Flow diverter stents in the treatment of recanalized intracranial aneurysms

Akgül, Erol; Onan, Hasan Bilen; Islek, Irem; Tönge, Mehmet; Durmus, Yavuz; Barburoğlu, Mehmet; Azizova, Aynur; Erol, Cengiz; Hakyemez, Bahattin; Sencer, Serra; Aydın, Kubilay; Arat, Anıl

doi:10.1177/1591019921990507

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…The safety and efficacy of PED implantation in a pre-existing stent remain unclear as data from different studies vary greatly. While previous studies indicated high recanalization rates with stent-assisted coiling, ranging from ∼57% to 78% (7,11), Park et al (12) reported a 94% complete closure rate of PED for recurrent aneurysms after stent-assisted coiling. Given the complexity of recurrent aneurysms after stentassisted coiling, these data suggest that PED may be the optimal alternative.…”

Section: Discussionmentioning

confidence: 95%

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Retreatment with a pipeline embolization device for recanalized aneurysms following stent-assisted coiling embolization

Ling,

Liu,

Zhou

et al. 2023

Front. Neurol.

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Background and purposeFlow diverters have emerged as viable alternatives for the retreatment of recanalized aneurysms following stent-assisted coiling embolization. In this study, we aim to present our experience of retreatment for such aneurysms using the pipeline embolization device (PED).Materials and methodsThis case series presents a retrospective single-center analysis of patients with recanalized aneurysms who underwent retreatment using the PED between July 2019 and April 2023, subsequent to stent-assisted coiling embolization.ResultsThe study includes five female patients, whose relevant clinical data were recorded. All patients had aneurysms located in the internal carotid artery, comprising two blood blister-like aneurysms and two giant aneurysms. Prior to the retreatment, two LVIS stents, two enterprise stents, and one solitaire stent were implanted. Among the five patients, one experienced a fatal post-operative subarachnoid hemorrhage, while two patients achieved complete embolization, and another patient achieved near-complete embolization during the last follow-up. Furthermore, one patient faced challenges during the placement of the PED and was unable to achieve successful deployment. We propose four overlapping relationships between a newly implanted PED and a previously deployed stent: (1) PED covering only the proximal end of the previous stent, (2) PED covering only the distal end of the previous stent, (3) PED covering both the proximal and distal ends of the previous stent, and (4) PED deployed within the previous stent. Antiplatelet therapy at our center involved daily dual therapy with aspirin (100 mg/day) and clopidogrel (75 mg/day) for at least 5 days before PED placement. Intra-arterial bolus administration of tirofiban (5 mcg/kg) was administered during or immediately after PED deployment, followed by a maintenance dose of 0.08 mcg/kg/min IV infusion for at least 24–48 h if necessary. Postprocedural dual antiplatelet therapy included clopidogrel (75 mg/day) for 6 months and aspirin (100 mg/day) for 12 months.ConclusionThe findings of this study support the efficacy of the PED for the retreatment of recanalized aneurysms following stent-assisted coiling embolization.

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Section: Discussionmentioning

confidence: 95%

“…However, the safety and effectiveness of PED treatment for recurrent aneurysms after stent-assisted embolization have not been conclusively established (5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Retreatment with a pipeline embolization device for recanalized aneurysms following stent-assisted coiling embolization

Ling,

Liu,

Zhou

et al. 2023

Front. Neurol.

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“…15 Several studies analyzed the use of flow diversion for recurrent or residual aneurysms with final complete obliteration results varying from 69% to 100%. 7,8,16,17 One such study by Daou et al 7 reported a complete aneurysm occlusion rate of 76.7% and near-complete aneurysm occlusion rate of 90% for a total rate of complete and near-complete aneurysm occlusion of 86.7% in 32 patients treated with FD for recurrent aneurysms after initial coiling. A similar study by Dornbos et al 8 evaluated 7 patients who underwent FD retreatment of previously coiled aneurysms with 80% complete occlusion at 6 months and 100% at 1 year.…”

Section: Discussionmentioning

confidence: 99%

Acute Coiling With Delayed Flow Diversion for Posterior Communicating Segment Internal Carotid Artery Aneurysms: A Multicenter Case Series

Enriquez Marulanda,

Young,

Shutran

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: In ruptured posterior communicating artery (PcomA) aneurysms, the protection of the aneurysm dome alone with initial subtotal coiling decreases the risk of rerupture in the acute setting but does not provide durable/definitive long-term protection against delayed rupture. Delayed flow diverter (FD) placement can be a potential alternative to definitively secure these aneurysms without increasing the risk of complications and PComA occlusion. We analyzed PComA aneurysms treated with a planned delayed FD after primary coiling and assess radiographic and clinical outcomes. METHODS: We performed a retrospective study of prospectively collected data for intracranial aneurysms treated with planned FD at 2 institutions from 2013 to 2022. PComA aneurysms that underwent primary coiling and delayed FD placement were included for analysis. RESULTS: There were 29 PComA aneurysms identified that were included in the analysis. Patients were mostly female (79.3%), with a median age of 60 years. The mean aneurysm maximum diameter was 7.2 mm ± (5.3). Immediate Raymond-Roy occlusion grade after primary coiling was I in 48.3%, II in 41.4%, and III in 10.3% of aneurysms. The median time from initial coiling to planned delayed FD placement was 6.3 months (3.2-18.6). A total of 21 (72.4%) aneurysms underwent follow-up radiological imaging. Complete and near-complete occlusion status was achieved in 76.2% of the evaluated aneurysms. There were no retreatments and no evidence of delayed aneurysm rupture. One case (3.5%) presented thromboembolic complications and 1 (3.5%) intracranial hemorrhagic complication after FD placement, which was associated with mortality. Most patients (90.5%) had a modified Rankin scale of ≤2 on the last follow-up. CONCLUSION: Primary coiling with planned staged FD placement is effective for treating ruptured PComA aneurysms with high occlusion rates and low complications.

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“…Longer devices with larger diameters were necessary for spanning of the fusiform segment, reliable opening, and improved apposition. Furthermore, rigorous platelet function testing and subsequent regimen adjustments were critical factors to mitigate neurologic complications from FD procedures ( 6 , 14 ). In our study, platelet function was assessed in 87.5% of procedures, and the rate of antiplatelet regimen adjustment was 21.4%.…”

Section: Discussionmentioning

confidence: 99%

Use of flow diverter device in basilar artery for aneurysm treatment: Case series and literature review

Wang

Zhu²,

Xu³

et al. 2022

Front. Neurol.

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BackgroundFlow diverters (FDs) for the treatment of basilar artery (BA) aneurysms remain controversial. In this study, we report our initial experience of flow diversion for treatment of this pathology.MethodsConsecutive patients with an aneurysm of the BA that was treated by implantation of the FD were included in our retrospective study. Procedural complications, aneurysm occlusion, and a functional outcome were evaluated. FD placement in BA for aneurysm treatment reported in the literature was also reviewed and summarized.ResultsSixteen patients with 16 BA aneurysms were treated by FD implantation with (n = 8) or without (n = 8) adjunctive coiling. The Tubridge was used in 13 (81.3%) and Pipeline in 3 (18.8%) procedures. Average aneurysm size was 15.7 mm. Four aneurysms were located at the basilar apex, six at the basilar trunk, and six at the vertebrobasilar junction. Three patients experienced procedural complications (18.8%), including two ischemic strokes and one hydrocephalus, with resultant mortality in one case (6.3%). Median follow-up was 7.7 months and available for 15 aneurysms. Complete/near-complete occlusion was seen in 13 (86.7%) aneurysms.ConclusionIn our initial experience, flow diversion is feasible and safe in the treatment of BA aneurysms with promising occlusion rates at mid-term follow-up. Larger cohort studies are required to validate these results.

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Flow diverter stents in the treatment of recanalized intracranial aneurysms

Cited by 6 publications

References 37 publications

Retreatment with a pipeline embolization device for recanalized aneurysms following stent-assisted coiling embolization

Retreatment with a pipeline embolization device for recanalized aneurysms following stent-assisted coiling embolization

Acute Coiling With Delayed Flow Diversion for Posterior Communicating Segment Internal Carotid Artery Aneurysms: A Multicenter Case Series

Use of flow diverter device in basilar artery for aneurysm treatment: Case series and literature review

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