O-004 Aneurysm occlusion rate decreases with increasing WEB width despite adequate WEB lateral compression

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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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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2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months’ post-flow diversion stent

Interventional Neuroradiology ◽

10.1177/1591019920908205 ◽

2020 ◽

Vol 26 (4) ◽

pp. 468-475 ◽

Cited By ~ 1

Author(s):

Ahmed E Hussein ◽

Meghana Shownkeen ◽

Andre Thomas ◽

Christopher Stapleton ◽

Denise Brunozzi ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Density Ratio ◽

Area Under The Curve ◽

Cerebral Aneurysms ◽

Flow Diversion ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Time Density

Objective Indications for the treatment of cerebral aneurysms with flow diversion stents are expanding. The current aneurysm occlusion rate at six months ranges between 60 and 80%. Predictability of complete vs. partial aneurysm occlusion is poorly defined. Here, we evaluate the angiographic contrast time-density as a predictor of aneurysm occlusion rate at six months’ post-flow diversion stents. Methods Patients with unruptured cerebral aneurysms proximal to the internal carotid artery terminus treated with single flow diversion stents were included. 2D parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) was used to calculate contrast time-density within the aneurysm and in the proximal adjacent internal carotid artery. The area under the curve ratio between the two regions of interests was assessed at baseline and after flow diversion stents deployment. The area under the curve ratio between completely vs. partially occluded aneurysms at six months’ follow-up was compared. Results Thirty patients with 31 aneurysms were included. Mean aneurysm diameter was 8 mm (range 2–28 mm). Complete occlusion was obtained in 19 aneurysms. Younger patients ( P = 0.006) and smaller aneurysms ( P = 0.046) presented higher chance of complete obliteration. Incomplete occlusion of the aneurysm was more likely if the area under the curve contrast time-density ratio showed absolute ( P = 0.001) and relative percentage ( P = 0.001) decrease after flow diversion stents deployment. Area under ROC curve was 0.85. Conclusion Negative change in the area under the curve ratio indicates less contrast stagnation in the aneurysm and lower chance of occlusion. These data provide a real-time analysis after aneurysm treatment. If validated in larger datasets, this can prompt input to the surgeon to place a second flow diversion stents.

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Pipeline Embolization device for intracranial aneurysms in a large Chinese cohort: factors related to aneurysm occlusion

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420967828 ◽

2020 ◽

Vol 13 ◽

pp. 175628642096782

Author(s):

Bin Luo ◽

Huibin Kang ◽

Hongqi Zhang ◽

Tianxiao Li ◽

Jianmin Liu ◽

...

Keyword(s):

Blood Flow ◽

Intracranial Aneurysms ◽

Registry Study ◽

Vessel Occlusion ◽

Clinical Trial Registration ◽

Pipeline Embolization Device ◽

Venous Phase ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Stent Stenosis

Background and Purpose: The Pipeline Embolization Device (PED, Covidien/Medtronic) is widely used to treat intracranial aneurysms. This PED in China post-market multi-center registry study (PLUS) investigated safety and effectiveness of the PED for intracranial aneurysms in the Chinese population. Methods: This was a panoramic, consecutive, real-world cohort registry study. Patients treated with PED with or without coils between November 2014 and October 2019 at 14 centers in China were included, and those treated by parent vessel occlusion or other stents were excluded. Study outcomes included angiographic evaluation of aneurysm occlusion, complications, in-stent stenosis, and predictors of aneurysm occlusion. A central committee reviewed all imaging and endpoint events. Results: In total, 1171 patients with 1322 intracranial aneurysms were included. The total occlusion rate was 81.4% (787/967) at mean follow-up of 8.96 ± 7.50 months, with 77.1% (380/493) occlusion in the PED alone and 85.9% (407/474) in the PED plus coiling group. On multi-variate analysis, female sex, hyperlipidemia, vertebral aneurysms, PED plus coiling, and blood flow detained to venous phase were significant predictors of aneurysm occlusion. In posterior circulation cohort, there was no variable associated with aneurysm occlusion. In-stent stenosis predictors included current smoking and cerebral sclerosis/stenosis. Conclusion: In the largest series on PED of multi-center date of China, data suggest that treatment with the flow-diverting PED in intracranial aneurysms was efficacious. The treatment of PED combined coiling and blood flow detained to venous phase after PED implant were associated with aneurysmal occlusion. The occlusion rate of vertebral aneurysms was higher than other location aneurysms. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT03831672.

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Flow diversion treatment for acutely ruptured aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015077 ◽

2019 ◽

Vol 12 (3) ◽

pp. 283-288 ◽

Cited By ~ 4

Author(s):

Michelle F M ten Brinck ◽

Maike Jäger ◽

Joost de Vries ◽

J André Grotenhuis ◽

René Aquarius ◽

...

Keyword(s):

Clinical Outcome ◽

Flow Diverter ◽

Poor Clinical Outcome ◽

Good Clinical Outcome ◽

Ruptured Aneurysms ◽

Secondary Endpoints ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Ruptured Intracranial Aneurysms

Background and purposeFlow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.MethodsWe conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0–2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.ResultsAt follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3–6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size ≥20 mm and <20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).ConclusionFlow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.

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Abstract 1122‐000103: FlowDiverter:A Study Safety and Efficacy in a Consecutive Group of 53 Patient and 60 Aneurysm

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000103 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Marcelo Bolcato ◽

ana Carolina Dalmonico ◽

Leo Ditzel ◽

Savio Machareti ◽

Thiago Yoshida ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Consecutive Series ◽

Safety And Efficacy ◽

Grading Scale ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Flow Diverters

Introduction : Endovascular flow diverters are increasingly used for the treatment of cerebral aneurysms. We assessed the safety and efficacy of the Flow Diverters in a consecutive series of 53 patients and 60 aneurysms. Methods : Inclusion criteria were wide‐neck, blister‐like, or fusiform aneurysms independent of size, treated with the FRED, PIPELINE and SILK between December 2014 and Junho 2021. Assessment criteria were aneurysm occlusion, manifest ischemic stroke, bleeding, or death. The occlusion rate was assessed at 6 months and 1 year with DSA by using the Raymond classification and the O'Kelly‐Marotta grading scale. Results : Fifty three patients (mean age 54.3 years;81.1% female) with 60 aneurysms were treated with 9 Silk, 38 FREDs and 13 Pipeline. Aneurysm size ranged from 2.5 to 30 mm. Deployment of the Flow diverters was successful in 52 aneurysms. Three patient developed mild stroke symptoms that fully receded within days, 4 patients occlusion total carotid because resistant antiagregation and another patient’s development Swelling syndrome. There has been one death. Initial follow‐up at 6 months showed complete occlusion in 90% of the overall study group and 93,33% at 1 year. Conclusions : The flow diverter is a safe device for the treatment of cerebral aneurysms of various types. Our data reveal high occlusion rates at 6 months and 1 year. Long‐term occlusion rates are expected.

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Flow-diverting stents allow efficient treatment of unruptured, intradural dissecting aneurysms of the vertebral artery: An explanatory approach using in vivo flow analysis

Interventional Neuroradiology ◽

10.1177/1591019915609166 ◽

2015 ◽

Vol 22 (1) ◽

pp. 76-83 ◽

Cited By ~ 4

Author(s):

Philipp Gölitz ◽

Tobias Struffert ◽

Philip Hoelter ◽

Ilker Eyüpoglu ◽

Frauke Knossalla ◽

...

Keyword(s):

Vertebral Artery ◽

Flow Analysis ◽

Threshold Value ◽

Efficient Treatment ◽

Inflow Velocity ◽

Outflow Velocity ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Dissecting Aneurysms

Object Our study aimed to evaluate the efficiency of flow-diverting stents (FDS) in treating unruptured, intradural dissecting aneurysms of the vertebral artery (VADAs). Additionally, the effect of FDS on the aneurysmal flow pattern was investigated by performing in vivo flow analysis using parametric color coding (PCC). Methods We evaluated 11 patients with unruptured, intradural VADAs, treated with FDS. Pre- and postinterventional DSA-series were postprocessed by PCC, and time-density curves were calculated. The parameters aneurysmal inflow-velocity, outflow-velocity and relative time-to-peak (rTTP) were calculated. Pre- and postinterventional values were compared and correlated with the occlusion rate after six months. Results Follow-up DSA detected 10 aneurysms occluded, meaning an occlusion rate of 91%. No procedure-related morbidity and mortality was found. Flow analyses revealed a significant reduction of aneurysmal inflow- velocity and prolongation of rTTP after FDS deployment. Concerning aneurysm occlusion, the postinterventional outflow-velocity turned out to be a marginally statistically significant predictor. A definite threshold value (–0.7 density change/s) could be determined for the outflow-velocity that allows prediction of complete aneurysm occlusion with high sensitivity and specificity (100%). Conclusions Using FDS can be considered an efficient and safe therapy option in treating unruptured, intradural VADA. From in vivo flow analyses the postinterventional aneurysmal outflow-velocity turned out to be a potential predictor for later complete aneurysm occlusion. Here, it might be possible to determine a threshold value that allows prediction of aneurysm occlusion with high specificity and sensitivity. As fast, applicable and easy-to-handle tool, PCC could be used for procedural monitoring and might contribute to further treatment optimization.

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Effect of Structural Remodeling (Retraction and Recoil) of the Pipeline Embolization Device on Aneurysm Occlusion Rate

American Journal of Neuroradiology ◽

10.3174/ajnr.a3920 ◽

2014 ◽

Vol 35 (9) ◽

pp. 1772-1778 ◽

Cited By ~ 9

Author(s):

L.- D. Jou ◽

B. D. Mitchell ◽

H. M. Shaltoni ◽

M. E. Mawad

Keyword(s):

Pipeline Embolization Device ◽

Structural Remodeling ◽

Aneurysm Occlusion ◽

Occlusion Rate

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Treatment of Unruptured Cerebral Artery Aneurysm: A Meta-Analysis

International Journal of Pharma and Bio Sciences ◽

10.22376/ijpbs/lpr.2021.11.5.l61-80 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

Turkistani Fatema ◽

Sawad Aseel Bin

Keyword(s):

Cerebral Artery ◽

Functional Outcomes ◽

Meta Analysis ◽

Case Series ◽

Cochrane Library ◽

Endovascular Coiling ◽

Microsurgical Clipping ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Meta Analyses

Unruptured middle cerebral artery (MCA) aneurysms can be treated using two techniques or procedures, microsurgical clipping and endovascular coiling. The aim of this meta-analysis study is to compare the safety and efficacy of microsurgical clipping with the endovascular coiling in the treatment of unruptured MCA aneurysms. We searched electronic databases (PubMed, EMBASE and the Cochrane library) to identify studies published between 1991 and 2019. For clipping and coiling techniques, separate meta-analyses were conducted on efficacy and safety after the intervention and at follow-up by using random- and fixed-effects models. Forty-one articles were included in our meta-analyses: 23 case series using clipping and 25 case series using coiling procedures. The complete aneurysm occlusion rate was higher in the clipping procedure (96.1%, 95% CI: 92.8%-97.9%) as compared to the coiling procedure (57.6%, 95% CI: 49.4 – 65.4%). Clipping procedure has a slightly higher rate of favorable functional outcomes (96.4%, 95% CI: 94.8 – 97.5%) compared to coiling procedure (94.8%, 95% CI: 93.1 – 96%). Interestingly, the rate of occlusion appears to decrease with time in the clipping group and increase with time in the coiling group, while the rate of favorable functional outcomes appears to increase with time in the clipping group and decrease with time in the coiling group. Publication bias was unlikely in all our analysis for studies assessing: coiling and occlusion rate, clipping and occlusion rate, coiling and functional outcomes, and clipping and functional outcomes. Microsurgical clipping yields a higher aneurysm occlusion rate, with slightly higher favorable functional outcomes in the treatment of unruptured MCA aneurysms than the endovascular coiling.

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Complex cerebral aneurysms: intra-luminal reconstruction using Pipeline flow-diverting stent and the obliteration mechanism

The Neuroradiology Journal ◽

10.1177/1971400919894879 ◽

2019 ◽

Vol 33 (2) ◽

pp. 91-97 ◽

Cited By ~ 2

Author(s):

Xianli Lv ◽

Chuhan Jiang ◽

Zhongxue Wu ◽

Weijian Jiang ◽

Guihuai Wang

Keyword(s):

Cerebral Aneurysms ◽

Side Wall ◽

Intracerebral Hematoma ◽

Parent Artery ◽

Pipeline Flow ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Small Aneurysms ◽

Flow Diverting Stent

Objectives Patients with complex cerebral aneurysms can now be treated intravascularly with the help of flow-diverting stents. The primary purpose of this article is to document the clinical and angiographic outcomes in 80 patients who were treated with the Pipeline flow-diverting stent (PFS; Medtronic, Dublin, Ireland) and the obliteration mechanism was discussed. Patients and methods Between October 2015 and October 2019, 80 patients with 90 complex (undefined neck, large/giant, blood blister–like, and recurrent side-wall) cerebral aneurysms treated with the PFS were retrospectively reviewed. Forty-five patients were women and 35 were men, with a mean age of 52 years. Large or giant aneurysms were defined as 10 mm or larger and small aneurysms were defined as less than 10 mm at the largest diameter measured on angiogram. Results Forty-one aneurysms (45.6%) were large or giant, 41 (45.6%) were small, four (4.4%) were recurrent side-wall aneurysms and four (4.4%) were blood blister–like aneurysms. In total, 87 PFSs were placed in 80 patients with 90 aneurysms. In six patients, coexisting proximal stenosis of parent artery was also covered with PFS without balloon angioplasty. Adjunct coils were placed in 31 aneurysms (34%). One patient died of intracerebral hematoma after thrombolysis. There was one intrastent occlusion at six-month follow-up without any symptoms. The morbidity and the mortality rate is 0% and 1.3% (95% confidence interval (CI), 0%–3.7%). Control angiography was available in 74 (92.5%) patients with 83 aneurysms, and the aneurysm occlusion rate was 98.8% (95% CI, 96.5%–100%) in 6 to 12 months. Conclusion For wide-necked saccular, large/giant, blood blister–like aneurysms and recurrent side-wall aneurysms, PFS is a valid and safe treatment option.

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