Placement of a Stent within a Flow Diverter Improves Aneurysm Occlusion Rates

Abstract

BACKGROUND AND PURPOSE: Placement of a stent within a flow diverter has been described previously but its consequences have not been analyzed. We evaluated the clinical and angiographic results of stent placement within a flow diverter during the same treatment session. MATERIALS AND METHODS: All patients treated with a Surpass flow diverter were retrospectively evaluated. Patients with previously deployed stents and procedures in which scaffolding stents, a second flow diverter, or intrasaccular devices were used were excluded. Patient and aneurysm characteristics and clinical and imaging follow-up results were compared between stented and nonstented Surpass flow-diverter groups and stent assisted coiling. RESULTS: Thirty-five patients (41 aneurysms) were treated with a Surpass flow diverter only (monotherapy group), and in 33 patients (35 aneurysms), a stent was placed within the Surpass flow diverter (stented group). Stents were placed inside the Surpass flow diverter for a variety of reasons at the operator's discretion. No statistical difference was noted between the 2 groups in age, body weight, sex, history of thromboembolic events, smoking, platelet inhibition levels, hypertension, hyperlipidemia, diabetes mellitus, malignancy, and aneurysm location. Aneurysms in the stented group were larger than those in the monotherapy group (14.8 versus 9.1 mm, P , .001). The rate of clinically significant adverse events and complete aneurysm occlusion rates at 0-3 and 3-6 months (73.3% versus 61.3%, P ¼ .31, and 84.8% versus 70.2%, P ¼ .14) were similar. At 9-12 months, a significantly higher proportion of aneurysms in the stented group achieved complete occlusion (93.9% versus 73.2%, P ¼ .019). There was a trend toward a higher obliteration rate on final follow-up in the stented group (93.9% versus 82.9%, P ¼ .14). CONCLUSIONS: Placement of a stent within a flow diverter increases the rate of aneurysm occlusion. We propose that these results are from improved flow-diverter apposition due to the higher radial force of intracranial stents.

The Safety and Efficacy of Flow Diversion versus Conventional Endovascular Treatment for Intracranial Aneurysms: A Meta-analysis of Real-world Cohort Studies from the Past 10 Years

“…In series studies, complete occlusion was noted in 63% of aneurysms in early postmarket results, 8 82.6% of aneurysms in the study were not restricted to the circle of Willis, 46 and 93.9% of aneurysms had a stent placed within an FD. 47 The occlusion rate at the last follow-up treatment with an FD can even reach 100%. 48 In this pooled study, the complete occlusion rate of the FD group was 2.5-fold that of the CEV group.…”

T-Stent or Half T-Stent-Assisted Embolization of Wide-Necked Aneurysms at the Internal Carotid-Posterior Communicating Artery Bifurcation

“…In Case 1, a braided stent was unable to be placed in the initial treatment because of marked kinking of the vessel at the neck of the aneurysm. We considered the possibility of recurrence at the time of initial treatment and planned to place an LVIS blue as a stent-in-stent by the scaffolding technique 16) in the event of recurrence. After retreatment using the LVIS blue, no recurrence was noted.…”

The exchange-free technique: A novel technique for enhancing surpass flow diverter placement

“…[ 8 9 ] There are few reports about combined usage of stents with flow diverters,[ 10 11 12 ] and recently, it has been shown that this technique reduces the time needed for complete aneurysm occlusion. [ 13 ] In this article, we describe a new technique, the exchange-free technique (EFT) that not only enhances the wall apposition of the surpass flow diverter (SFD) but also, in selected cases, allows us to anchor the landing zones by pinning the device by means of a laser-cut stent directly placed through the unique delivery system of the SFD. EFT provides a fast and easy way to appose and pin the Surpass device without a need to re-cross the deployed flow diverter.…”