Microsurgical clipping of the anterior circulation aneurysms

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

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Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v23i4.383 ◽

2019 ◽

Vol 23 (4) ◽

Author(s):

MUHAMMAD JAHANGIR KHAN ◽

MUHAMMAD HAMMAD NASIR ◽

SIKANDAR ALI ◽

SARFRAZ KHAN ◽

MUHAMMAD WAQAS ◽

...

Keyword(s):

Anterior Communicating Artery ◽

Sex Distribution ◽

Surgical Clipping ◽

Anterior Circulation ◽

Efficient Treatment ◽

Microsurgical Clipping ◽

The Mean ◽

Anterior Circulation Aneurysms ◽

Grading Scales

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient.

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OLFACTORY DYSFUNCTION AFTER IPSILATERAL AND CONTRALATERAL PTERIONAL APPROACHES FOR CEREBRAL ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000350225.36099.0b ◽

2009 ◽

Vol 65 (4) ◽

pp. 727-732 ◽

Cited By ~ 28

Author(s):

Jaechan Park ◽

Sun-Ho Lee ◽

Dong-Hun Kang ◽

Jung-Soo Kim

Keyword(s):

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Olfactory Dysfunction ◽

Anterior Communicating Artery ◽

Pterional Approach ◽

Anterior Circulation ◽

Related Risk ◽

Lateral Distance ◽

Contralateral Pterional Approach ◽

Anterior Circulation Aneurysms

Abstract OBJECTIVE This study investigated olfactory dysfunction after using a contralateral or ipsilateral pterional approach for anterior circulation aneurysms and related risk factors. METHODS This study included 189 patients who experienced an aneurysmal subarachnoid hemorrhage and in whom a pterional approach was used, including a contralateral pterional approach (12 patients), a pterional approach for an anterior communicating artery (AComA) aneurysm (70 patients), and an ipsilateral pterional approach for aneurysms of the anterior circulation, excluding the AComA (107 patients). In addition to questionnaires on olfactory function, Sniffin' Sticks tests were performed 12 to 38 months after the operation. RESULTS The incidence of olfactory dysfunction was high: 58% (7 of 12) with a contralateral pterional approach, 14% (10 of 70) with a pterional approach for an AComA aneurysm, and 4% (4 of 107) with an ipsilateral pterional approach for aneurysms of the anterior circulation, except for the AComA. In addition, patients 55 years and older had a higher incidence of olfactory dysfunction. Among the 12 patients in whom the contralateral pterional approach was used, 5 (42%) were anosmic and 2 (17%) were hyposmic. The incidence of olfactory dysfunction was also significantly higher at ages 55 years and older. The size and location of the contralateral aneurysm, if small (<1 cm) and located within a 3-cm lateral distance from the midline, were not found to influence the incidence. CONCLUSION A higher incidence of olfactory dysfunction was found in those patients in whom a contralateral pterional approach and a pterional approach for an AComA aneurysm were used. Another major risk factor was an age of 55 years and older.

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Flow diversion of tandem cerebral aneurysms: a multi-institutional retrospective study

Neurosurgical FOCUS ◽

10.3171/2017.2.focus1731 ◽

2017 ◽

Vol 42 (6) ◽

pp. E10 ◽

Cited By ~ 4

Author(s):

Al-Wala Awad ◽

Karam Moon ◽

Nam Yoon ◽

Marcus D. Mazur ◽

M. Yashar S. Kalani ◽

...

Keyword(s):

Salt Lake ◽

Demographic Data ◽

Salt Lake City ◽

Cerebral Aneurysms ◽

Flow Diversion ◽

Single Session ◽

Anterior Circulation ◽

The Mean ◽

Lake City

OBJECTIVEFlow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms.METHODSThe authors conducted a retrospective review of flow diversion with the Pipeline embolization device (PED) for the treatment of tandem aneurysms in a single session at 2 participating medical centers: University of Utah, Salt Lake City, Utah, and Barrow Neurological Institute, Phoenix, Arizona. Patient demographic data, aneurysm characteristics, treatment strategy and results, complications, and follow-up data were collected from the medical record and analyzed.RESULTSBetween January 2011 and December 2015, 17 patients (12 female, 5 male) with a total of 38 aneurysms (mean size 4.7 ± 2.7 mm, mean ± SD) were treated. Sixteen patients had aneurysms in the anterior circulation, and 1 patient had tandem aneurysms in the posterior circulation. Twelve patients underwent only placement of a PED, whereas 5 underwent adjunctive coil embolization of at least 1 aneurysm. One PED was used in each of 9 patients, and 2 PEDs were required in each of 8 patients. There were 2 intraprocedural complications; however, in both instances, the patients were asymptomatic at the last follow-up. The follow-up imaging studies were available for 15 patients at a mean of 7 months after treatment (216 days, range 0–540 days). The mean initial Raymond score after treatment was 2.7 ± 0.7, and the mean final score was 1.3 ± 0.7.CONCLUSIONSIn this series, the use of flow diversion for the treatment of tandem cerebral aneurysms had an acceptable safety profile, indicating that it should be considered as an effective therapy for this complicated subset of patients. Further prospective studies must be performed before more definitive conclusions can be made.

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ANEURYSMS OF THE DISTAL ANTERIORCEREBRAL ARTERY

Neurosurgery ◽

10.1227/01.neu.0000249267.33945.e7 ◽

2007 ◽

Vol 60 (2) ◽

pp. 227-234 ◽

Cited By ~ 35

Author(s):

David A. Steven ◽

Stephen P. Lownie ◽

Gary G. Ferguson

Keyword(s):

Cerebral Artery ◽

Endovascular Coiling ◽

Anterior Circulation ◽

Operative Morbidity ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Grade Ii ◽

The Mean ◽

Distal Anterior Cerebral Artery ◽

Anterior Circulation Aneurysms

Abstract OBJECTIVE The aim of this study was to present the clinical and radiological characteristics, surgical management, and outcome in a large series of patients with aneurysms of the distal anterior cerebral artery (DACA) managed in the microsurgical era. METHODS The records of 1109 patients with anterior circulation aneurysms managed at the authors' institution between 1970 and 1998 were reviewed. RESULTS Fifty-nine patients (5.3%) were identified with 67 DACA aneurysms. Seventy-three percent of the patients were women. The mean age of all patients was 47 years. Multiple aneurysms were identified in 51% of all patients, most commonly on the middle cerebral artery. Thirty-six patients had ruptured DACA aneurysms and 23 had unruptured aneurysms. In those with ruptured aneurysms, the admission grade was Grade I in 10 patients (27.8%), Grade II in three patients (8.3%), Grade III in 10 patients (27.8%), Grade IV in seven patients (19.4%), and Grade V in six patients (16.7%). Frontal lobe hematomas occurred in 28% of the patients with ruptured aneurysms and carried a poor prognosis. In those with unruptured aneurysms, 11 were incidental and 12 were identified after a subarachnoid hemorrhage from another aneurysm. The mean diameter was 10 mm in ruptured aneurysms and 5.8 mm in unruptured aneurysms. Fifty-eight patients underwent surgery and one patient was treated with endovascular coiling. Six patients, all with ruptured aneurysms, died. Seventy percent of survivors with ruptured aneurysms had a favorable outcome. CONCLUSION DACA aneurysms possess a number of characteristics that distinguish them from the more common intracranial aneurysms. With modern neurosurgical and endovascular techniques, an acceptable operative morbidity and mortality can be achieved.

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Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Journal of Neurosurgery ◽

10.3171/2017.12.jns163090 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1376-1382 ◽

Cited By ~ 5

Author(s):

Badih Daou ◽

Elias Atallah ◽

Nohra Chalouhi ◽

Robert M. Starke ◽

Jeffrey Oliver ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Previous Treatment ◽

Anterior Circulation ◽

Pipeline Embolization Device ◽

Aneurysm Size ◽

Paraclinoid Aneurysms ◽

Long Term Follow Up ◽

The Mean ◽

Anterior Choroidal

OBJECTIVEThe Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty.METHODSElectronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment.RESULTSOf 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33–5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15–7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19–6.18; p = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03–1.09; p < 0.001) were associated with incomplete aneurysm occlusion.CONCLUSIONSWhile the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.

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Treatment of Distal Anterior Circulation Aneurysms With the Pipeline Embolization Device

Neurosurgery ◽

10.1227/neu.0000000000001117 ◽

2016 ◽

Vol 79 (1) ◽

pp. 14-22 ◽

Cited By ~ 50

Author(s):

Ning Lin ◽

Giuseppe Lanzino ◽

Demetrius K. Lopes ◽

Adam S. Arthur ◽

Christopher S. Ogilvy ◽

...

Keyword(s):

Cerebral Artery ◽

Anterior Communicating Artery ◽

Modified Rankin Scale ◽

Anterior Circulation ◽

Pipeline Embolization Device ◽

Long Term Follow Up ◽

Collective Experience ◽

Carotid Circulation ◽

Anterior Circulation Aneurysms

Abstract BACKGROUND Utilization of the Pipeline embolization device (PED) to treat distal carotid circulation aneurysms has not been well studied. OBJECTIVE: To report the collective experience of using PED to treat distal anterior circulation aneurysms. METHODS: We retrospectively reviewed clinical and radiographic records of all patients who underwent Pipeline embolization of distal anterior circulation aneurysms at 10 US neurosurgical centers between 2011 and 2013. RESULTS: Twenty-eight patients (mean age 51.7 years; 18 women) with 28 aneurysms were included in the analyses. Fifteen aneurysms were fusiform, 5 dissecting, and 8 saccular. Average aneurysm size was 12.3 mm; 7 were giant. Twenty aneurysms were located along the middle cerebral artery, 6 along the anterior cerebral artery, and 2 along the anterior communicating artery. PED deployment was successful in 27 patients, with coils utilized in 6 cases. Clinical follow-up was available for an average of 10.7 months (range 3-26). Twenty-seven patients had follow-up neurovascular imaging: 21 aneurysms had complete occlusion, 4 had residual neck filling, and 2 had residual dome filling. Periprocedural complications (<30 days) occurred in 3 patients (10.7%), including 1 case of device failure resulting in stroke. Outcomes were good (modified Rankin Scale score 0 to 2) in 27 patients (96.4%) and fair (modified Rankin Scale 3) in 1. CONCLUSION: PED can be utilized in the treatment of distal anterior circulation aneurysms with difficult anatomy for conventional surgical or endovascular techniques. Larger-scale studies with long-term follow-up are needed to further elucidate the durability of PED treatment and its effect on perforator-rich vascular segments.

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Techniques and outcomes of microsurgical management of ruptured and unruptured fusiform cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/2016.9.jns161165 ◽

2017 ◽

Vol 127 (6) ◽

pp. 1353-1360 ◽

Cited By ~ 7

Author(s):

Sam Safavi-Abbasi ◽

M. Yashar S. Kalani ◽

Ben Frock ◽

Hai Sun ◽

Kaan Yagmurlu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Patient Outcomes ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Vascular Bypass ◽

The Mean ◽

Annual Risk

OBJECTIVEFusiform cerebral aneurysms represent a small portion of intracranial aneurysms; differ in natural history, anatomy, and pathology; and can be difficult to treat compared with saccular aneurysms. The purpose of this study was to examine the techniques of treatment of ruptured and unruptured fusiform intracranial aneurysms and patient outcomes.METHODSIn 45 patients with fusiform aneurysms, the authors retrospectively reviewed the presentation, location, and shape of the aneurysm; the microsurgical technique; the outcome at discharge and last follow-up; and the change in the aneurysm at last angiographic follow-up.RESULTSOverall, 48 fusiform aneurysms were treated in 45 patients (18 male, 27 female) with a mean age of 49 years (median 51 years; range 6 months–76 years). Twelve patients (27%) had ruptured aneurysms and 33 (73%) had unruptured aneurysms. The mean aneurysm size was 8.9 mm (range 6–28 mm). The aneurysms were treated by clip reconstruction (n = 22 [46%]), clip-wrapping (n = 18 [38%]), and vascular bypass (n = 8 [17%]). The mean (SD) hospital stay was 19.0 ± 7.4 days for the 12 patients with subarachnoid hemorrhage and 7.0 ± 5.6 days for the 33 patients with unruptured aneurysms. The mean follow-up was 38.7 ± 29.5 months (median 36 months; range 6–96 months). The mean Glasgow Outcome Scale score for the 12 patients with subarachnoid hemorrhage was 3.9; for the 33 patients with unruptured aneurysms, it was 4.8. No rehemorrhages occurred during follow-up. The overall annual risk of recurrence was 2% and that of rehemorrhage was 0%.CONCLUSIONSFusiform and dolichoectatic aneurysms involving the entire vessel wall must be investigated individually. Although some of these aneurysms may be amenable to primary clipping and clip reconstruction, these complex lesions often require alternative microsurgical and endovascular treatment. These techniques can be performed with acceptable morbidity and mortality rates and with low rates of early rebleeding and recurrence.

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Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012946 ◽

2017 ◽

Vol 9 (7) ◽

pp. 679-685 ◽

Cited By ~ 37

Author(s):

Geoffrey P Colby ◽

Matthew T Bender ◽

Li-Mei Lin ◽

Narlin Beaty ◽

Judy Huang ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Good Alternative ◽

Flow Diversion ◽

Definitive Treatment ◽

Endovascular Coiling ◽

Anterior Communicating Artery ◽

Microsurgical Clipping ◽

Alternative Treatment Option ◽

Procedural Success

BackgroundFlow diversion represents a novel but definitive treatment for recurrent and difficult-to-coil aneurysms of the anterior communicating artery (ACoA) region, of which reports are limited.ObjectiveTo determine the effectiveness of the Pipeline embolization device (PED) in treating aneurysms in the ACoA region.MethodsWe retrospectively reviewed an IRB-approved database of patients with an aneurysm at a single institution for patients with ACoA or A1–A2 aneurysms treated with PED. Data analyzed included demographics, aneurysm characteristics, procedural details, follow-up results, and outcomes.ResultsA total of 50 procedures were performed on 41 patients, including seven patients who underwent bilateral ‘H-pipe’ PED placement. The average age was 56 years and 46% of the patients were female. The average aneurysm size was 4.5 mm, and two large (>10 mm) aneurysms were treated. The vessel of origin was either the ACoA (26 aneurysms, 63%) or the A1–A2 junction (15 aneurysms, 37%). Eighteen patients (44%) had prior subarachnoid hemorrhage and 20 had previously been treated either with clipping (6 aneurysms, 15%) or coiling (14 aneurysms, 34%). Procedural success was achieved in 48/50 cases (96%) and two cases were aborted. Coils were deployed adjunctively in two cases (4%). Procedural outcomes included no deaths, one major ischemic stroke (2%), and two patients with intracranial hemorrhage (4%). Complete aneurysm occlusion was achieved in 81% of patients at 6 months and 85% of patients at last follow-up digital subtraction angiography.ConclusionsThe PED can be used safely and effectively in the treatment of aneurysms of the ACoA region. This represents a good alternative treatment option to microsurgical clipping and endovascular coiling.

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Risk of Dependency Following Microsurgical Clipping in Good Grade Patients With Ruptured Anterior Circulation Aneurysms

Iranian Journal of Neurosurgery ◽

10.32598/irjns.7.1.6 ◽

2021 ◽

Vol 7 (1) ◽

pp. 49-56

Author(s):

Sundus Ali ◽

◽

Fauzia Sajjad ◽

Asif Shabbir ◽

Akmal Azeemi ◽

...

Keyword(s):

Surgical Techniques ◽

Neurological Deficits ◽

Anterior Circulation ◽

Microsurgical Clipping ◽

Operative Complications ◽

Good Grade ◽

Intraoperative Rupture ◽

The Impact ◽

Anterior Circulation Aneurysms

Background and Aim: Most good grade (WFNS I and II) patients who undergo microsurgical clipping achieve a favorable outcome. However, some independent patients before surgery face unfavorable outcomes after the operation, signifying the impact of microsurgical clipping. This study aimed to identify the risk of developing dependency in patients without previous neurological deficits. Methods and Materials/Patients: We reviewed 50 consecutive good grade patients with ruptured anterior circulation aneurysms who underwent microsurgical clipping between May 2017 and May 2020 in the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan. The clinical outcome at discharge and three months follow-up was assessed using the Glasgow Outcome Scale (GOS). Results: In this study, seven patients (14%) became dependent (GOS II and III) following clipping. Of whom, five patients (10%) suffered surgical insult in the form of intraoperative rupture (4%), post-op infarct (4%), and direct brain damage (2%). Conclusion: Patients without neurologic deficit pre-operatively still suffer unfavorable outcomes mainly due to operative complications. Vascular injuries remain the main cause of morbidity-producing dependency. Therefore, all surgical techniques must minimize the risk to vessels, both during dissection and at clip placement.

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Abstract 1122‐000142: Safety and Efficacy of Surpass Streamline for Intracranial Aneurysms: A Multicenter US Real‐World Experience (SESSIA)

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000142 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Juan Vivanco‐Suarez ◽

Alan Mendez‐Ruiz ◽

Farooqui Mudassir ◽

Cynthia B Zevallos ◽

Milagros Galecio‐Castillo ◽

...

Keyword(s):

Real World ◽

Intracranial Aneurysms ◽

The United States ◽

Chromium Alloy ◽

Cobalt Chromium ◽

Anterior Circulation ◽

Safety And Efficacy ◽

Post Marketing ◽

The Mean

Introduction : Flow diversion has established itself as standard treatment of wide complex intracranial aneurysms (IA). Its recognition has been validated with positive occlusion rates and favorable clinical outcomes. The Surpass Streamline (SS) flow diverter (FD) is a braided cobalt/chromium alloy implant with 72 or 96 wires approved by the FDA in 2018. The aim of this study is to determine the safety and efficacy of the SS in a post‐marketing large US cohort. Methods : We performed a multicenter, retrospective study for consecutive patients treated with the SS FD for IA between January 2018 and June 2021 in the United States. Inclusion criteria for participants were: 1. Adults (≥ 18 years) and 2. Treatment with SS FD for IA. Primary safety end point was a major ipsilateral stroke (increase in National Institutes of Health Stroke Scale Score of ≥ 4) or neurological death within 12 months. Primary efficacy was assessed using the 3‐point Raymond‐Roy (RR) occlusion scale on digital subtraction angiography (DSA) at 6‐12‐month follow‐up. Results : A total of 276 patients with 313 aneurysms were enrolled. The median age was 59 years and 199 (72%) were females. The most common comorbidities included hypertension in 156 (57%) subjects followed by hyperlipidemia in 76 (28%) patients. One hundred and twenty‐two (44%) patients were asymptomatic while subarachnoid hemorrhage was present in only 10 (4%) patients. A total of 143 (46%) aneurysms were left‐sided. Aneurysms were located as follows: 274 (88%) were in the anterior circulation with paraophthalmic being the most common in 120 (38%) followed by petrocavernous ICA in 81 (26%); 33 (11%) aneurysms were located in the posterior circulation with basilar trunk being the most common in 14 (5%). The mean maximum aneurysm dome width was 5.77 ± 4.7 mm, neck width 4.22 ± 3.8 mm and dome to neck ratio was 1.63 ± 1.3 mm. The mean number of SS FD implanted per aneurysm was 1.06 (range 1–3) with more than one SS FD implanted in 21 (7%) aneurysms. Modified Rankin Scale (mRS) of 0–2 was present in 206/213 (97%) patients at 6–12 month follow‐up. The complete aneurysm occlusion (RR 1) rate was 145/175 (83%) among subjects who had angiographic follow‐up at 6–12 months. Major stroke and death was encountered in 7 (2%) and 5 (1.8%) of the patients respectively. Conclusions : Our data represent the largest real‐world study using SS FD. These results corroborate its post‐marketing safety and efficacy for the treatment of intracranial aneurysms showing more favorable rates to the initial experience during SCENT trial.

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