Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: a single-center series with special emphasis on covered cortical branches and perforating arteries

Gawlitza, Matthias; Januel, Anne-Christine; Tall, Philippe; Bonneville, Fabrice; Cognard, Christophe

doi:10.1136/neurintsurg-2015-011682

Cited by 98 publications

(69 citation statements)

References 25 publications

(28 reference statements)

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“…This phenomenon can be logically explained by the progressive flow reduction through the covered perforators into a brain area without adequate collateral feeders. This seems to be in line with the report by Gawlitza et al, 14 which noted that caliber reduction and asymptomatic occlusion of covered cortical branches and lacunar infarcts after FDD placement are common events, being reported in 41.2% of the procedures. No other complication occurred at the longerterm follow-up (> 24 months).…”

Section: Figsupporting

confidence: 92%

Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center

Briganti¹,

Leone²,

Cirillo

et al. 2017

Neurosurgical Focus

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OBJECTIVEFlow diversion has emerged as a viable treatment option for selected intracranial aneurysms and recently has been gaining traction. The aim of this study was to evaluate the safety and effectiveness of flow-diverter devices (FDDs) over a long-term follow-up period.METHODSThe authors retrospectively reviewed all cerebral aneurysm cases that had been admitted to the Division of Neurosurgery of the Università degli Studi di Napoli between November 2008 and November 2015 and treated with an FDD. The records of 60 patients (48 females and 12 males) harboring 69 cerebral aneurysms were analyzed. The study end points were angiographic evidence of complete aneurysm occlusion, recanalization rate, occlusion of the parent artery, and clinical and radiological evidence of brain ischemia. The occlusion rate was evaluated according to the O’Kelly-Marotta (OKM) Scale for flow diversion, based on the degree of filling (A, total filling; B, subtotal filling; C, entry remnant; D, no filling). Postprocedural, midterm, and long-term results were strictly analyzed.RESULTSComplete occlusion (OKM D) was achieved in 63 (91%) of 69 aneurysms, partial occlusion (OKM C) in 4 (6%), occlusion of the parent artery in 2 (3%). Intraprocedural technical complications occurred in 3 patients (5%). Postprocedural complications occurred in 6 patients (10%), without neurological deficits. At the 12-month follow-up, 3 patients (5%) experienced asymptomatic cerebral infarction. No further complications were observed at later follow-up evaluations (> 24 months). There were no reports of any delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, ischemic complications, or procedure- or device-related deaths.CONCLUSIONSEndovascular treatment with an FDD is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. In the present study, the authors observed effective and stable aneurysm occlusion, even at the long-term follow-up. Data in this study also suggest that ischemic complications can occur at a later stage, particularly at 12–18 months. On the other hand, no other ischemic or hemorrhagic complications occurred beyond 24 months.

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Section: Figsupporting

confidence: 92%

Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center

Briganti¹,

Leone²,

Cirillo

et al. 2017

Neurosurgical Focus

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show abstract

“…[15][16][17] In accordance with previous reports, transient symptoms were noted during the first follow-up months. 18 In our opinion, they were not related to in situ thrombotic events but rather to hemodynamic parameters. These events were not positively correlated with branch remodelling or occlusion; on the contrary, they were likely the expression of a regional decrease in perfusion, related to the presence of a moderately developed pial network, which might decrease the pressure gradient inside the jailed branch 17 but was not yet sufficient to compensate for the perfusion requirement.…”

Section: Discussionmentioning

confidence: 99%

Middle Cerebral Artery Bifurcation Aneurysms Treated by Extrasaccular Flow Diverters: Midterm Angiographic Evolution and Clinical Outcome

Iosif

Mounayer

Yavuz

et al. 2016

AJNR Am J Neuroradiol

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“…Gawlitza et al 17 found occlusion rates of just 33% after treatment of MCA and anterior communicating artery aneurysms with flow-diverter stents. The challenging factors for treating bifurcation aneurysms with flow diverters include the need to cover branch vessels and perforators with the flow-diverter stent and technical challenges with device delivery.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Coiling of Wide-Neck and Wide-Neck Bifurcation Aneurysms: A Systematic Review and Meta-Analysis

Zhao¹,

Yin

Lanzino³

et al. 2016

AJNR Am J Neuroradiol

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Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: a single-center series with special emphasis on covered cortical branches and perforating arteries

Cited by 98 publications

References 25 publications

Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center

Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center

Middle Cerebral Artery Bifurcation Aneurysms Treated by Extrasaccular Flow Diverters: Midterm Angiographic Evolution and Clinical Outcome

Endovascular Coiling of Wide-Neck and Wide-Neck Bifurcation Aneurysms: A Systematic Review and Meta-Analysis

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