Flow diversion of fusiform intracranial aneurysms

Griffin, Andrew; Lerner, Emily; Zuchowski, Adam; Zomorodi, Ali R.; Gonzalez, L. Fernando; Hauck, Erik F.

doi:10.1007/s10143-020-01332-0

Cited by 14 publications

(25 citation statements)

References 27 publications

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“…Further limitations in our study arise from its retrospective design, heterogeneity in PED delivery systems employed, variable follow-up times, inclusion of previously-treated aneurysms, and inclusion of a small number of fusiform aneurysms. 45 Additionally, while the number of patients in our study is large enough to reach broad conclusions about safety and efficacy, it is insufficient for high precision estimates.…”

Section: Discussionmentioning

confidence: 94%

Pipeline embolization of proximal middle cerebral artery aneurysms: A multicenter cohort study

et al. 2021

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Background and purpose Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort. Materials and methods Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Additional details were extracted for patients with complications. Results In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients. Conclusion Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes.

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Section: Discussionmentioning

confidence: 94%

Pipeline embolization of proximal middle cerebral artery aneurysms: A multicenter cohort study

et al. 2021

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“…The morphology of fusiform aneurysms is a predictor of incomplete occlusion after flow diverter treatment ( 13 ). Previous reports of intracranial fusiform aneurysms treated with flow diverter devices (FDD) have been based on small series studies, with an overall occlusion rate of 59–100% ( 7 – 10 ). In one meta-analysis of AC fusiform aneurysms located distal to the circle of Willis and PC fusiform aneurysms, Cagnaggo et al reported an occlusion rate of 83% ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Fusiform aneurysms were defined as aneurysmal dilatations of >50% of the vessel wall circumference without a discrete aneurysm neck ( 2 , 10 ). Aneurysms were categorized as fusiform based on 3D rotational digital subtraction angiography (DSA) findings, and all cases were reviewed for inclusion by the senior author.…”

Section: Methodsmentioning

confidence: 99%

“…Fusiform intracranial aneurysms are rare, and their unique morphology and pathological development continue to present a challenge for neurosurgical treatment ( 1 – 4 ). While the Pipeline Embolization Device (PED; Medtronic, Minneapolis, MN, USA) provides a treatment option for fusiform aneurysms, few studies have investigated this ( 5 – 10 ), especially in posterior circulation (PC) and anterior circulation (AC) fusiform aneurysms beyond the circle of Willis, for which PED use is off-label ( 11 ). Previous studies on fusiform aneurysms have mostly been single-center studies; the present study included data from multiple centers.…”

Section: Introductionmentioning

confidence: 99%

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Anterior Circulation Fusiform Aneurysms Have a Lower Occlusion Rate After Pipeline Embolization Device Treatment Than Posterior Circulation Fusiform Aneurysms: A Multicenter Cohort Study

Zou

et al. 2022

Front. Neurol.

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Objective:Intracranial fusiform aneurysms are uncommon and can occur in vessels of the anterior circulation (AC) or posterior circulation (PC). While flow diversion is one treatment option, research into Pipeline Embolization Device (PED) treatment is lacking. This study explored the efficacy and safety of PED treatment for intracranial fusiform aneurysms, and compared therapeutic effects between AC and PC aneurysms.MethodsIn the post-market multi-center cohort study of embolization of intracranial aneurysms with PED in China (PLUS) registry study, we retrospectively analyzed 71 fusiform aneurysms in 67 patients among 1,171 patients treated with a PED from November 2014 to October 2019. The general characteristics, perioperative status, aneurysm occlusion rate at the last follow-up angiography, and changes in modified Rankin Scale scores were analyzed. Aneurysms were divided into AC and PC groups, and univariate and multivariate analyses were conducted.ResultsThe study included 26 AC (25 patients) and 45 PC (42 patients) aneurysms. A total of 75 PEDs were used, an average of 1.1 PEDs were used, and the median follow-up was 6.7 months. Fifty aneurysms (71.4%) were occluded and twenty (28.5%) were incompletely occluded. There were significantly more occluded aneurysms in the PC group than in the AC group (12 vs. 38; P = 0.001). Risk factors for incomplete occlusion were AC aneurysms (P = 0.001) and a perforating artery originating from the aneurysm (P = 0.006). The mean modified Rankin Scale score was significantly lower at the last follow up than preoperatively (0.58 vs. 0.21; P = 0.0001).ConclusionNon-overlapping PED is a safe and effective treatment for both AC and PC fusiform aneurysms. The occlusion rate of AC fusiform aneurysms is lower than that of PC.

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“…In theory, FD plus coiling may be helpful, especially for ruptured acute IFCAs, because adjunctive coils can act as scaffolds to reduce foreshortening of the FD. In addition, the coils may also protect against delayed aneurysm rupture as stasis promoters and result in higher rates of IFCA occlusion (50,51). However, the effect of coiling assistance in FD deployment remains controversial in chronic IFCAs, and coiling does not prompt aneurysm occlusion (52).…”

Section: Fd Deploymentmentioning

confidence: 99%

Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects

et al. 2021

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Intracranial fusiform and circumferential aneurysms (IFCAs), especially those located on the main trunk, are uncommon and difficult to manage. Currently, literature focused on IFCAs on the main trunk of cerebral arteries is lacking. The treatment of IFCAs is still under debate. Therefore, in this review, we further explore the treatment of this complicated entity. In addition, we also present some interesting cases. Based on the literature review and our experience, we found that IFCAs are often located in the vertebrobasilar system and that ruptured or large symptomatic IFCAs are associated with increased mortality and higher rebleeding rates. The treatment strategies for IFCAs can be classified as deconstructive and reconstructive methods via open surgery and/or endovascular treatment (EVT). Currently, EVT is a popular method and the main therapeutic choice. In particular, flow diversion has revolutionized the treatment of IFCAs. Parent artery occlusion (PAO) with or without revascularization may still be considered a suitable choice. Complex IFCAs that cannot be resolved by EVT can also be treated via open surgery with or without extracranial–intracranial bypass. Targeted embolization for the weak points of IFCAs is a temporary or palliative choice that is rarely used. In summary, despite complications, both surgical treatment and EVT are effective options for appropriately selected cases. Due to the development of endovascular implants, EVT will have better prospects in the future.

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Flow diversion of fusiform intracranial aneurysms

Cited by 14 publications

References 27 publications

Pipeline embolization of proximal middle cerebral artery aneurysms: A multicenter cohort study

Pipeline embolization of proximal middle cerebral artery aneurysms: A multicenter cohort study

Anterior Circulation Fusiform Aneurysms Have a Lower Occlusion Rate After Pipeline Embolization Device Treatment Than Posterior Circulation Fusiform Aneurysms: A Multicenter Cohort Study

Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects

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