Endovascular Treatment of Intracranial Aneurysms With Flow Diverters

Brinjikji, Waleed; Murad, M. Hassan; Lanzino, Giuseppe; Cloft, Harry J.; Kallmes, David F.

doi:10.1161/strokeaha.112.678151

Cited by 734 publications

(571 citation statements)

References 35 publications

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“…4,[6][7][8] Our current series of 12 patients demonstrated that the use of these small devices is technically feasible and safe, with excellent clinical and radiologic outcomes at a median latest follow-up of 1.5 years. The rates of occlusion (75%) and near-or complete occlusion (92%) are similar to overall data published for flow-diversion treatment (76% complete occlusion at 1 year), 9 and our current series comprises 50% posterior circulation aneu- rysms, which are known to carry higher rates of complications. The early morbidity rate of 8% is similar to the established 5%-7% seen in overall data, 9,10 and no aneurysm ruptures or delayed complications were observed among these data, whereas published data suggest a late morbidity of 3% and mortality of 1%.…”

Section: Discussionsupporting

confidence: 86%

Small Pipes: Preliminary Experience with 3-mm or Smaller Pipeline Flow-Diverting Stents for Aneurysm Repair prior to Regulatory Approval

Martín¹,

Cruz

O’Kelly

et al. 2014

AJNR Am J Neuroradiol

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SUMMARY:Flow diversion has become an established treatment option for challenging intracranial aneurysms. The use of small devices of Յ3-mm diameter remains unapproved by major regulatory bodies. A retrospective review of patients treated with Pipeline Embolization Devices of Յ3-mm diameter at 3 Canadian institutions was conducted. Clinical and radiologic follow-up data were collected and reported. Twelve cases were treated with Ն1 Pipeline Embolization Device of Յ3-mm diameter, including 2 with adjunctive coiling, with a median follow-up of 18 months (range, 4 -42 months). One patient experienced a posttreatment minor complication (8%) due to an embolic infarct. No posttreatment hemorrhage or delayed complications such as in-stent stenosis/thrombosis were observed. Radiologic occlusion was seen in 9/12 cases (75%) and near-occlusion in 2/12 cases (17%). Intracranial aneurysm treatment with small-diameter flow-diverting stents provided safe and effective aneurysm closure in this small selected sample. These devices should be further studied and considered for regulatory approval.

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Section: Discussionsupporting

confidence: 86%

Small Pipes: Preliminary Experience with 3-mm or Smaller Pipeline Flow-Diverting Stents for Aneurysm Repair prior to Regulatory Approval

Martín¹,

Cruz

O’Kelly

et al. 2014

AJNR Am J Neuroradiol

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“…Ischemic strokes may develop as a result of thrombus and distal thromboembolic events forming along the stent wall. Encountering ischemic strokes is higher in large and giant aneurysms (1). Also in our study, a multiple number of embolic infarctions developed in the right cerebral hemisphere in one patient one day after intervention.…”

Section: Discussionsupporting

confidence: 70%

“…The reason is insufficiency of collateral circulation and sensitivity of brain stem formations to perfusions (1). So, no endovascular treatments should be performed in posterior circulation, unless necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Flow diverter stents are safe and reliable therapeutic modalities in the treatment of wide-necked intracranial aneurysms (1). In the treatment of wide-necked large and giant aneurysms inappropriate for embolization with coils, the use of flow diverter stents are becoming more widespread with increased rates of aneurysm occlusion, and decreased complications and mortality levels (2-4).…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Flow Diverter Stents in the Treatment of Wide-Necked Intracranial Aneurysms

Özdemır

Arslan²,

Duman

et al. 2017

Iran J Radiol

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Background: To present our findings obtained from the treatment of wide-necked intracranial aneurysms with flow diverter stents. Patients and Methods: Intracranial aneurysms were determined in 19 patients (14 females, 5 males; mean age, 56.6 years) between May 2011 and June 2014, and the patients were treated using flow diverter stents. A total of 28 flow diverter stents, including 9 Silk and 19 Pipeline stents were used. Occlusion rates evaluated with computed tomography at the end of month 6 and digital subtraction angiography after one year, intraoperative success, morbidity and mortality rates were determined. Results: A total of 20 endovascular interventions, including two interventions in two different aneurysms in one patient were performed in 19 patients. Flow diverter stents were successfully implemented for wide-necked aneurysms at a success rate of 100%. Coil treatment had previously been performed in four patients. Aneurysm occlusion rates were 77.2% at month 6 and 90.9% at the end of month 12. Conclusions: The use of flow diverter stents is a reliable and effective method in the treatment of wide-necked intracranial aneurysms with high aneurysm occlusion, and low morbidity and mortality rates.

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“…As reported in recent meta-analyses, early and late complication rates of the technique were not negligible. 2,6 At present, inhomogeneity of practices exists regarding intracranial arterial locations where flow diverters are considered safe for use. In the US flow diverters are FDA approved only for ophthalmic segments of the ICA.…”

Section: Supplementary Comparison With the Department's Series Of Stementioning

confidence: 99%

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Iosif

Camilleri²,

Saleme

et al. 2015

JNS

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abbreviatioNs ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACoA = anterior communicating artery; ARU = aspirin reaction unit; cICA = cavernous segment of the internal carotid artery; DSA = digital subtraction angiography; DWI = diffusion-weighted imaging; ECA = external carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; OKM = O'Kelly and Marotta; PCoA = posterior communicating artery; PRU = P2Y12 reactivity unit; SAH = subarachnoid hemorrhage; VA = vertebral artery. submitted November 22, 2013. accepted October 7, 2014. iNclude wheN citiNg Published online January 6, 2015; DOI: 10.3171/2014.10.JNS132566. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect It was initially considered safe for flow-diverting stents to cover the ostia of branching vessels during endovascular procedures for the treatment of intracranial aneurysms. As more recent evidence suggests, however, their use is not always free of ischemic concerns in terms of covered arterial ostia. The authors sought to determine the frequency of silent and clinically evident diffusion-weighted imaging (DWI)-detected abnormalities related to stent placement as a means of elucidating potential clinical risks. methods This is a prospective single-center study on a series of patients with intracranial aneurysms that were treated with flow-diverting stents. All patients systematically underwent an MRI protocol that included DWI before treatment, between 24 and 48 hours postprocedure, and 3 months postembolization. Effectiveness of anticoagulation treatment was assessed for all patients. Lesions seen on DWI were correlated to the parent artery and the side-branch territories and were statistically analyzed in relation to their time of occurrence and clinical presentation. The authors compared the DWI findings in these patients to findings obtained in patients treated with a stent-assisted coiling technique during the same time period. results Over the course of 18 consecutive months, 38 consecutive patients (7 males and 31 females) with 49 intracranial aneurysms were treated using flow-diverting stents. Overall, 81.6% of the DWI spots found remained clinically silent during the follow-up period. Five ischemic clinical complications (13.2%) occurred in the postprocedural period. No statistically significant correlation could be established between DWI spots or aneurysm location and clinical complications or follow-up modified Rankin Scale score at 3 months. The complication rate was 7.8% (n = 3) at the 3-month follow-up, and mortality was 0%. Compared with stent-assisted coiling, use of flow-diverting stents showed a statistically significant correlation with silent DWI findings postintervention. coNclusioNs Lesions seen on DWI resulting from the procedure are far more common than anticipated, but the technique remains safe and effective, providing an interesting alternative for "difficult" aneurysms, regardless of ...

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Endovascular Treatment of Intracranial Aneurysms With Flow Diverters

Cited by 734 publications

References 35 publications

Small Pipes: Preliminary Experience with 3-mm or Smaller Pipeline Flow-Diverting Stents for Aneurysm Repair prior to Regulatory Approval

Small Pipes: Preliminary Experience with 3-mm or Smaller Pipeline Flow-Diverting Stents for Aneurysm Repair prior to Regulatory Approval

The Efficacy of Flow Diverter Stents in the Treatment of Wide-Necked Intracranial Aneurysms

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

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