Bhogal, Pervinder (2020) The use of flow diverters in the intracranial circulation. PhD thesis, University of Warwick.

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Abstract

Intracranial aneurysms are common lesions with autopsy studies suggesting a prevalence of between 1-5% in the adult population. Intracranial aneurysms can be asymptomatic, present with acute subarachnoid haemorrhage or present due to mass effect, for example with cranial nerve palsies. The most common presentation of intracranial aneurysm is rupture leading to subarachnoid haemorrhage. With the increased access to advanced imaging modalities such as MRI and greater imaging of the brain for unrelated conditions such as headache aneurysms are increasingly detected prior to rupture. Following the publication of ISAT endovascular treatment of intracranial aneurysms was considered by many to be the gold standard of treatment. Flow diverters entered clinical use around a decade ago and have gained wide spread acceptance however, there remained numerous unanswered questions from the original trials on flow diversion.

The aim of this project was to compile real world published data to help answer some critical questions regarding the use of flow diversion. The results show that flow diversion is safe to use beyond the circle of Willis in vessels such as the MCA and ACA, as well as to treat aneurysms of the anterior choroidal artery. Furthermore, the risk of covering side branches appears to be minimal. The combined use of flow diversting stents with endosaccular/intra-aneurysmal flow diverting devices can also be performed and appears to offer rapid occlusion of aneurysms which may be particularly useful in large or partially thrombosed aneurysms. Flow diversion in the posterior circulation is also feasible however, it is likely that any benefits seen from flow diversion for non-saccular posterior circulation aneurysms must take into account the clinical state and flow diversion should be performed prior to symptoms of brainstem compression.

Item Type:	Thesis (PhD)
Subjects:	Q Science > QP Physiology R Medicine > RC Internal medicine R Medicine > RD Surgery
Library of Congress Subject Headings (LCSH):	Intracranial aneurysms, Cerebral circulation -- Imaging, Nervous system -- Surgery, Brain -- Blood-vessels -- Abnormalities
Official Date:	19 May 2020
Dates:	Date Event 19 May 2020 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	School of Life Sciences
Thesis Type:	PhD
Publication Status:	Unpublished
Extent:	187 leaves : illustrations

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