Abstract 1122‐000056: Trends in the Endovascular Treatment of Intracranial Aneurysms in a Single Institution During 10 Years

Introduction : Endovascular treatment of intracranial aneurysms has increased compared to microsurgery since the creation of the Guglielmi Detachable Coils (GDC), and is the treatment of choice in several centers worldwide. Our study aimed to analyze the trends over time of number of patients, number of aneurysms, rupture status, location, size and endovascular technique employed in a retrospective cohort of consecutive intracranial aneurysms treated during a 10‐year period. Methods : Data extracted from clinical records, surgical reports, angiographies and CT scans of 765 consecutive patients who underwent endovascular treatment of 845 intracranial aneurysms at our institution between January 2010 and December 2020 was carried out. The Mann‐Kendal test was used to assess time trends. The moving average technique was also employed, using one lagged observation, the current observation and one forward observation in order to create smoother curves. The statistical software Stata v14.0 (StataCorp, College Station, TX, USA) was used. Results : We evaluated 765 patients who underwent 845 endovascular treatments of intracranial aneurysms. Women represented 81% of the cohort. Mean age was 53.9 ± 14.6 years. We identified a significant increase in the number of patients (p = 0.016; p for moving average = 0.005) and in the number of aneurysms over time (p = 0.003; p for moving average = 0.003). For ruptured aneurysms, we did not find changes in the trends over time (p = 0.117; p for moving average = 0.1), whereas in the case of unruptured aneurysms, we identified a significant increase in their treatment (p = 0.029; p for moving average = 0.001). Posterior communicating (p = 0.042: p for moving average = 0.002), paraclinoid (p = 0.06; p for moving average = 0.019) and posterior fossa aneurysms (p = 0.813; p for moving average = 0.028) increased their frequency of treatment over time. Anterior communicating (p = 0.235; p for moving average = 0.21), middle cerebral artery (p = 0.431; p for moving average = 0.347) and internal carotid artery aneurysms (p = 1; p for moving average = 0.754) did not show differences over time. We did not identify changes over time in large (p = 0.31; p for moving average = 0.213), as well as width (p = 0.35; p for moving average = 0.876) and neck diameter (p = 1; p for moving average = 0.815). Balloon‐assisted coiling (p = 0.01; p for moving average = 0.003), flow diverters (p = 0.016; p for moving average < 0.001) and stent‐assisted coiling (p = 0.531; p for moving average = 0.014) showed a positive trend over time. Simple coiling (p = 0.75; p for moving average = 0.184) did not show significant variations over time. Conclusions : We identified a positive trend in the endovascular treatment of unruptured aneurysms, as well as posterior communicating artery, paraclinoid and posterior fossa aneurysms. Assisted‐coiling techniques and flow diverters also showed a positive trend over time. These results are in accordance with the increasing trends in endovascular treatment of intracranial aneurysms worldwide.

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Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991001600301 ◽

2010 ◽

Vol 16 (3) ◽

pp. 231-239 ◽

Cited By ~ 5

Author(s):

L.M. Pyysalo ◽

L.H. Keski-Nisula ◽

T.T. Niskakangas ◽

V.J. Kähärä ◽

J.E. Öhman

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Bleeding Rate ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Follow Up Study ◽

Long Term Follow Up ◽

Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

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Endovascular Treatment of Unruptured Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991101700404 ◽

2011 ◽

Vol 17 (4) ◽

pp. 420-424 ◽

Cited By ~ 8

Author(s):

W. Yue

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Mass Effect ◽

Mortality And Morbidity ◽

Unruptured Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Mean Size ◽

Large And Giant Aneurysms ◽

Brain Stem Ischemia

We report the clinical and angiographic results of endovascular treatment of unruptured intracranial aneurysms. Over a three-year period, 80 unruptured aneurysms in 74 patients were electively treated with endovascular management. One aneurysm was diagnosed during investigations for a second ruptured aneurysm, 54 aneurysms were incidentally discovered, 18 aneurysms presented with symptoms of mass effect and seven aneurysms presented with symptoms of brain stem ischemia. Mean size of the 80 unruptured aneurysms was 12.5±8.0 mm (range, 2–39 mm). Thirty-six aneurysms (45%) were small (<10 mm), 38 aneurysms (47.5%) were large (10–25 mm), and six aneurysms (7.5%) were giant (25–39 mm). Forty-eight wide-necked aneurysms (60%) were coiled with the aid of a supporting device. The mortality rate was 1.25%, and the overall morbidity was 1.25%. Of these, one of the patients suffered a stroke, leading to severe disability (1.25%). In one patient, the aneurysm ruptured during treatment, resulting in death. Initial aneurysm occlusion was complete (100%) in 76.25% aneurysms, nearly complete (90%–98%) in 10% aneurysms and incomplete (60%–85%) in 13.75% aneurysms. Follow-up angiography was available in 67 patients with 73 treated aneurysms (91.25%) from one to 36 months (mean 9.3 months); partial reopening occurred in 7.5%, mainly large and giant aneurysms (5.5%). Additional coiling was performed in four aneurysms. There were no complications in additional treatments. At 14.1-month clinical follow-up (range, 2 to 36 months), mRS score was 0 in 78.75% patients, 1 in 10% patients, 2 in 8.75% and 3 in 1.25%. There was no aneurysmal rupture during the follow-up period. Endovascular treatment of unruptured intracranial aneurysms has low procedural mortality and morbidity rates.

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Flow diverters for intracranial aneurysms

Innovative Neurosurgery ◽

10.1515/ins-2014-0017 ◽

2015 ◽

Vol 3 (3-4) ◽

Author(s):

Alice Venier ◽

Beatrice Gardenghi ◽

Giuseppe Lanzino ◽

Stylianos K. Rammos

Keyword(s):

Present Article ◽

Intracranial Aneurysms ◽

Flow Diversion ◽

Parent Artery ◽

Endovascular Management ◽

Innovative Technologies ◽

Unruptured Aneurysms ◽

Flow Diverters

AbstractThe progressive establishment of endovascular management in treating intracranial aneurysms had lead to continuous technique advancements and development of innovative technologies. Flow diverters are “stent-like” devices currently used for complex unruptured aneurysms allowing endoluminal reconstruction of the parent artery and occlusion of the aneurysm sac. In the present article, we review the development of flow diversion devices through

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Endovascular Treatment of Intracranial Aneurysms in the Elderly: Single-Center Experience in 63 Consecutive Patients

Neurosurgery ◽

10.1227/01.neu.0000185583.25420.df ◽

2005 ◽

Vol 57 (6) ◽

pp. 1096-1102 ◽

Cited By ~ 71

Author(s):

YiLing Cai ◽

Laurent Spelle ◽

Huan Wang ◽

Michel Piotin ◽

Charbel Mounayer ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Endovascular Procedures ◽

The Elderly ◽

High Grade ◽

Single Center ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms

Abstract OBJECTIVE: With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older. METHODS: Between November 1998 and December 2003, among a total of 990 patients with intracranial aneurysms treated endovascularly at our center, 63 patients (6%) were 70 years of age or older. Forty-one patients presented with subarachnoid hemorrhage (SAH), and 22 presented with symptomatic unruptured aneurysms. A total of 84 aneurysms were detected in these 63 patients. Only those responsible for either the subarachnoid hemorrhage or clinical symptoms (68 aneurysms) were treated. The aneurysm characteristics, endovascular procedures and techniques, angiographic and clinical outcomes, and complications were reviewed. RESULTS: Selective embolization failed in three aneurysms (4%). In the remaining 65 aneurysms, complete occlusion was achieved in 33 aneurysms (51%), neck remnant was observed in 17 aneurysms (27%), and residual aneurysmal filling was observed in six aneurysms (9%). Parent vessel occlusion was used in the treatment of nine aneurysms (13%). Thirteen procedure-related complications occurred (19%), six of which resulted in clinical complications (9%). Nine deaths (14%) occurred; three (5%) were directly related to the endovascular procedures, and six (9%) were related to the medical complications of SAH. The remaining 54 patients had a mean clinical follow-up time of 13 months (range, 1–47 mo). Ninety-one percent (20 out of 22) of the patients with unruptured aneurysms and 89% (25/28) of the patients with low-grade (Hunt and Hess Grade I and II) ruptured aneurysms achieved excellent outcomes (modified Rankin Scale score, 0–1), whereas 77% (10 out of 13) of the patients with high-grade (Hunt and Hess Grade ≥ III) ruptured aneurysms either died or had very poor outcomes (modified Rankin Scale score, 4–5). Angiographic follow-up (mean, 11 mo; range, 3–38 mo) was obtained in 34 of the 54 living patients (63%). Two aneurysms demonstrated minor changes that required no further treatment (5%). Five aneurysms showed major recurrences (17%), all of which were successfully retreated endovascularly. CONCLUSION: The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.

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Volumes, outcomes, and complications after surgical versus endovascular treatment of aneurysms in the United States (1993–2015): continued evolution versus steady-state after more than 2 decades of practice

Journal of Neurosurgery ◽

10.3171/2019.12.jns192755 ◽

2020 ◽

pp. 1-14 ◽

Cited By ~ 2

Author(s):

Pedram Golnari ◽

Pouya Nazari ◽

Roxanna M. Garcia ◽

Hannah Weiss ◽

Ali Shaibani ◽

...

Keyword(s):

Endovascular Treatment ◽

Fold Increase ◽

The United States ◽

Diagnosis And Treatment ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

The Past ◽

The Us ◽

Risk Ratios ◽

Over Time

OBJECTIVEAdoption of endovascular treatment (EVT) and other advances in aneurysm care have shifted practice patterns of cerebral aneurysm treatment over the past 2 decades in the US. The objective of this study was to determine whether resulting trends in volumes, outcomes, and complications have matured in general practice or continue to evolve.METHODSData were obtained from the National Inpatient Sample from 1993 to 2015. ICD-9 codes were used to estimate annual volumes, outcomes, and complications following treatment of ruptured and unruptured aneurysms. Univariate and multivariate analyses were used to estimate risk ratios for complications and outcomes. Trends in time were assessed utilizing annual percentage change (APC).RESULTSThe authors found a nearly 5-fold increase in annual admissions with diagnoses of unruptured aneurysms, whereas SAH volume increased less than 50%. Clipping ruptured aneurysms steadily declined (APC −0.86%, p = 0.69 until 1999, then −6.22%, p < 0.001 thereafter), whereas clipping unruptured aneurysms slightly increased (APC 2.02%, p < 0.001). EVT tripled in 2002–2004 and steadily increased thereafter (APC 7.22%, p < 0.001 and 5.85%, p = 0.01 for unruptured and ruptured aneurysms, respectively). Despite a 3-fold increase in both diagnosis and treatment of unruptured aneurysms, the incidence of SAH remained steady at 12 per 100,000 persons per year (APC 0.04%, p = 0.83). In contrast, SAH severity increased over time, as did patient age and comorbidities (all p < 0.001). SAH led to nonroutine discharge more frequently over time after both EVT and clipping (APC 1.24% and 1.10%, respectively), although mortality decreased during the same time (APC −2.48% and −1.44%, respectively). Complications were more frequent after clipping than EVT, but this differential risk diminished during the study period and was less perceptible in ruptured aneurysms. The proportion of patients discharged home after treatment of unruptured aneurysms was significantly lower (p < 0.001) after clipping (69.3%–79.5%) than EVT (88.3%–93.3%); both proportions changed minimally since 1998 (APC −0.39%, p = 0.02, and APC −0.11%, p = 0.14, respectively).CONCLUSIONSEVT volume markedly increased for ruptured and unruptured aneurysms from 1993 to 2015, whereas clipping decreased for ruptured and slightly increased for unruptured aneurysms. The incidence of SAH remained unchanged despite increased diagnosis and treatment of unruptured aneurysms. In ruptured aneurysms, SAH severity has increased over time, as have age, comorbidities, and nonroutine discharges. In contrast, routine discharge after treatment of unruptured aneurysms remains largely unchanged since 1998 and remains lower with clipping.

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Residuals, recurrences and re-treatment after endovascular repair of intracranial aneurysms: A retrospective methodological comparison

Interventional Neuroradiology ◽

10.1177/1591019919867841 ◽

2019 ◽

Vol 26 (1) ◽

pp. 45-54 ◽

Cited By ~ 3

Author(s):

Jens J Froelich ◽

Nicholas Cheung ◽

Johan AB de Lange ◽

Jessica Monkhorst ◽

Michael W Carr ◽

...

Keyword(s):

Endovascular Treatment ◽

Medical Records ◽

Intracranial Aneurysms ◽

Aneurysm Rupture ◽

Flow Diversion ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Methodological Comparison

Objective Incomplete aneurysm occlusions and re-treatment rates of 52 and 10–30%, respectively, have been reported following endovascular treatment of intracranial aneurysms, raising clinical concerns regarding procedural efficacy. We compare residual, recurrence and re-treatment rates subject to different endovascular techniques in both ruptured and unruptured intracranial aneurysms at a comprehensive state-wide tertiary neurovascular centre in Australia. Methods Medical records, procedural and follow-up imaging studies of all patients who underwent endovascular treatment for intracranial aneurysms between July 2010 and July 2017 were reviewed retrospectively. Residuals, recurrences and re-treatment rates were assessed regarding initial aneurysm rupture status and applied endovascular technique: primary coiling, balloon- and stent-assisted coiling and flow diversion. Results Among 233 aneurysms, residual, recurrence and re-treatment rates were 27, 11.2 and 9.4%, respectively. Compared with unruptured aneurysms, similar residual and recurrence (p > .05), but higher re-treatment rates (4.5% vs. 19%; p < .001) were found for ruptured aneurysms. Residual, recurrence and re-treatment rates were: 13.3, 16 and 12% for primary coiling; 12, 12 and 10.7% for balloon-assisted coiling; 14.9, 7.5 and 4.5% for stent-assisted coiling; 91.9, 0 and 5.4% for flow diversion. Stent-assistance and flow-diversion were associated with lower recurrence and re-treatment rates, when compared with primary- and balloon-assisted coiling (p < .05). Conclusions Residuals and recurrences after endovascular treatment of intracranial aneurysms are less common than previously reported. Stent assistance and flow diversion seem associated with reduced recurrence- and re-treatment rates, when compared with primary- and balloon-assisted coiling. Restrained use of stents in ruptured aneurysms may be a contributing factor for higher recurrence/retreatment rates compared to unruptured aneurysms.

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Preliminary experience of stent-assisted coiling of wide-necked intracranial aneurysms with a single microcatheter

BMC Neurology ◽

10.1186/s12883-019-1470-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Keun Young Park ◽

Chang Ki Jang ◽

Jae Whan Lee ◽

Dong Joon Kim ◽

Byung Moon Kim ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Complete Occlusion ◽

Unruptured Aneurysms

Abstract Background The purpose of this study was to report our preliminary experience of stent-assisted coiling (SAC) of wide-necked intracranial aneurysms with a single microcatheter in patients with parent arteries that were small-caliber, with stenosis, or a very tortuous course. Methods Between March 2018 and December 2018, we treated 394 aneurysms in 359 patients with endovascular treatment. Among 197 aneurysms treated by SAC, there were 16 cases (all wide-necked unruptured aneurysms) treated by SAC with a single microcatheter and a Neuroform Atlas stent. Follow-up angiography was performed at 6 to 12 months after SAC, and clinical follow-up was performed from 6 to 12 months in all patients. Results The reasons for SAC with a single 0.0165-in. microcatheter were small-caliber (n = 4), stenosis (n = 2), and very tortuous course (n = 10) of the parent arteries. There was no complication related to delivering or deploying the Neuroform Atlas stent as well as no failure of selecting aneurysm by cell-through technique. All patients had a modified Rankin score of 0 at discharge and at follow-up. Initial angiographic results showed six cases (37.5%) of complete occlusion. In follow-up angiographies, 12 cases (75.0%) achieved compete occlusion. Conclusion When performing SAC of wide-necked intracranial aneurysms in parent arteries with small-caliber, stenosis, or a very tortuous course, cell-through SAC using a single microcatheter and a Neuroform Atlas stent within a 5 Fr- (or smaller) guiding or intermediate catheter might be a useful option.

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Abstract 1122‐000071: Large and Giant Intracranial Aneurysms, Clinico‐Radiological Outcome and Predictors with Flow Diverter Stent

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000071 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Islam El Malky ◽

Ayman Zakaria ◽

Essam Abdelhameed ◽

Hazem Abdelkhalek

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Flow Diverter ◽

Artery Occlusion ◽

Parent Artery ◽

Giant Aneurysms ◽

Complex Aneurysms ◽

Parent Artery Occlusion ◽

Large And Giant Aneurysms ◽

Flow Diverters

Introduction : Endovascular treatment for large and giant aneurysms has included either a reconstructive approach or a deconstructive approach by parent artery occlusion. 1,2 Stent‐assisted coiling and balloon‐assisted coiling were alternative techniques developed to deal with such complex aneurysms, but studies have shown less expected efficacy. This study aims to assess the safety and efficacy of the flow diverter stents for treating large and giant intracranial aneurysms and to examine possible predictors for radiological and clinical outcomes such as location and presence of branching artery, bifurcation, and adjuvant coiling. Methods : This study had been conducted on 65 consecutive patients with 65 large and giant aneurysms (size ≥ 10 mm) treated with flow diverters; Periprocedural complications were reported in all patients and clinical outcomes. Follow‐up angiography was done for 60 patients (92.3%) at 12 months. Results : The study included 65 patients who harbored 65 aneurysms. The median age was 55.5 years (IQR: 44.25 ‐ 62.75 years), the female represented 70.8 % of all patients. The clinical presentation had been reported (Headache, cranial nerve palsy, motor deficit, seizures, and visual field defect in 40 patients (61.5%), nine patients (13.8%), seven patients (10.8%), five patients (7.7%), and four patients (6.2%) respectively. The vascular risk factors had been reviewed (HTN, DM, smoking, and Hyperlipidemia in 25 patients (9.2%), Six patients (9.2%), sixteen (24.6%), and 10 patients (15.4%) respectively). The median size of aneurysms was 16.4 mm (IQR: 12.50 ‐ 23.85 mm) and the median neck width was 7.15 mm (IQR: 5.85‐10.24 mm). Fourteen aneurysms (21.4 %) had previous treatment, eleven aneurysms (16.9%) were treated by coils only, one case (1.5%) by assisted procedure, one case (1.5%) by previous FDS, and parent artery occlusion in one case (1.5%). Complete occlusion in 50 from 60 aneurysms (83.4%), neck remnant in 8 aneurysms (13.3%), and sac remnant in two aneurysms (3.3%). Periprocedural problems were encountered in 14 patients (21.5%) with morbidity in six patients (9.2%) and mortality in one patient (1.5%). Univariate and multivariate logistic regression analysis was used to discover possible predictors of combined mortality and morbidity and occlusion in Table (1). Conclusions : From this study, it could be concluded that Endovascular treatment of the large and giant aneurysms with flow diverters represents a safe method for treating this kind of complex intracranial aneurysms. Complex aneurysms with branching artery and bifurcation were associated with aneurysm persistence and complications respectively while the location of the aneurysm was the only predictor for clinical outcome.

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Large Population Multi-Center Study of Small Unruptured Intracranial Aneurysms in Prospective Cohorts: Initial Sac Morphology and Longitudinal Outcome

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80731 ◽

2012 ◽

Author(s):

Manasi Ramachandran ◽

Steve Lin ◽

Tatiana Correa ◽

Ben Dickerhoff ◽

B. Berkowitz ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Large Population ◽

Unruptured Aneurysms ◽

Longitudinal Outcome ◽

Unruptured Intracranial Aneurysms ◽

Prospective Cohorts ◽

Potential Factors ◽

Group 2 ◽

Multi Center Study ◽

Over Time

Most intracranial aneurysms (IA) that present unruptured at the clinic remain stable over time with no measurable change or symptoms, if left untreated. But a few do grow larger and occasionally rupture. The ability to preemptively identify aneurysms that will become unstable over time (i.e., those that will grow and/or rupture) can result in timely intervention for these few patients while avoiding unnecessary treatment for countless others [1]. Previous reports assessing potential factors including by our group [2–4] have been confined to comparing geometric and/or biomechanical indices of aneurysms between populations that presented with ruputred lesions from those that presented with unruptured lesions. But, such indices (that discriminate rupture ‘status’) need not necessarily distinguish unruptured aneurysms that fork toward growth and/or rupture over a period of time from those that remain stable over time. Further, the physician’s dilemma to treat or not to treat presents itself mostly only in small aneurysms (< 7mm).

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The Medina Embolic Device: early clinical experience from a single center

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012539 ◽

2016 ◽

Vol 9 (1) ◽

pp. 77-87 ◽

Cited By ~ 28

Author(s):

Marta Aguilar Perez ◽

Pervinder Bhogal ◽

Rosa Martinez Moreno ◽

Hansjörg Bäzner ◽

Oliver Ganslandt ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Internal Carotid ◽

Clinical Status ◽

Anterior Communicating Artery ◽

Major Step ◽

Unruptured Aneurysms ◽

True Value ◽

Unruptured Intracranial Aneurysms ◽

Flow Diverters

ObjectiveTo report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices.Methods15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices.ResultsThe MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant.ConclusionsThe MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion.

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