In Reply: Occlusion Rate and Visual Complications With Flow-Diverter Stent Placed Across the Ophthalmic Artery's Origin for Carotid-Ophthalmic Aneurysms: A Meta-Analysis

Background The treatment of posterior inferior cerebellar artery aneurysms is controversial. Recently, flow diverters have emerged as an attractive treatment option. Here, we performed a systematic review and meta-analysis of the angiographic and clinical outcomes of flow diverter-treated posterior inferior cerebellar artery aneurysms. Methods We searched the PubMed, EMBASE and Web of Science databases for studies published from inception to January 2021. We included studies that described flow diverters procedures for posterior inferior cerebellar artery aneurysms with ≥2 patients. The outcomes were the complete occlusion rate and flow diverter-related complication rate. Meta-analysis was performed using a random or fixed effects model based on heterogeneity. Results We included six studies involving 46 posterior inferior cerebellar artery aneurysms. There were 14 ruptured aneurysms. All flow diverters were successfully released and the technical success rate was 100%. The complete occlusion rate was 81% (95% confidence interval = 65–93%; I2 = 0.00%; P < 0.01). The flow diverter-related complication rate was 18% (95% confidence interval = 5–36%; I2 = 0.00%; P < 0.01). One patient died of rebleeding. The mortality rate was <1% (95% confidence interval = -1–1%; I2 = 0.00%; P = 0.951). Conclusions Treatment of posterior inferior cerebellar artery aneurysms with flow diverters is feasible and carries a high degree of technical success. However, this treatment is underutilized in patients with posterior inferior cerebellar artery aneurysms due to a higher complication rate and lower occlusion rate compared with clipping and traditional endovascular treatment. Further well-designed prospective and randomized studies are required to fully understand the effects of flow diverters especially in posterior inferior cerebellar artery aneurysms patients requiring endovascular treatment.

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Management of giant internal carotid aneurysm by extracranial-intracranial bypass and flow diverter stent

British Journal of Neurosurgery ◽

10.1080/02688697.2021.1947974 ◽

2021 ◽

pp. 1-5

Author(s):

Assylbek Kaliyev ◽

Yerbol Makhambetov ◽

Yerkin Medetov ◽

Marat Kulmirzayev ◽

Serik Dusembayev ◽

...

Keyword(s):

Internal Carotid ◽

Flow Diverter ◽

Flow Diverter Stent

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Investigation of intracranial aneurysm hemodynamics following flow diverter stent treatment

Medical Engineering & Physics ◽

10.1016/j.medengphy.2012.07.005 ◽

2013 ◽

Vol 35 (5) ◽

pp. 608-615 ◽

Cited By ~ 49

Author(s):

Y. Zhang ◽

W. Chong ◽

Y. Qian

Keyword(s):

Intracranial Aneurysm ◽

Flow Diverter ◽

Flow Diverter Stent ◽

Stent Treatment

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Treatment of Middle Cerebral Artery Aneurysms with Flow-Diverter Stents: A Systematic Review and Meta-Analysis

American Journal of Neuroradiology ◽

10.3174/ajnr.a5388 ◽

2017 ◽

Vol 38 (12) ◽

pp. 2289-2294 ◽

Cited By ~ 35

Author(s):

F. Cagnazzo ◽

D. Mantilla ◽

P.-H. Lefevre ◽

C. Dargazanli ◽

G. Gascou ◽

...

Keyword(s):

Systematic Review ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Meta Analysis ◽

Flow Diverter ◽

Middle Cerebral Artery Aneurysms

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Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

Interventional Neuroradiology ◽

10.1177/15910199211027991 ◽

2021 ◽

pp. 159101992110279

Author(s):

Muhammad Waqas ◽

Rimal H Dossani ◽

Modhi Alkhaldi ◽

Jocelyn Neveu ◽

Justin M Cappuzzo ◽

...

Keyword(s):

Systematic Review ◽

Intracranial Aneurysms ◽

Flow Diverter ◽

Complication Rates ◽

Mesh Terms ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Layered Flow ◽

Comparative Safety

Introduction The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data. Methods The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed. Results Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies). Conclusion This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.

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Ocular Trauma with Ophthalmic Artery Injury as a Rare Cause of Subarachnoid Hemorrhage: a Case Report and Review of the Literature

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1725956 ◽

2021 ◽

Author(s):

Michael Veldeman ◽

Hani Ridwan ◽

Dimah Hasan ◽

Annette Rieg ◽

Hans Clusmann ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Ophthalmic Artery ◽

Ocular Trauma ◽

Delayed Cerebral Ischemia ◽

Penetrating Trauma ◽

Flow Diverter ◽

Pseudoaneurysm Formation ◽

Flow Diverter Stent ◽

Close Observation

Abstract Background and Importance Traumatic avulsion of the ophthalmic artery is a rare cause of subarachnoid hemorrhage (SAH). In this case, a relative minor fall with isolated ocular trauma caused bulbar dislocation and rupture of the ophthalmic artery in its intracranial segment resulting in subarachnoid bleeding. Clinical Presentation In a female patient in her 70s, a direct penetrating trauma to the orbit by a door handle resulted in basal SAH with blood dispersion into both Sylvian fissures. Cerebral angiography revealed a blunt-ending stump at the origin of the ophthalmic artery. To provide protection against further bleeding, a flow diverter stent was placed in the internal carotid artery to cover the origin of the ophthalmic artery. After a longer intensive care stay complicated by pneumonia and respiratory insufficiency, the patient made a full recovery. Of all four reported cases (including ours), delayed cerebral ischemia was seen in one patient and hydrocephalus in two patients. These potential complications necessitate close observation and fitting treatment similar to aneurysmal SAH. Conclusion Due to similar physiologic aspects, this type of bleed mimics many aspects of aneurysmal SAH. In this case, we observed no hydrocephalus or the development of delayed cerebral ischemia. This represents, however, the first reported case treated by placement of a flow diverter stent to prevent rebleeding and pseudoaneurysm formation.

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Metal coverage ratio of pipeline embolization device for treatment of unruptured aneurysms: Reality check

Interventional Neuroradiology ◽

10.1177/1591019915617315 ◽

2015 ◽

Vol 22 (1) ◽

pp. 42-48 ◽

Cited By ~ 18

Author(s):

Liang-Der Jou ◽

Gouthami Chintalapani ◽

Michel E Mawad

Keyword(s):

Flow Diverter ◽

Pipeline Embolization Device ◽

Unruptured Aneurysms ◽

Coverage Ratio ◽

Reality Check ◽

Local Mean ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

The Mean ◽

The Difference

Background and purpose The metal coverage ratio (MCR) of a flow diverter influences the intra-aneurysmal hemodynamics; a high MCR will occlude an aneurysm early, while a low MCR may delay aneurysm occlusion. The true MCR of a pipeline embolization device (PED) could be lower due to oversize, device deformation, or aneurysm location. In this study deviation of the true MCR from the nominal MCR is assessed and whether their difference affects aneurysm occlusion rate is determined. Methods A total of 40 consecutive patients, each of them treated by one PED for their aneurysms at the internal carotid artery (ICA), were retrospectively analyzed. The DynaCT images of these deployed PEDs were used to determine their true dimensions and estimate three MCRs (local, mean, and nominal). These data were compared in two groups of patients who had different aneurysm outcomes at six months. Results The difference in the local MCR between two groups is small, but statistically significant (24.5% vs 21.6%, p = 05). The local MCR is consistently lower than the nominal MCRs (23.2% vs 30.2%, p < 0.001); however, the difference between the mean and local MCRs is small (23.9% vs 23.2%). Conclusions An expectation that a PED can achieve a MCR of 30% may not be reasonable. Device oversize and deformation during deployment lower the local MCR by 5–7%. A lowered MCR affects the aneurysm occlusion rate at six months.

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