Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases

Bender, Matthew T.; Colby, Geoffrey P.; Jiang, Bowen; Lin, Li; Campos, Jessica K.; Xu, Risheng; Westbroek, Erick M.; Vo, Chau D.; Zarrin, David A.; Caplan, Justin M.; Huang, Judy; Tamargo, Rafael J.; Coon, Alexander L.

doi:10.1093/neuros/nyy076

Cited by 60 publications

(50 citation statements)

References 28 publications

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“…With published reports of safe off label use for aneurysms beyond the petrous to ophthalmic ICA and development of second generation FDS, the IFU has since expanded to small (<7 mm) and medium (7-15 mm), wide neck aneurysms of the entire intracranial ICA. To date, safe off-label use has been reported for cerebral aneurysms in most cerebrovascular territories with a parent vessel diameter of 2-5 mm 6,9,10,16,18,21,26,47,73,94,107,120,121) .…”

Section: Development Of Flow-diverting Stents (Fds)mentioning

confidence: 99%

“…Mortality rates were lower in the reconstructive group (4.0% vs. 10.0%) but the difference was not statistically significant. In a single center series of 59 cases, Bender et al 6) achieved 78% complete occlusion using FDS for posterior circulation aneurysms with a 9% complication rate. These results were somewhat at odds with contemporary case series, but the authors attributed their improved results to a preponderance of posterior circulation aneurysms isolated to the vertebral artery in their series 6) .…”

Section: Non-saccular and Posterior Circulation Aneurysmsmentioning

confidence: 99%

“…In a single center series of 59 cases, Bender et al 6) achieved 78% complete occlusion using FDS for posterior circulation aneurysms with a 9% complication rate. These results were somewhat at odds with contemporary case series, but the authors attributed their improved results to a preponderance of posterior circulation aneurysms isolated to the vertebral artery in their series 6) . While efficacy may have been less than traditional techniques, FDS was often associate with a relatively lower complication rate for posterior circulation aneurysms.…”

Section: Non-saccular and Posterior Circulation Aneurysmsmentioning

confidence: 99%

“…A common theme across studies is the association of parent artery occlusion or in-stent stenosis with discontinuation of antiplatelet agents 6,10,41,63,79) . Accordingly, FDS demands strict attention to DAPT and screening for clopidogrel non-responders -platelet function testing can be a meaningful adjunct in the later task 40) .…”

Section: Complications In Aneurysms Treated With Fdsmentioning

confidence: 99%

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The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

Shin

Carroll

Elghareeb

et al. 2020

J Korean Neurosurg Soc

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In spite of the developing endovascular era, large (15-25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.

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Section: Development Of Flow-diverting Stents (Fds)mentioning

confidence: 99%

Section: Non-saccular and Posterior Circulation Aneurysmsmentioning

confidence: 99%

Section: Non-saccular and Posterior Circulation Aneurysmsmentioning

confidence: 99%

Section: Complications In Aneurysms Treated With Fdsmentioning

confidence: 99%

See 2 more Smart Citations

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

Shin

Carroll

Elghareeb

et al. 2020

J Korean Neurosurg Soc

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show abstract

“…However, ow diversion in vertebral and basilar artery aneurysms carries a high risk of periprocedural stroke, and might be associated with high overall mortality. [14][15][16] Numerous studies showed that LVIS stents also have ow diverting effects to minimize aneurysmal hemodynamics. [7,17] Wang et al [7] quanti ed the ow diverting effects of the LVIS device, and compared the effect with the Pipeline device (Chestnut Medical Technologies, Menlo Park, CA) and the Enterprise stent.…”

Section: Angiographic Results At Follow-upmentioning

confidence: 99%

Endovascular Treatment of Vertebral and Basilar Artery Aneurysms with Low-Profile Visualized Intraluminal Support Device

Qiang

et al. 2020

Preprint

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Background: The Low-profile Visualized Intraluminal Support (LVIS) device is a self-expanding, nitinol, single-braid, closed-cell device that was recently developed for endovascular embolization of intracranial aneurysms. However, current knowledge regarding the use of LVIS devices to treat vertebral and basilar artery aneurysms is limited. We aimed to evaluate the feasibility, efficacy, and safety of the LVIS device for treating vertebral and basilar artery aneurysms.Methods: Between January 2015 and December 2017, patients with vertebral and basilar artery aneurysms treated using LVIS stents were enrolled in this study. We analyzed patients’ demographic, clinical and aneurysmal characteristics, procedural details, complications, and angiographic and clinical follow-up results.Results: We identified 63 patients with 64 vertebral and basilar artery aneurysms who underwent treatment with (n=59) or without (n=5) LVIS stenting, including 10 patients with ruptured aneurysms. Forty-one aneurysms were located at the vertebral artery, and 23 at the basilar artery. Intraprocedural-related complications developed in three (4.8%) patients, while none of these patients developed morbidities or died during follow-up. Three patients developed post-procedural complications (4.8%). Two patients experienced ischemic events immediately post-procedure. A minor permanent morbidity developed in one of the two patients (1.6%). The mortality rate was 1.6%, for that the patient died of brainstem hemorrhage after 1 month of follow-up. At a mean follow-up of 12.5 months, 39/43 (90.7%) patients had stable or improved aneurysms, and four (9.3%) had recanalized.Conclusions: Endovascular treatment of vertebral and basilar artery aneurysms with the LVIS device is feasible, safe, and effective in the short-term. Long-term and larger cohort studies are necessary to validate our results.

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Imagine a Giant Aneurysm in the Posterior Cerebral Artery: More Ultrasound Than Words

Deana¹,

Vetrugno

Bove

et al. 2020

J of Ultrasound Medicine

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Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases

Abstract: This is a large single-institution series of Pipeline (Medtronic Inc) for posterior circulation aneurysms and demonstrates acceptable safety and effectiveness in these challenging cases.

Cited by 60 publications

References 28 publications

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

Endovascular Treatment of Vertebral and Basilar Artery Aneurysms with Low-Profile Visualized Intraluminal Support Device

Imagine a Giant Aneurysm in the Posterior Cerebral Artery: More Ultrasound Than Words

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