Flow-diverter devices in the treatment of intracranial aneurysms: A meta-analysis and systematic review

Lv, Xianli; Yang, Hongchao; Liu, Peng; Li, Youxiang

doi:10.1177/1971400915621321

Cited by 89 publications

(61 citation statements)

References 44 publications

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“…Most studies evaluating flow diverting stents have used similar regimes and premature cessation of clopidogrel has been linked with a higher risk stent thrombosis, even at 3 months (De Vries et al, 2013). An alternative regime is to load the patients with higher doses of aspirin and clopidogrel in the hours prior to the procedure (Lv et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Flow diversion is a well-established technique for the treatment of intracranial aneurysms with high technical success and low recurrence rates (Cagnazzo et al, 2017;Lv et al, 2016;Lylyk et al, 2009;Madaelil et al, 2017;Pierot et al, 2018;Pumar et al, 2017). The unique properties of flow diverting stents allows for rapid and significant flow reduction within the aneurysm without compromising parent artery flow (Dholakia et al, 2017;Kadirvel et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Endovascular treatment of visceral artery and renal aneurysms (VRAA) using a constant mesh density flow diverting stent

et al. 2019

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Background: Flow diverting stents have been used safely and effectively for the treatment of intracranial aneurysms, particularly for large and wide necked aneurysms that are not amenable to conventional endovascular treatment with coiling. The Surpass Streamline device (Stryker Neurovascular, MI, USA) is a relatively new and unique flow diverting stent which maintains constant device mesh density over varying vessel diameters. This may potentially provide advantages compared to other flow diverting stents in achieving aneurysmal occlusion. Case presentation: Two patients with VRAA were treated using the Surpass Streamline device. The first patient was a 65-year-old male with an incidental 2.4 cm aneurysm originating from the hepatic artery near the gastroduodenal artery (GDA). The second patient was a 56-year-old male with an incidental 1.9 cm renal aneurysm arising from an anterior inferior segmental branch of the left renal artery. A Surpass flow diverting stent was used to successfully exclude the aneurysm neck in both cases. Reduced flow was achieved in one patient (equivalent to O'Kelly-Marotta [OKM] Grade B1). Preserved flow and stagnation (equivalent to OKM Grade A3) was achieved in the other. There was preserved distal flow in the parent arteries. No immediate complications were encountered in either case. Complete occlusion of both aneurysms was seen on follow up CT angiographic imaging within 8-weeks. Conclusions: The Surpass flow diverting stent can be used safely and effectively to treat VRAA. It should be considered in unruptured large and giant wide necked VRAAs aneurysms. Additional large prospective studies are required for further validation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of visceral artery and renal aneurysms (VRAA) using a constant mesh density flow diverting stent

et al. 2019

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“…78 Higher rates of complications have been reported for the treatment of aneurysms in the posterior circulation and distal cerebral vasculature. 58 Rangel-Castilla et al 74 found a long-term rate of side-branch occlusion of 15.8% after flow-diverter treatment; however, these occlusions appeared to be clinically silent. Terminal branch occlusions in vessels such as the anterior choroidal artery were not observed.…”

Section: Complications and Technical Difficultiesmentioning

confidence: 98%

Update on flow diverters for the endovascular management of cerebral aneurysms

Rajah

Narayanan

Rangel-Castilla

2017

Neurosurgical Focus

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Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion.

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“…According to a meta-analysis of 29 studies, morbidity and mortality of flow diverter devices is 4% and 5%, respectively (14). The rate of post-procedural complications of PED seems to be less likely.…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Outcome Following Pipeline Embolization of Unruptured Intracranial Aneurysms

et al. 2017

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Background: As an advanced generation of flow diverters (FD), pipeline embolization device (PED) is introduced for endovascular aneurysm occlusion. In the present study, we aimed to present the mid-term results after endovascular treatment of unruptured intracranial aneurysms using PED. Methods: A total of 20 patients with 20 intracranial wide neck aneurysms were treated with PED between July and October 2010. Patients were followed up 4 to 8 months after the procedure. Digital subtraction angiography (DSA) was carried out to assess stent integrity, displacement, and the presence of residual aneurysm. Results: Out of 20 participants, PED deployment was successful in 19; whereas, intervention failed in one patient due to technical factors in device deployment. No severe acute complications were observed. One patient died after three months as a result of subarachnoid hemorrhage (SAH). Out of the remaining patients, DSA showed complete occlusion of aneurysms in 14 individuals (77.8%), while in four patients (22.2%), residual aneurysm was noted. Stent migration was not observed in any patients. Intra-stent stenosis (25% -50%) was visualized in only one patient (5.5%). Conclusions: This study showed promising mid-term results for the pipeline embolization device in the treatment of unruptured intracranial aneurysms. Larger studies with longer follow-up duration are warranted.

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Flow-diverter devices in the treatment of intracranial aneurysms: A meta-analysis and systematic review

Abstract: Fusiform, dissecting and circumferential aneurysm, posterior circulation and peripheral locations have greater procedure-related complications.

Cited by 89 publications

References 44 publications

Endovascular treatment of visceral artery and renal aneurysms (VRAA) using a constant mesh density flow diverting stent

Endovascular treatment of visceral artery and renal aneurysms (VRAA) using a constant mesh density flow diverting stent

Update on flow diverters for the endovascular management of cerebral aneurysms

Mid-Term Outcome Following Pipeline Embolization of Unruptured Intracranial Aneurysms

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