Flow diverter stents in the treatment of cerebral aneurysms less than 5 mm

Abstract

AIM:To evaluate the safety and efficacy of flow diverter (FD) stents in the treatment of intracranial aneurysms less than 5 mm. MATERIAL and METHODS:We treated 66 aneurysms in 43 patients with aneurysms less than 5 mm. Of the patients, 29 were females and 14 males (mean age: 50.2 years). Headache was the most frequent symptom. In 8 patients the aneurysms were recanalized and these had been treated with coils or stent-assisted coiling. All aneurysms were in the anterior circulation. In the treatment, one of the SILK, Pipeline, Derivo or FRED FD stents was used for each patient. Neurointerventional stent medication (double antiplatelet) was used. All patients were investigated for new ischemic lesions with diffusion-weighted imaging one day later. The first follow-up angiogram was planned 3-6 months later. RESULTS:The treatment was technically successful in all patients. Minor complications occurred in 3 patients (7%). In one patient, thrombus inside the SILK was seen and was relieved with tirofiban. The second patient bled from the right common femoral artery entrance, which was operated on. In the third patient, the complication was technical. All patients were discharged without any neurological deficit. The mean follow-up period was 26 (6-52) months. Of the aneurysms, 64 (97.0%) were completely closed. CONCLUSION:The FD treatment of cerebral, anterior circulation small aneurysms less than 5 mm is effective and safe.

Analysis of reported adverse events of pipeline stents for intracranial aneurysms using the FDA MAUDE database

“…This stent allows blood to be diverted away from the aneurysm itself, thus taking pressure off the aneurysm to reduce risk of rupture by inducing aneurysm thrombosis and endothelialization of the device. FDS are often considered as a first choice of treatment for several aneurysms due to their high rate of successful management, low rate of aneurysm recanalization, ease of insertion, and short procedure duration [ 1 , 27 ].…”

Patient outcomes after treatment of brain aneurysm in small diameter vessels with the silk vista baby flow diverter: A systematic review

“…2 Initially, the use of FDs was reserved for the management of large and giant aneurysms in the anterior circulation, but recent studies demonstrated that the device can be safely used for the treatment of small and medium aneurysms. 3,4 Nonetheless, evidence of the safety and efficacy of FD treatment for intracranial aneurysms in small parent vessels remains unclear. 5 Technical constraints on the treatment of aneurysms in small parent vessels included challenges in navigating the delivery system and catheter size compatibility, as well as unavailability of smaller devices.…”