Endovascular Treatment of Intracranial Aneurysms in the Flow Diverter Era: Frequency of Use and Results in a Consecutive Series of 550 Treatments in a Single Centre

Abstract

<jats:p> Flow diverter devices became available in our department in 2009. We considered treatment with flow diverters only in patients with aneurysms not suitable for surgery or conventional endovascular techniques. This paper presents our preliminary experience with flow diverters in a consecutive series of 550 endovascular aneurysm treatments. </jats:p><jats:p> Between January 2009 and July 2013, 550 endovascular treatments for intracranial aneurysms were performed. Of these, 490 were first-time aneurysm treatments in 464 patients and 61 were additional treatments of previously coiled aneurysms in 51 patients. Endovascular treatments consisted of selective coiling in 445 (80.8%), stent-assisted coiling in 68 (12.4%), balloon-assisted coiling in 13 (2.4%), parent vessel occlusion in 12 (2.2%) and flow diverter treatment in 12 (2.2%). </jats:p><jats:p> Eleven patients with 12 aneurysms were treated with flow diverters. Two patients had ruptured dissecting aneurysms. One patient with a basilar trunk aneurysm died of acute in stent thrombosis and another patient died of brain stem ischaemia at 32 months follow-up. One patient had ischaemia with permanent neurological deficit. Two aneurysms are still open at up to 30 months follow-up. </jats:p><jats:p> Flow diversion was used in 2% of all endovascular treatments. Both our own poor results and the high complication rates reported in the literature have converted our initial enthusiasm to apprehension and hesitancy. The safety and efficacy profile of flow diversion should discourage the use of these devices in aneurysms that can be treated with other techniques. </jats:p>

Treatment of ruptured intracranial aneurysms yesterday and now

“…Far distal aneurysms (14.2% to 38.2%; p < 0.0001) and the presence of an intracranial hematoma (8.9% to 20.1%; p = 0.0015) were the actual top reasons for microsurgical clipping in our study. Besides the standard coiling procedure many new endovascular occlusion techniques and devices like stent-assisted coiling procedures, WEB-devices and flow-diverters have been developed, which allow the treatment of aneurysms with unfavourable neck configuration [ 11 – 17 ]. Moreover, the ISAT-study resulted in a preference of the endovascular procedure for occlusion of ruptured intracranial aneurysms if both procedures (clipping and coiling) were possible [ 4 – 6 ].…”

Symptomatic Very Delayed Parent Artery Occlusion After Flow Diversion Stent Embolization

“…One of the serious complications associated with PED embolization are the parent artery occlusion due to the in-stent thrombosis. Although there are some reports of periprocedural in-stent thrombosis, 2 – 4) those of delayed in-stent thrombosis are scarce. Chiu et al (2015) reported two patients with delayed PED occlusions.…”

Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization

“…ticulostriate arteries (LSAs) or other arterial trunks, which can cause unintended occlusions and ischemic complications, 10,16,40,41,46,47 and devices such as intraaneurysmal flow diverters or bifurcation stents are new and unproven and have not been compared rigorously with the microsurgical standard. 5,27 Complex MCA aneurysms can be managed with bypass procedures when conventional clipping fails and a parent artery requires deliberate occlusion.…”