Flow Diversion for the Treatment of Intracranial Aneurysms

Walcott, Brian P.; Stapleton, Christopher J.; Choudhri, Omar; Patel, Aman B.

doi:10.1001/jamaneurol.2016.0609

Cited by 121 publications

(64 citation statements)

References 48 publications

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“…Given the study size limitation, this represents a significant portion of the patients who developed PAO. As has been proposed earlier,19 it remains to be elucidated the optimal agents and duration of anticoagulation therapy post-flow diverter stent deployment. Our study provides further evidence that PAO may be associated with poor adherence to this therapy.…”

Section: Discussionmentioning

confidence: 98%

Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Macdonald

Shankar

2018

J NeuroIntervent Surg

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BackgroundThe efficacy of SILK flow diverters (SFD) in the management of cerebral aneurysms has been established. However, the risk of complications with parent artery occlusion (PAO) remains to be fully elucidated. The purpose of our study was to analyze intracranial aneurysms treated with SFDs and assess for occurrences and potential risk factors for PAO.Materials and methodsBetween September 2010 and September 2017, 34 patients were treated for intracranial aneurysms using SFDs at a Canadian institution. This database was retrospectively analyzed for frequency of PAOs and statistical analysis performed for potential contributing factors.ResultsFollowing treatment with SFDs, average clinical and imaging follow-ups were 31 and 22 months, respectively. PAOs were identified in 21% (7/34) of patients and occurred between 8 days and 1.5 years from intervention but only in 11.8% in those compliant to anti-platelet medications. These were all associated with anterior circulation aneurysms (P=0.131) and had no associated neurological deficits. Of these, 57% (4/7) had a fusiform morphology compared with only 19% (5/27) in non-occluded patients (P=0.039). The presence of clinical symptoms at the time of initial SFD intervention was significantly associated with PAO (P=0.021).ConclusionDelayed PAO is not an uncommon outcome of flow diverter deployment and could be seen up to 1.5 years after treatment with no associated neurological deficits. Anti-platelet non-adherence remains a risk factor for PAO. Fusiform morphology of the aneurysm and symptoms at the time of intervention were associated with subsequent occlusion.

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Section: Discussionmentioning

confidence: 98%

Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Macdonald

Shankar

2018

J NeuroIntervent Surg

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“…This is followed by endothelialization and, similar to cerebral aneurysms treated with flow-diverting stents or carotid bulb atherosclerotic ulcers, the excluded area (CaW pocket) resolves over time likely due to laminar thrombosis and vascular remodeling [12,13]. Scarce literature regarding stenting for symptomatic CaWs is available.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Experience with Stenting for Symptomatic Carotid Web

Haussen¹,

Grossberg²,

Koch³

et al. 2018

Intervent Neurol

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Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

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“…75 Currently ongoing trials investigating the long-term effectiveness of FDs will be of importance in further understanding the long-term adverse outcomes and safety of FD in the future. 75 Currently ongoing trials investigating the long-term effectiveness of FDs will be of importance in further understanding the long-term adverse outcomes and safety of FD in the future.…”

Section: Mechanism: Endothelializationmentioning

confidence: 99%

Flow diversion for treatment of intracranial aneurysms: Mechanism and implications

Chua

Silveira

Moore

et al. 2019

Annals of Neurology

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Flow diverters are new generation stents that have recently garnered a large amount of interest for use in treatment of intracranial aneurysms. Flow diverters reduce blood flow into the aneurysm, with redirection along the path of the parent vessel. Flow stagnation into the aneurysm and neck coverage with subsequent endothelialization are the important synergistic mechanisms by which the therapy acts. Several studies have examined the mechanisms by which flow diverters subsequently lead to aneurysm occlusion. This review aims to provide a general overview of the flow diverters and their mechanism of action and potential implications. ANN NEUROL 2019;85:793-800 View this article online at wileyonlinelibrary.com.

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Flow Diversion for the Treatment of Intracranial Aneurysms

Cited by 121 publications

References 48 publications

Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Multicenter Experience with Stenting for Symptomatic Carotid Web

Flow diversion for treatment of intracranial aneurysms: Mechanism and implications

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