Small Unruptured Intracranial Aneurysms Can Be Effectively Treated With Flow-Diverting Devices

Li, Li; Gao, Bu-Lang; Shao, Qiuji; Zhang, Guang-Lin; Wang, Ziliang; Li, Tianxiao; Zhu, Ling

doi:10.3389/fneur.2022.913653

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…Ever since the Pipeline embolization device (Medtronic, Irvine, CA, USA), the first flow diverter, was approved for clinical use in 2008, an increasing number of cerebral aneurysms have been treated with flow diverters, especially large, giant, and irregular aneurysms 1 , 3 – 5 . With experience accumulation, the indications for use of flow diverters have been expanded, and the flow diverter has been increasingly applied to treat very small, small, wide-necked, dissecting, complex, ruptured cerebral aneurysms and aneurysms of small vessels 3 – 11 , leading to good outcomes. The mechanism of flow diverters in treating cerebral aneurysms involves directing blood flow away from the aneurysm, slowing flow into the aneurysm cavity, promoting thrombosis within the aneurysm, and providing a scaffold at the aneurysm neck for endothelialization to resume the integrity of arterial wall.…”

Section: Introductionmentioning

confidence: 99%

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Li,

Gao,

et al. 2024

Sci Rep

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To investigate the safety and effect of Tubridge flow diverter deployment for the treatment of intracranial aneurysms, 85 patients with intracranial aneurysms treated with the Tubridge flow diverter were retrospectively enrolled. The clinical data including the baseline data, aneurysm parameters before and after treatment, and follow-up outcomes were assessed. Among 85 patients, there were 35 (41.2%) males and 50 females (58.8%) aged 17–77 (mean 56.7 ± 11.1) years with 110 aneurysms. Five (5.9%) patients initially presented with subarachnoid hemorrhage from aneurysm rupture. The aneurysm size was 2–30 (mean 8.6) mm, and the aneurysm neck was 2–10.6 (mean 5.7 ± 2.3) mm. Ninety-three Tubridge stents were deployed. Twenty-five (29.4%) patients experienced adjunctive loose coiling. Blood flow was significantly reduced from entering the aneurysm after stent deployment. Periprocedural complications occurred in three (3.5%) patients, including in-stent thrombosis during embolization in one patient (1.2%), conjunctiva edema on the right in one patient (1.2%), and acute multiple cerebral infarctions in one patient (1.2%). Angiographic follow-up was conducted in 67 (78.8%) patients 3–36 (mean 15.3 ± 5.6) months later. In 11 (16.4% or 11/67) patients, blood flow still entered the aneurysm with the O’Kelly-Marotta (OKM) grade B in two (3.0%) patients and grade C in nine (13.4%), whereas complete occlusion (OKM grade D) was achieved in the other 56 (83.6% or 56/67) aneurysms. In-stent stenosis was present in five (7.5%) patients with approximately 25% stenosis in three (4.5%) patients and 50% in two (3.0%). In conclusion, the Tubridge flow diverter can be safely and efficiently applied in the treatment of small and large intracranial aneurysms, with a low periprocedural complication rate, a high occlusion degree, and a low in-stent stenosis rate at follow-up even though large aneurysms may necessitate a longer surgical time and adjunctive coiling.

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Section: Introductionmentioning

confidence: 99%

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Li,

Gao,

et al. 2024

Sci Rep

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“…Ever since the short-, medium-, and long-term results of the International Subarachnoid Hemorrhage Trial (ISAT) were published (1)(2)(3), the proportion of endovascular embolization for intracranial aneurysms has been increasing (4)(5)(6)(7)(8)(9)(10)(11). Endovascular embolization of cerebral aneurysms is no longer an alternative to surgical clipping, but one of the preferred treatment approaches (4,5,(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

Han

Jiang²,

Tian³

et al. 2022

Front. Neurol.

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PurposeTo explore the risk factors of recurrence after second endovascular embolization of recurrent aneurysms and the characteristics of recurrent refractory aneurysms to help clinical decision-making.Materials and methodsForty-nine patients with recurrent aneurysms who underwent repeated embolization were retrospectively enrolled and divided into the recurrent and non-recurrent group. The risk factors of recurrence, complications and follow-up results of repeated embolization, and characteristics of recurrent refractory aneurysms were analyzed.ResultsAmong the 49 patients with the second embolization, 5 were lost to follow-up, 9 recurred, and 35 did not. Univariate analysis showed that aneurysm size (P = 0.022), aneurysm classification (P = 0.014), and Raymond-Roy grade after the second embolization (P = 0.001) were statistically different between the two groups. Multivariate analysis demonstrated the Raymond-Roy grade as an independent risk factor for the recurrence of aneurysms after the second embolization (P = 0.042). The complication rate after the second embolization was 4%. There were five recurrent refractory aneurysms with an average aneurysm size of 23.17 ± 10.45 mm, including three giant aneurysms and two large aneurysms. To achieve complete or near-complete embolization of the recurrent refractory aneurysms, multiple treatment approaches were needed with multiple stents or flow diverting devices.ConclusionAneurysm occlusion status after the second embolization is an independent risk factor for the recurrence of intracranial aneurysms. Compared with near-complete occlusion, complete occlusion can significantly reduce the risk of recurrence after second embolization. In order to achieve complete or near-complete occlusion, recurrent refractory aneurysms need multiple treatments with the use of multiple stents or flow diverting devices.

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Pipeline Flex with Shield Technology Placement for Small- and Medium-sized Aneurysms Achieves Early Complete Occlusion

Arai

Fujii

Teranishi

et al. 2023

Neurol. Med. Chir.(Tokyo)

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The flow diverter has been shown to be a safe and effective device for large cerebral aneurysms in the proximal internal carotid artery (ICA). Recently, its indication has been expanded to small-and medium-sized cerebral aneurysms in the distal segment of the ICA. In this study, we report a singlecenter, retrospective investigation of the safety and efficacy of the Pipeline Flex device to treat these aneurysms. Of the patients who underwent Pipeline implantation for small-and medium-sized ICA aneurysms (! 12 mm) at our hospital between July 2013 and October 2021, 102 patients with 104 aneurysms were included in this study. The mean age of the patients was 57.7 ± 12.1 years, and 94 (90.4%) were female. The mean aneurysmal dome diameter was 9.2 ± 2.3 mm, the mean neck diameter was 5.3 ± 1.6 mm, and the mean dome-to-neck ratio was 1.8 ± 0.5. Twenty-five patients (24.0%) had incorporated vessels from the aneurysm. Complete occlusion of the aneurysms was obtained in 96 patients (92.3%). There were no cases of parent artery stenosis or major stroke after the procedure. Absence of incorporated vessel from the aneurysm dome and adjunctive coil embolization are statistically significant factors indicating complete occlusion in multivariate analysis. The time to complete occlusion was determined earlier with the use of the Pipeline Shield (p = 0.0386) and with adjunctive coils (p = 0.0025). We showed that Pipeline implantation for small-and medium-sized aneurysms was safe and highly effective.

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Small Unruptured Intracranial Aneurysms Can Be Effectively Treated With Flow-Diverting Devices

Cited by 3 publications

References 41 publications

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Use of the Tubridge flow diverter in the treatment of intracranial aneurysms: a single center experience

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

Pipeline Flex with Shield Technology Placement for Small- and Medium-sized Aneurysms Achieves Early Complete Occlusion

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