Flow diversion of tandem cerebral aneurysms: a multi-institutional retrospective study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Flow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors conducted a retrospective review of flow diversion with the Pipeline embolization device (PED) for the treatment of tandem aneurysms in a single session at 2 participating medical centers: University of Utah, Salt Lake City, Utah, and Barrow Neurological Institute, Phoenix, Arizona. Patient demographic data, aneurysm characteristics, treatment strategy and results, complications, and follow-up data were collected from the medical record and analyzed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Between January 2011 and December 2015, 17 patients (12 female, 5 male) with a total of 38 aneurysms (mean size 4.7 ± 2.7 mm, mean ± SD) were treated. Sixteen patients had aneurysms in the anterior circulation, and 1 patient had tandem aneurysms in the posterior circulation. Twelve patients underwent only placement of a PED, whereas 5 underwent adjunctive coil embolization of at least 1 aneurysm. One PED was used in each of 9 patients, and 2 PEDs were required in each of 8 patients. There were 2 intraprocedural complications; however, in both instances, the patients were asymptomatic at the last follow-up. The follow-up imaging studies were available for 15 patients at a mean of 7 months after treatment (216 days, range 0–540 days). The mean initial Raymond score after treatment was 2.7 ± 0.7, and the mean final score was 1.3 ± 0.7.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In this series, the use of flow diversion for the treatment of tandem cerebral aneurysms had an acceptable safety profile, indicating that it should be considered as an effective therapy for this complicated subset of patients. Further prospective studies must be performed before more definitive conclusions can be made.</jats:p></jats:sec>

The Minimum Distance May Affect Perioperative Complications and Completed Occlusions of Endovascular Treatment for Tandem Intracranial Aneurysms: A Multi-Institutional Retrospective Study

“…The complete occlusion rate in the coiling group was 77.4%, which is consistent with the current literature regarding both TAs [10,11] and single wide-necked IAs [14,15]. In the FDS treatment, the complete occlusion rate was reported to range from 85 to 90% in previous studies [6][7][8][9]. In our cohort, only 58.8% of the IAs achieved complete occlusion in the FDS group.…”

“…At the latest follow-up, 76.5% IAs achieved complete occlusion, and all patients had mRS scores of 0-1. At the same time, many studies have reported the safety and efficacy of FDS in management of tandem lesions [6][7][8][9]. However, there is still a debate over which treatment is better, and studies comparing the 2 strategies are still rare.…”

“…TAs are also clearly different from solitary IA [6][7][8][9][10][11]. Although there are several reports on treating tandem lesions with coiling or flow-diverting stent (FDS) [6][7][8][9][10][11], the existing literature on the treatment of TAs is limited Diagram of maximum distance and minimum distance. D1 is the minimum distance (length between the distal end of the proximal aneurysm and the proximal end of the distal aneurysm); D2 is the maximum distance (length between the proximal end of the proximal aneurysm to the distal end of the distal aneurysm).…”

Off-Label Application of Pipeline Embolization Device for Intracranial Aneurysms

“…1). Awad et al [27] reported PED treatment for tandem aneurysms in seventeen patients with a mean final Raymond-Roy score of 1.3±0.7. We had one unruptured, previously untreated M1 aneurysm that was found during the work-up of tinnitus in a 64-year-old female patient.…”

Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms

“…Initially, flow diversion was used to treat complex, giant and fusiform aneurysms. However, with more data available which supports the efficacy and safety of flow diverters for treatment of smaller (<7 mm) aneurysms, [21][22][23] the device is now being used more often in patients with small and less complex aneurysms. Given that the average size of a ruptured aneurysm was determined to lie between 6 mm and 7 mm, 24 it is important to consider treatment in patients with aneurysms approaching this size.…”