Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

Object The introduction of flow diverter devices is revolutionizing the endovascular approach to cerebral aneurysms. Midterm and long-term results of angiographic, cross-sectional imaging and clinical follow-up are still lacking. The authors report their experience with endovascular treatment of intracranial aneurysms using both the Pipeline embolization device and Silk stents. Methods From October 2008 to July 2011 a consecutive series of 104 intracranial aneurysms in 101 patients (79 female, 22 male; average age 53 years) were treated. Three of the 104 aneurysms were ruptured and 101 were unruptured. Silk stents were implanted in 47 of the aneurysms and Pipeline stents in the remaining 57. In 14 cases a combination of flow diverter devices and coils were used to treat larger aneurysms (maximum diameter > 15 mm). Patients underwent angiographic follow-up examination at 6 months after treatment, with or without CT or MRI, and at 1 year using CT or MRI, with or without conventional angiography. Results In all cases placement of flow diverter stents was technically successful. The mortality and morbidity rates were both 3%. Adverse events without lasting clinical sequelae occurred in 20% of cases. Angiography performed at 6 months after treatment showed complete aneurysm occlusion in 78 of 91 cases (86% of evaluated aneurysms) and subocclusion in 11 (12%); only in 2 cases were the aneurysms unchanged. Fifty-three aneurysms were evaluated at 1 year after treatment. None of these aneurysms showed recanalization, and 1 aneurysm, which was incompletely occluded at the 6-month follow-up examination, was finally occluded. Aneurysmal sac shrinkage was observed in 61% of assessable aneurysms. Conclusions Parent artery reconstruction using flow diverter devices is a feasible, safe, and successful technique for the treatment of endovascular treatment of cerebral aneurysms.

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Treatment of Intracranial Aneurysms Using the Pipeline Flow-Diverter Embolization Device: A Single-Center Experience with Long-Term Follow-Up Results

American Journal of Neuroradiology ◽

10.3174/ajnr.a3246 ◽

2012 ◽

Vol 33 (8) ◽

pp. 1436-1446 ◽

Cited By ~ 278

Author(s):

I. Saatci ◽

K. Yavuz ◽

C. Ozer ◽

S. Geyik ◽

H.S. Cekirge

Keyword(s):

Intracranial Aneurysms ◽

Flow Diverter ◽

Single Center ◽

Pipeline Flow ◽

Single Center Experience ◽

Long Term Follow Up

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The p64 Flow Diverter—Mid-term and Long-term Results from a Single Center

Clinical Neuroradiology ◽

10.1007/s00062-019-00823-y ◽

2019 ◽

Vol 30 (3) ◽

pp. 471-480 ◽

Cited By ~ 8

Author(s):

S. Sirakov ◽

A. Sirakov ◽

P. Bhogal ◽

M. Penkov ◽

K. Minkin ◽

...

Keyword(s):

Flow Diverter ◽

Long Term Results ◽

Single Center

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Abstract WP85: Flow-diverter Embolization for Tandem Intracranial Aneurysms: A Single Center Experience

Stroke ◽

10.1161/str.48.suppl_1.wp85 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Russell Cerejo ◽

Seby John ◽

Andrew Bauer ◽

Mark Bain ◽

Thomas Masaryk ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Flow Diverter ◽

Single Center ◽

Anterior Circulation ◽

Single Center Experience ◽

Flow Diverter Stent ◽

Artery Segment ◽

Treat All

Introduction: Flow diverter embolization is a novel method to treat intracranial aneurysms. The device has been shown to reduce procedure time and radiation exposure along with excellent long-term occlusion rates for single lesions. However, the effect of flow diversion on multiple adjacent aneurysms has not been well studied. We present our single center experience with flow diverter treatment of tandem aneurysms. Methods: We retrospectively collected clinical, imaging, procedural and follow up data on patients in whom flow diverters were used to treat intracranial anterior circulation aneurysms between 2011 and 2016. We included patients who had 2 or more tandem aneurysms of the internal carotid artery segment and where flow diverter was intended to treat all the aneurysms either as primary or secondary method. Results: We identified 21 patients with 52 aneurysms that met inclusion criteria. All were females with median age of 57 (Interquartile range [IQR] 51 - 69). Seventeen patients had 2 adjacent aneurysms, while 4 patients had 3 contiguous aneurysms. Of these, only one patient was treated acutely for ruptured aneurysm. The median largest aneurysm diameter was 3.1mm (IQR 2.5 - 4.8) with most common locations being cavernous and ophthalmic aneurysms. In 19 patients (90.5%) only a single flow diverter stent was used; only one patient required concurrent coiling. One patient (4.8%) suffered a post procedural mild stroke but improved rapidly. There were no other procedural complications. Follow up data in 13 patients (61.9%) with a median follow up of 8 months (IQR 6 - 13) demonstrated that 20 out of 28 aneurysms showed complete occlusion (71.4%). None of the patients at follow up required re-treatment, and there were no delayed/late aneurysm ruptures. Conclusion: Flow diverter is a feasible, efficacious and safe treatment option in patients with multiple tandem aneurysms, in a single session with good early outcomes. Long term follow up data and large cohort studies are required.

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Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center

Neurosurgical FOCUS ◽

10.3171/2017.3.focus1732 ◽

2017 ◽

Vol 42 (6) ◽

pp. E3 ◽

Cited By ~ 21

Author(s):

Francesco Briganti ◽

Giuseppe Leone ◽

Luigi Cirillo ◽

Oreste de Divitiis ◽

Domenico Solari ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Long Term Results ◽

Parent Artery ◽

Long Term Follow Up ◽

Ischemic Complications ◽

Flow Diverter Devices ◽

Aneurysm Occlusion

OBJECTIVEFlow diversion has emerged as a viable treatment option for selected intracranial aneurysms and recently has been gaining traction. The aim of this study was to evaluate the safety and effectiveness of flow-diverter devices (FDDs) over a long-term follow-up period.METHODSThe authors retrospectively reviewed all cerebral aneurysm cases that had been admitted to the Division of Neurosurgery of the Università degli Studi di Napoli between November 2008 and November 2015 and treated with an FDD. The records of 60 patients (48 females and 12 males) harboring 69 cerebral aneurysms were analyzed. The study end points were angiographic evidence of complete aneurysm occlusion, recanalization rate, occlusion of the parent artery, and clinical and radiological evidence of brain ischemia. The occlusion rate was evaluated according to the O’Kelly-Marotta (OKM) Scale for flow diversion, based on the degree of filling (A, total filling; B, subtotal filling; C, entry remnant; D, no filling). Postprocedural, midterm, and long-term results were strictly analyzed.RESULTSComplete occlusion (OKM D) was achieved in 63 (91%) of 69 aneurysms, partial occlusion (OKM C) in 4 (6%), occlusion of the parent artery in 2 (3%). Intraprocedural technical complications occurred in 3 patients (5%). Postprocedural complications occurred in 6 patients (10%), without neurological deficits. At the 12-month follow-up, 3 patients (5%) experienced asymptomatic cerebral infarction. No further complications were observed at later follow-up evaluations (> 24 months). There were no reports of any delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, ischemic complications, or procedure- or device-related deaths.CONCLUSIONSEndovascular treatment with an FDD is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. In the present study, the authors observed effective and stable aneurysm occlusion, even at the long-term follow-up. Data in this study also suggest that ischemic complications can occur at a later stage, particularly at 12–18 months. On the other hand, no other ischemic or hemorrhagic complications occurred beyond 24 months.

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Endovascular Treatment of Posterior Circulation Saccular Aneurysms With the p64 Flow Modulation Device: Mid-and Long-Term Results in 54 Aneurysms From a Single Center

Frontiers in Neurology ◽

10.3389/fneur.2021.711863 ◽

2021 ◽

Vol 12 ◽

Author(s):

Victoria Hellstern ◽

Marta Aguilar-Pérez ◽

Elina Henkes ◽

Carmen Serna-Candel ◽

Christina Wendl ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Posterior Circulation ◽

Long Term Results ◽

Single Center ◽

Parent Vessel ◽

Unruptured Aneurysms ◽

Saccular Aneurysms

Objective: Flow diverter (FD) stents have become one of the most common tools for treating intracranial aneurysms; however, their role in treating posterior circulation aneurysms is still discussed with controversy. In this study, we evaluated the safety and effectiveness of p64 FD for the treatment of saccular, unruptured aneurysms in the posterior circulation over a long-term follow-up period in a single center.Methods: From our prospectively maintained database, we retrospectively identified patients who underwent treatment of an intracranial saccular aneurysm arising from the posterior circulation with ≥1 p64 FD implanted or attempted between October 2012 and December 2019. Aneurysms could have been treated with prior or concomitant saccular treatment (e.g., coiling, intra-aneurysmal flow diversion). Aneurysms with parent vessel implants other than p64, fusiform aneurysms, and dissections were excluded. Peri- and postprocedural complications, clinical outcome, and clinical and angiographic follow-up results were evaluated.Results: In total, 54 patients (45 female, 9 male; mean age 55.1 years) with 54 intracranial aneurysms met the inclusion criteria. In 51 cases (94.4%), one p64 was implanted; in 2 cases (3.7 %), two p64s were implanted; in one case, deployment of the p64 was not feasible. Procedural complications occurred in 3.7% and postprocedural complications in 9.3 %, respectively. Hemorrhagic complications occurred in 2/54 patients (3.7%), thereof one fatal parenchymal hemorrhage. Ischemic complications were observed in 5/54 patients (9.3%). Early, mid-term, and long-term angiographic follow-up examinations showed complete or near-complete aneurysm occlusion, defined according to the O'Kelly –Marotta (OKM) scale as OKM C + D in 56, 75.6, and 82.9 %, respectively. Asymptomatic side vessel occlusions occurred in 3.8%, each during the first follow-up.Conclusions: The implantation of a p64 FD is a safe and effective device for endovascular treatment of posterior circulation saccular aneurysms with a high success rate and low morbi-mortality.

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