scholarly journals Hemodynamic analysis for endovascular treatment in small unruptured intracranial aneurysms: a matched comparison study of flow diverter versus LVIS

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jian Liu ◽  
Wenqiang Li ◽  
Yisen Zhang ◽  
Kun Wang ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Clinical Analysis ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate ◽  
Two Parameters

Abstract Background We compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment. Methods Fifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent, which were defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match. Results There was no difference in procedural complications between the two groups (P = 0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs. 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in the PED group achieved 100%, which was higher than that in the LVIS group (98.0%). Compared with the LVIS group after treatment, cases in the PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs. 0.01 ± 0.01, P = 0.037) and WSS on the aneurysm (2.32 ± 5.40 vs. 0.33 ± 0.47, P = 0.011). Consequently, the reduction ratios of these two parameters also showed statistical differences. These parameters in the LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. Conclusions Both LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.

scholarly journals Hemodynamic Analysis for Endovascular Treatment in Small Unruptured Intracranial Aneurysms: A Matched Comparison Study of Flow Diverter Versus LVIS

2021 ◽  
Author(s):  
Jian Liu ◽  
Wenqiang Li ◽  
Yisen Zhang ◽  
Kun Wang ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Clinical Analysis ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Key Factor ◽  
Occlusion Rate ◽  
Two Parameters

Abstract BackgroundWe compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment.MethodsFifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study, and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who treated with LVIS stent, which defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match.ResultsThere was no difference in procedural complications between two groups (P=0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in PED group achieved 100%, which was higher than that in LVIS group (98.0%). Compared with the LVIS group after treatment, cases in PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs 0.01 ± 0.01, P=0.037) and WSS on the aneurysm (2.32 ± 5.40 vs 0.33 ± 0.47, P=0.011). Consequently, the reduction ratios of these two parameters were also showed statistical differences. These parameters in LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. ConclusionsBoth LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.

scholarly journals Flow diverter neuroendovascular stents – Reconstructive endovascular treatment of intracranial aneurysms – Single centre experience

2013 ◽  
Vol 02 (02) ◽  
pp. 182-188 ◽  
Author(s):  
Krzysztof Kadzioloka ◽  
Laurent Estrade ◽  
Laurent Pierot ◽  
Girish Rajpal
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Antiplatelet Agents ◽  
Flow Diverter ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Digital Subtraction Angiogram ◽  
Age Range

AbstractFlow diverter stents (FDS) are new neuroendovascular tools able to achieve the complete and curative treatment of aneurysm by reconstruction of the parent arteries from which the aneurysm arises. We present our initial experience with flow diverter embolization devices and follow-up results.Patients with large, giant and wide necked aneurysms, saccular, fusiform and recurrent aneurysms were selected for the treatment. All patients were pretreated with dual antiplatelet agents at least for 7 days before procedure and continued taking both agents for 3 months after treatment. A MRI was done after 3 months of treatment and digital subtraction angiogram was performed at 4 months of treatment. After 1 year both MRI and digital subtraction angiogram was performed.11 patients (age range 37 year to 79 year, mean 51.1) with 11 intracranial aneurysms were treated with 15 flow diverter stents. 9 aneurysm were located on the anterior circulation and 2 on posterior circulation. 8 aneurysms were large (10-25 mm), 2 were small (<10 mm) and 1 was giant (>25 mm) with mean largest diameter of 13.22 mm. 9 were saccular aneurysm and 2 were fusiform, out of these 3 were remnant of the previously treated aneurysm. Treatment was achieved with 10 Silk stents in 7 patients and 5 Pipeline embolization devices in 4 patients. The mean time between treatment and follow up was 9.6 months (range 4-12 months). One mortality was noted due to rebleed after 3 weeks of treatment. Complete angiographic occlusion was achieved in 9 (90%) patients after 4 months and 1 (10%) patient had near complete occlusion at 12 months. All the patients were stable clinically during follow up period.Endovascular treatment with FDS is safe, easy, and permanent treatment for the selected group of aneurysms. The complete occlusion rate in follow-up study approaches 100% with no angiographic recurrence in this study.

scholarly journals Solitaire AB Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Benjamin Gory ◽  
Joachim Klisch ◽  
Alain Bonafé ◽  
Charbel Mounayer ◽  
Remy Beaujeux ◽  
...  
Keyword(s):  
Prospective Study ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Mean Width ◽  
Mean Diameter ◽  
The Mean ◽  
Wide Neck

Abstract BACKGROUND: Endovascular treatment of intracranial aneurysms can be technically difficult when the neck is wide. The Solitaire AB stent (Covidien, Irvine, California), the only fully retrieved stent, assists in the coiling of wide-neck intracranial aneurysms. OBJECTIVE: To evaluate the mid-term angiographic follow-up of wide-necked aneurysms treated with the Solitaire AB stent. METHODS: SOLARE (SOLitaire Aneurysm Remodeling) is a consecutive, prospective study conducted in 7 European centers. A core laboratory evaluated the postoperative and mid-term (6 month ± 15 days) angiographic results by using the Raymond classification Scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement in the Raymond scale score. RESULTS: The mean width of the aneurysm sac was 7.5 mm, and the mean diameter of the aneurysm neck was 4.7 mm. Angiographic mid-term follow-up was obtained in 55 of 65 aneurysms (85.9%). Complete occlusion was achieved in 33 aneurysms (60%); a neck remnant was seen in 16 aneurysms (29.1%) and an aneurysm remnant in 6 aneurysms (10.9%). Of 55 aneurysms, recanalization was observed in 8 aneurysms (14.5%), and progressive thrombosis was observed in 17 aneurysms (30.9%). No bleeding or rebleeding was observed during the follow-up period. CONCLUSION: Stent-assisted coiling of wide-necked intracranial aneurysms was found to be safe and effective with the Solitaire AB stent at 6-month follow-up. Angiographic results improve with time due to progressive thrombosis of the aneurysm.

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

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

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.

scholarly journals Endovascular Treatment of Unruptured Intracranial Aneurysms

2011 ◽  
Vol 17 (4) ◽  
pp. 420-424 ◽  
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.

Intracranial aneurysms managed by parent artery reconstruction using Tubridge: Study protocol for a prospective, multicenter, post-market clinical trial

2020 ◽  
pp. 159101992097623
Author(s):  
Qiaowei Wu ◽  
Li Li ◽  
Qiuji Shao ◽  
Tianming Xu ◽  
Kaitao Chang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Reconstruction Technique ◽  
Long Term Outcomes ◽  
Complete Occlusion ◽  
Post Market ◽  
Occlusion Rate

Background As a new endovascular reconstruction technique, flow diverter (FD) shows excellent efficacy and safety for treatment of intracranial aneurysms. In a previous multicenter, randomized, controlled, pre-market study, Tubridge FD showed remarkably higher complete occlusion rate compared with traditional stent-assisted coiling. However, a nonsignificant higher complication rate in the Tubridge group was noted. Considering the learning curve, the safety, and long-term outcomes of Tubridge FD should be verified in new prospective, real world, multicenter, post-market trials. Methods This study is a prospective, multicenter, single-arm, post-market clinical trial that evaluates the safety and efficacy of Tubridge in the treatment of patients with intracranial aneurysms by reconstructing parent artery. We expect 200 participants who meet the inclusion and exclusion criteria to be included. Clinical information and angiographic results (Raymond–Roy grading scale, RRGS) will be recorded objectively. The primary endpoint will be the complete occlusion rate of the target aneurysm (RRGS 1) at 12-month follow-up. Secondary endpoints will include the adequate occlusion rate (RRGS 1 & 2) and the rate of major in-stent stenosis (>50%) at 12-month follow-up, technique success rate, changes of modified Rankin Scale before and after the procedure, the rate of aneurysm related disability, neurological mortality, and all-cause mortality within follow-up period. Discussion This post-market, prospective trial may offer more information on the safety and long-term outcomes of Tubridge FD. When the study is complete, the results may provide us a new strategy for the treatment of intracranial aneurysms. Trial registration: WHO-Chinese Clinical Trial Registry: ChiCTR2000032282.

scholarly journals Long-term occlusion results with SILK flow diversion in 28 aneurysms: Do recanalizations occur during follow-up?

2015 ◽  
Vol 21 (3) ◽  
pp. 300-310 ◽  
Author(s):  
Anastasios Mpotsaris ◽  
Martin Skalej ◽  
Oliver Beuing ◽  
Bernd Eckert ◽  
Daniel Behme ◽  
...  
Keyword(s):  
Prospective Study ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Success Rates ◽  
Imaging Data ◽  
Complete Occlusion ◽  
Complex Aneurysms ◽  
Multicenter Prospective Study

Background and purpose The purpose of this article is to report on the long-term success rates of Silk flow-diverter (FD) treatment in a multicenter prospective study for the treatment of complex aneurysms. Methods Between May 2008 and January 2011, all consecutive patients featuring complex intracranial aneurysms eligible for FD treatment with the Silk in three neurovascular centers were included. Clinical and imaging data were assessed during hospitalization and follow-up. Results Five patients were initially asymptomatic, 20 patients showed various neurological symptoms. Twenty-eight FDs were implanted in 25 patients treating 28 aneurysms. The immediate procedure-related morbidity was 8% (two of 25), mortality 0%. One procedure-related death was observed during follow-up (in-stent thrombosis). Compared to the immediate result nearly two of three aneurysms improved during follow-up; all angiographically confirmed inflow changes took place within six months after treatment. Final anatomic outcome in 24 aneurysms of 22 patients comprised 14 (59%) with complete occlusion, seven (29%) with a neck remnant, two (8%) with residual filling <50%, none with residual filling >50% and one (4%) unchanged in comparison to its pretreatment status. Postinterventional recanalizations were seen in three of 13 (23%) aneurysms treated with FD alone; none were observed in 15 aneurysms treated with adjunctive coiling. Conclusion Anatomic presentation and location are key for successful FD treatment. The rate of successful occlusion increases during follow-up. Postinterventional monitoring for at least six months is paramount, as anatomic outcome is not reliably predictable and recanalizations may occur in initially completely occluded aneurysms.

scholarly journals Single-Center Retrospective Series of Intracranial Aneurysms Treated with the Barricade Coil System: Immediate and Six-Month Results

2020 ◽  
Vol 74 (3) ◽  
pp. 181-187
Author(s):  
Kārlis Kupčs ◽  
Aigars Lācis ◽  
Zane Saleniece ◽  
Helmuts Kidikas
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Stent Implantation ◽  
Intracranial Aneurysms ◽  
Neurological Symptoms ◽  
University Hospital ◽  
Complete Occlusion ◽  
Coil System ◽  
Unruptured Intracranial Aneurysms ◽  
First Choice

AbstractIntracranial aneurysms (IAs) are most commonly found at the branch points of large arteries that form the circle of Willis. The prevalence of IAs in the adult population is 1–5%. IAs rupture is associated with subarachnoid haemorrhage (SAH) in 6–8 cases per 100 000 population, causing mortality in 40–50%. Aneurysm treatment is used to prevent rupture or rebleeding (for ruptured IAs). Randomised trials demonstrated the superiority of endovascular treatment (EVT) of ruptured aneurysms with coil systems over surgery. The objective of the study was to evaluate the effectiveness of the Barricade coil system in the treatment of intracranial aneurysms. Detachable platinum coils, since their introduction 25 years ago, have become the first choice EVT method for ruptured and unruptured IAs and have shown acceptable mortality (~2%). The retrospective study of intracranial aneurysms treated with the Barricade coil system at Pauls Stradiņš Clinical University Hospital (Rīga, Latvia) conducted in a 20-month period included 95 patients and 97 IAs. Thirty-one (32.6%) males and 64 (67.4%) females with median age 56 ± 15 years underwent endovascular treatment. The minority, 22 (23.16%) patients, were asymptomatic, while 73 (76.84%) patients had neurological symptoms directly associated with aneurysm progression and SAH development. Preoperatively, 52 (53.6%) aneurysms were ruptured, causing SAH, and 24 (25.26%) patients with unruptured IAs had neurological symptoms. Sixty-four (66.0%) IAs were treated using coils without neurovascular stent implantation or balloon assistance, 22 (22.7%) — with coils and stent implantation, and 11(11.3%) aneurysms were embolised with balloon-assisted coiling. The immediate anatomical result of endovascular treatment of IAs and technical success of aneurysm coiling was evaluated using the simplified Raymond scale. In the majority of cases, complete occlusion of the aneurysm was achieved while residual neck of the aneurysm or aneurysm remnant was uncommon. Immediate clinical results were evaluated using the modified Rankin scale (mRs). The majority of patients had favourable immediate clinical outcome (mRs 0–2), but four (4.21%) patients died in 1–6 days after the procedure as a consequence of SAH. In 72 (75.79%), patients no new neurological pathological symptoms developed 2–3 days after endovascular procedure and they were discharged from the hospital. Intraprocedural complications occurred in 4 (4.21%) cases. Technical issues occurred in two (2.1%) patients. In 19 (20%) patients, neurological symptoms remained even after the procedure, six (6.32%) patients had clinical worsening, and we had one case of procedural related mortality. Six-month follow-up evaluation was performed for 58 (61.0%) patients (59 IAs). In the majority of cases, complete occlusion of the aneurysm and favourable clinical outcome (mRs 0–2) was observed. Our experience showed that the treatment of ruptured and unruptured intracranial aneurysms with the Barricade coil system is feasible, effective, clinically safe and has a low risk of intraprocedural complications.

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

2019 ◽  
Vol 26 (1) ◽  
pp. 45-54 ◽  
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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