptly initiating the best treatment for the patient, which could be pharmacologic or endovascular.
Educational Goals / Teaching Points
The main focus of this exhibit is to recognize the most common endovascular devices used in the treatment of cerebral aneurysms (stents, flow-diverters, endo-saccular devices, and liquid embolic agents). Also, it will demonstrate the importance in identifying malpositioning, migration or flow disturbances associated with these devices, which should be included in the imaging report and, in some cases, urgently notified. This exhibit will be most useful to those who work around these patients on a day-to-day basis: general radiologists, neuroradiologists, and radiology residents.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The treatment of cerebral aneurysms include the use of endovascular devices with distinct mechanisms of action that dictate their proper placement with respect to the aneurysm sac. Radiologists often encounter these devices in CTAs ordered for follow up or to evaluate potential complications. Proper identification of these devices and knowledge of their correct placement/positioning allows us to identify potential complications.
Conclusion
Endovascular devices used to treat aneurysms include both intraluminal devices placed in the parent artery, as well as intrasaccular devices deployed within the aneurysm sac. Knowledge and proper recognition of the device(s) used to treat an aneurysm allows a better understanding of its mechanism of action (i.e., flow diversion away from the aneurysm sac). Radiologists should be able to identify complications associated with these devices, including malpositioning, migration and thromboembolic phenomena.
