Single-center experience with the new generation Derivo Embolization Device in ruptured dissecting and blister aneurysms

Abstract

Background Treatment of ruptured dissecting and blister aneurysms is technically challenging with potentially high morbidity and mortality. The Derivo Embolisation Device (Derivo) is a flow diverter stent designed for the treatment of intracranial aneurysms. Purpose To assess the safety and feasibility of the Derivo in the treatment of ruptured dissecting and blister aneurysms. Material and Methods We retrospectively analyzed all patients with ruptured dissecting and blister aneurysms treated with the Derivo between February 2016 and July 2018. Procedural details, complications, morbidity within 30 days, and angiographic aneurysm occlusion rates, initially and after six months, were assessed. Results In 10 patients 11 ruptured dissecting and blister aneurysms were treated with 12 Derivos as monotherapy. No aneurysm rebleeding was observed at follow-up. One treatment-related complication occurred including a coil perforation of an additionally treated aneurysm. One patient died due to brain edema. Initial digital subtraction angiography revealed complete (O’Kelly–Marotta [OKM] classification D) and favorable (OKM D+C) occlusion rate in three aneurysms. Six-month follow-up for digital subtraction angiography and clinical evaluation was available in 6/9 patients with complete (OKM D) occlusion in all aneurysms (6/6). Favorable (modified Rankin Scale [mRS] ≤ 2) and moderate (mRS 3) clinical outcome after a mean follow-up of 10 months was observed in six and two patients, respectively. Conclusion Endovascular treatment with the Derivo in ruptured dissecting and blister aneurysms revealed a sufficient initial division of aneurysms from the circulation without rebleeding. The Derivo is associated with high procedural and clinical short-term safety.

Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

“…The BBA subgroup in the review demonstrated a 35% immediate occlusion rate and an 18% overall complication rate (7). Several studies have reported 0-33.3% immediate occlusion rates and 0-27% periprocedural complication rates (25,(33)(34)(35)(36). In this study, the immediate occlusion rate and periprocedural complication rate were 16.6%, and these results are consistent with those in the literature.…”

“…To our knowledge, there is no article focusing on the early treatment of ruptured BBAs treated with FDs. There had been some mixed (early and delayed treatment fashion) data and only one aforementioned delayed treatment safety and efficacy report ( 3 , 8 , 25 , 30 , 33 , 35 , 38 ). Our results contribute to the safety profile of FDs in the early treatment period of ruptured BBAs of ICA with a similar outcome and complication rates compared to delayed treatment and overall data regardless of time to treatment.…”

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

“…So far, 12 case series of ruptured dissecting aneurysms or ruptured blood blister-like aneurysms treated in acute phase with flow diverter have been reported. [13][14][15][16][17][18][19][20][21][22][23][24] In these reports, 115 ruptured site (68 internal carotid artery, six middle cerebral artery, one anterior cerebral artery, 26 vertebral artery, six basilar artery, two posterior cerebral artery, three anterior inferior cerebellar artery, three posterior inferior cerebellar artery) were treated; 101 were treated with only flow diverter, 14 with flow diverter and coil. In these 115 cases, no rebleeding from ruptured site and 10 symptomatic thrombotic events were observed after procedure.…”

Computational Flow Diverter Implantation—A Comparative Study on Pre-Interventional Simulation and Post-Interventional Device Positioning for a Novel Blood Flow Modulator

“…It has no distal or proximal device markers. The safety and efficacy of the Derivo ® device have been shown in several studies [10,[34][35][36]. Post-interventional data for Derivo ® 2 show the desired flow redirection and activity reduction inside the aneurysm, which is beneficial for thrombosis formation with marked decreases in neck flow rate and mean inflow velocity [37].…”