Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion

2021 ◽  
pp. 159101992110240
Author(s):  
Andreas Simgen ◽  
Christine Mayer ◽  
Michael Kettner ◽  
Ruben Mühl-Benninghaus ◽  
Wolfgang Reith ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Complication Rates ◽  
Long Term Follow Up ◽  
Aneurysm Growth ◽  
Short And Long Term ◽  
Aneurysm Occlusion ◽  
Unruptured Cerebral Aneurysms

Purpose Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past years. Complete aneurysm occlusion is a process that often takes a certain amount of time and is usually difficult to predict. Our aim was to investigate different syngo iFlow parameters in order to predict aneurysm occlusion. Methods Between 2014 and 2018 patients with unruptured cerebral aneurysms treated with a FD were reviewed. Aneurysm occlusion and complication rates have been assessed. In addition, various quantitative criteria were assessed using syngo iFlow before, after the intervention, and after short and long-term digital subtraction angiography (DSA). Results A total of 66 patients hosting 66 cerebral aneurysms were included in this study. 87.9% (n = 58) aneurysms in the anterior and 12.1% (n = 8) in the posterior circulation were treated. Adequate aneurysm occlusion at long-term follow-up (19.05 ± 15.1 months) was achieved in 90.9% (n = 60). Adequately occluded aneurysm revealed a significantly greater peak intensity delay (PI-D, p = 0.008) and intensity decrease ratio (ID-R, p < 0.001) compared to insufficiently occluded aneurysms. Increased intra-aneurysmal contrast agent intensity (>100%) after FD implantation resulted in an ID-R < 1, which was associated with aneurysm growth during follow-up DSA. Retreatment with another FD due to foreshortening and/or aneurysm growth was performed in 10.6% (n = 7). Overall morbidity and mortality rates were 1.5% (n = 1) and 0%. Conclusion The applied syngo iFlow parameters were found to be useful in predicting adequate aneurysm occlusion and foresee aneurysm growth, which might indicate the implantation of another FD.

scholarly journals Two- to five-year follow-up of 78 patients after treatment with the Flow Redirection Endoluminal Device

2019 ◽  
Vol 26 (1) ◽  
pp. 38-44 ◽  
Author(s):  
Hannes Luecking ◽  
Arnd Doerfler ◽  
Philipp Goelitz ◽  
Philip Hoelter ◽  
Tobias Engelhorn ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Recurrence Rates ◽  
Distal Internal Carotid Artery ◽  
Aneurysm Growth ◽  
Aneurysm Occlusion ◽  
One Year ◽  
Related Mortality

Background and purpose Flow-diverter stents are well-established for the treatment of cerebral aneurysms. Flow Redirection Endoluminal Device differs from other flow-diverter stents by its dual-layer design and has proved equality to other devices in numerous short-term surveys. However, follow-up data covering substantially more than one year are still limited for this device. We present our long-term experience with Flow Redirection Endoluminal Device. Materials and methods Seventy-eight patients harboring distal internal carotid artery (91%) or vertebrobasilar (9%) cerebral aneurysms treated with Flow Redirection Endoluminal Device with or without adjunctive coiling met the inclusion criteria. All cases were evaluated for aneurysm occlusion (according to Modified Raymond Roy Classification, MRRC), for flow-diverter stents patency and configuration and for procedure- and device-related morbidity and mortality. Results Mean follow-up interval was 36.9 ± 9.5 months (<30 months: n = 18; 31–42 months: n = 31; >42 months: n = 24). Total and subtotal aneurysm occlusion after six months was assessed in 92.0% (MRRC1 = 77.3%, MRRC2 = 14.7%, MRRC3a =2.7%, MRRC3b = 4.1%) and increased to 95.9% (MRRC1 = 90.5%, MRRC2 = 5.4%, MRRC3a = 2.7%). There was one case of aneurysm growth requiring early re-treatment. Procedure-related morbidity was observed in three cases (3.8%; one transient hemiparesis, one suspected foreign-body reaction, and one micro-wire perforation). There was no procedure- or device-related mortality. In-stent stenosis due to intimal hyperplasia was observed in two cases and fish-mouthing in three cases. Conclusions Our long-term data covering two to five years after flow diversion confirm that Flow Redirection Endoluminal Device is a safe and effective device for the treatment of cerebral aneurysms with progressive high aneurysm occlusion rates; recurrence rates were very low. Overall device-related morbidity was low and was not observed later than six months after intervention.

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

2017 ◽  
Vol 42 (6) ◽  
pp. E3 ◽  
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.

scholarly journals Long-term Follow-up after Treatment for Cerebrovascular Disease. Semi-long-term Follow-up Results for the Treatment of the Unruptured Cerebral Aneurysms.

2002 ◽  
Vol 30 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Katsumi MATSUMOTO ◽  
Katsuhito AKAGI ◽  
Makoto ABEKURA ◽  
Tateo SAKAGUCHI ◽  
Takahiro TOMISHIMA ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Cerebral Aneurysms ◽  
Long Term Follow Up ◽  
Unruptured Cerebral Aneurysms

Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review

2020 ◽  
Vol 12 (7) ◽  
pp. 688-694
Author(s):  
Valerio Da Ros ◽  
Francesco Diana ◽  
Federico Sabuzi ◽  
Emanuele Malatesta ◽  
Antioco Sanna ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Treatment Options ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
Complication Rates ◽  
Lower Complication ◽  
Long Term Follow Up ◽  
Ischemic Complication

BackgroundThe management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed.MethodsWe retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed.ResultsSeven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt–Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3–72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up.ConclusionsThe best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.

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

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.

scholarly journals Cones and sleeves present good survival and clinical outcome in revision total knee arthroplasty: a meta-analysis

2021 ◽  
Author(s):  
Laura Theresa Fischer ◽  
Markus Heinecke ◽  
Eric Röhner ◽  
Peter Schlattmann ◽  
Georg Matziolis
Keyword(s):  
Aseptic Loosening ◽  
Meta Analysis ◽  
Fixation Method ◽  
Good Survival ◽  
Complication Rates ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Short And Long Term

Abstract Purpose The fixation of revision total knee arthroplasties (rTKA) tends to be difficult, leading to a reduction in implant survival. One option for achieving a more stable anchorage is to use metaphyseal cones and sleeves. The objective of the present paper is to provide a current comparative meta-analysis on survival and clinical results of cones vs. sleeves, with a differentiation between the short- and long-term outcome. Methods A search of the literature was conducted systematically to include original papers from 2010 to June 2021. The following parameters were taken into account: revision for aseptic loosening, revision for any reason, periprosthetic joint infections (PJI), KSS as well as KSFS. Studies with a mean follow-up of at least 60 months were defined to be long-term follow-up studies (LT). All other studies were included in the short-term (ST) study analysis. A pooled incidence was used as a summary statistic using a random intercept logistic regression model. Results The present meta-analysis included 43 publications with 3008 rTKA. Of these, 23 publications with 1911 cases were allocated to the sleeve group (SG) and 20 papers with 1097 cases to the cone group (CG). CG showed overall numerically higher complication rates in short- and long-term follow-up, compared with SG. Aseptic loosening occurred at a rate of 0.4% in SG (LT) and 4.1% in CG (LT) (p = 0.09). Periprosthetic joint infection (PJI) was more frequent in the cone group (7% in ST and 11.7% in LT) than in the sleeve group (3.4% in ST and 4.9% in LT, p = 0.02 both). The total revision rate was 5.5% in SG (LT) and 14.4% in CG (LT) (p = 0.12). The clinical scores were also comparable between the two groups. Hinged prothesis were used more frequent in the cone group (ST p < 0.001; LT p = 0.10), whereas CC type protheses were used more frequently in the sleeve group (ST p < 0.001; LT p < 0.11). Conclusions This meta-analysis takes into account the longest follow-up periods covered to date. Both cones and sleeves represent a reliable fixation method in the case of severe bone loss in rTKA, although the higher rate of PJI after cone fixation remains a source of concern. A metaphyseal fixation of hinged implants should be taken into account. Level of evidence II (meta-analysis).

Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results

2014 ◽  
Vol 120 (5) ◽  
pp. 1158-1171 ◽  
Author(s):  
Naci Kocer ◽  
Civan Islak ◽  
Osman Kizilkilic ◽  
Burak Kocak ◽  
Muzaffer Saglam ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Short Term ◽  
Radiological Data ◽  
Procedural Complication ◽  
Long Term Follow Up ◽  
Permanent Morbidity ◽  
Additional Device

Object Flow diverter (FD) stents are relatively new and important devices in the treatment of cerebral aneurysms. The Flow Re-Direction Endoluminal Device has been recently released for clinical use. The authors' aim in this paper is to report their initial single-center FRED experience with short-term results. Methods Between February 2012 and May 2013, 33 patients with 37 aneurysms (35 unruptured and 2 previously ruptured aneurysms) were treated with the FRED. Clinical and radiological data of the patients were retrospectively reviewed. Results In all patients only 1 device was used without any additional device or material, such as a stent or coil. All procedures were successfully performed. The procedural complication rate was 3% (1 of 33). Thirty patients underwent clinical and radiological follow-up. During the follow-up period, changes in stent morphology, such as “fish mouth” and “foreshortening” phenomena, occurred in 5 patients. The mortality and permanent morbidity rates were 0%. The complete occlusion rates were 32% (6 of 19) at 0–1 month, 67% (8 of 12) at 2–3 months, 80% (4 of 5) at 4–6 months, and 100% (8 of 8) at 7–12 months. The rates for some aneurysms were assessed at more than one time point. Conclusions The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid- and long-term follow-up results of multicenter large series.

Long-term follow-up of unruptured intracranial aneurysms repaired in California

2014 ◽  
Vol 120 (6) ◽  
pp. 1349-1357 ◽  
Author(s):  
David D. Gonda ◽  
Alexander A. Khalessi ◽  
Brandon A. McCutcheon ◽  
Logan P. Marcus ◽  
Abraham Noorbakhsh ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Treatment Groups ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Unruptured Cerebral Aneurysms ◽  
Aneurysm Repair

Object Using a database that enabled longitudinal follow-up, the authors assessed the long-term outcomes of unruptured cerebral aneurysms repaired by clipping or coiling. Methods An observational analysis of the California Office of Statewide Health Planning and Development (OSHPD) database, which follows patients longitudinally in time and through multiple hospitalizations, was performed for all patients initially treated for an unruptured cerebral aneurysm in the period from 1998 to 2005 and with follow-up data through 2009. Results Nine hundred forty-four cases (36.5%) were treated with endovascular coiling, 1565 cases (60.5%) were surgically clipped, and 76 cases were treated with both coiling and clipping. There was no significant difference in any demographic variable between the two treatment groups except for age (median: 55 years for the clipped group, 58 years for the coiled group, p < 0.001). Perioperative (30-day) mortality was 1.1% in patients with coiled aneurysms compared with 2.3% in those with clipped aneurysms (p = 0.048). The median follow-up was 7 years (range 4–12 years). At the last follow-up, 153 patients (16.2%) in the coiled group had died compared with 244 (15.6%) in the clipped group (p = 0.693). The adjusted hazard ratio for death at the long-term follow-up was 1.14 (95% CI 0.9–1.4, p = 0.282) for patients with endovascularly treated aneurysms. The incidence of intracranial hemorrhage was similar in the two treatment groups (5.9% clipped vs 4.8% coiled, p = 0.276). One hundred ninety-three patients (20.4%) with coiled aneurysms underwent additional hospitalizations for aneurysm repair procedures compared with only 136 patients (8.7%) with clipped aneurysms (p < 0.001). Cumulative hospital costs per patient for admissions involving aneurysm repair procedures were greater in the clipped group (median cost $98,260 vs $81,620, p < 0.001) through the follow-up. Conclusions For unruptured cerebral aneurysms, an observed perioperative survival advantage for endovascular coiling relative to that for surgical clipping was lost on long-term follow-up, according to data from an administrative database of patients who were not randomly allocated to treatment type. A cost advantage of endovascular treatment was maintained even though endovascularly treated patients were more likely to undergo subsequent hospitalizations for additional aneurysm repair procedures. Rates of aneurysm rupture following treatment were similar in the two groups.

scholarly journals Flow-diverter stents for endovascular management of non-fetal posterior communicating artery aneurysms—analysis on aneurysm occlusion, vessel patency, and patient outcome

2018 ◽  
Vol 24 (4) ◽  
pp. 363-374 ◽  
Author(s):  
Anna Luisa Kühn ◽  
Guilherme Dabus ◽  
Peter Kan ◽  
Ajay K Wakhloo ◽  
Ajit S Puri
Keyword(s):  
Flow Diverter ◽  
Aneurysm Rupture ◽  
Posterior Communicating Artery ◽  
Flow Diversion ◽  
New Findings ◽  
Vessel Patency ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Use of flow-diversion technology in the treatment of incidental and recanalized posterior communicating artery (PComA) aneurysms. Methods Patients treated with the Pipeline embolization device (PED) for PComA aneurysms were identified and included in our retrospective analysis. We evaluated aneurysm characteristics, modified Rankin Scale score (mRS) on admission, angiography follow-up, and patient clinical outcome at discharge, at three to nine months, and at 12–18 months. Results We included 56 patients with a mean age of 56 years. Median mRS on admission was 0. All aneurysms involved the PComA and were either new findings or found to have shown recanalization at angiography follow-up from previous coil embolization or surgical clipping. Intraprocedural device foreshortening was observed in one case requiring additional placement of a self-expanding stent. One intraprocedural aneurysm rupture occurred because of a broken distal wire. This patient had an mRS of 4 after the procedure. Three- to nine-month and 12- to 18-month follow-up angiography showed near complete or complete aneurysm occlusion in most cases. Minimal to mild intimal hyperplasia was seen in five cases at three to nine months. PComA patency over time showed 29 of 46 initially patent vessels still patent at six months. Thirteen and seven PComAs showed progressive decrease in flow at three to nine months and 12–18 months, respectively. Median mRS remained 0 for all patients at three- to nine-month and 12- to 18-month follow-up. Conclusions Our preliminary results show that flow-diversion technology is an effective and safe treatment option. Larger studies with long-term follow-up are needed to validate our promising results.

Sign in / Sign up

Export Citation Format

Share Document