Treatment of Intra- and Extracranial Aneurysms Using the Flow-Redirection Endoluminal Device: Multicenter Experience and Follow-Up Results

Drescher, F; Weber, W.; Berlis, Ansgar; Rohde, Stefan; Carolus, Anne; Fischer, Sebastian

doi:10.3174/ajnr.a4964

Cited by 35 publications

(12 citation statements)

References 28 publications

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“…FD stents are an important development in the endovascular approach to the treatment of intracranial aneurysms, shifting the aim of the procedure from occluding the dome of the aneurysm to repairing the parent vessel wall. Stent therapy is now an alternative treatment for intracranial aneurysms because of its efficacy and safety profile 12–17…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the dual-layer flow-diverting stent (FRED) for the treatment of intracranial aneurysms

Guimaraens

Vivas

Saldaña

et al. 2019

J NeuroIntervent Surg

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PurposeTo describe the efficacy and complications of treating cerebral aneurysms with the Flow Re-direction Endoluminal Device (FRED) and to identify predictors for aneurysm occlusion.MethodsA prospective observational registry including all consecutive aneurysms treated with FRED between December 2015 and July 2018 was designed in one therapeutic neuroangiography department. The primary endpoint for treatment efficacy was complete or near-complete occlusion (O’Kelly–Marotta (OKM) C–D), assessed by three-dimensional digital subtraction angiography. Major (all symptomatics) and minor complications were described and those with modified Rankin Scale scores 3–6 were considered clinically relevant. Univariate and multivariate analyses were performed to identify predictors of efficacy.ResultsA total of 185 aneurysms were analyzed in 150 patients (mean age 54.3±11.5 years). Mean follow-up was 18.99±11.32 months (range 0–43). Efficacy was evaluated in 156 (84.32%) cases: 132 (84.6%) had OKM C–D occlusion, 31/47 (66%) within the first year and 101/109 (92.7%) later on. Major complications were observed in 12 (6.5%) cases: three strokes (one transient ischemic accident, two minor strokes), six intra-stent thrombosis, and three with bleeding, but only one (0.5%) was clinically relevant. Minor complications (all asymptomatic) were observed in 10 (5.4%) cases: three shortening/repositioning of stent; two arterial dissection, two arterial occlusion, and three intra-stent stenosis. Independent predictors of occlusion were immediate OKM grade B–C–D (OR 4.01, 95% CI 1.51 to 10.62), single aneurysm (OR 3.29, 95% CI 1.05 to 10.32), and small size aneurysm (OR 4.74, 95% CI 1.57 to 14.30).ConclusionThe FRED stent fully complied with efficacy and safety requirements for treatment of intracranial aneurysms. Three predictors of aneurysm occlusion were identified.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the dual-layer flow-diverting stent (FRED) for the treatment of intracranial aneurysms

Guimaraens

Vivas

Saldaña

et al. 2019

J NeuroIntervent Surg

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“…2,3 Due to its singular design, a metal-covered inner stent layer with low permeability and an outer, more porous and stable stent scaffold, the Flow Re-Direction Endoluminal Device (FRED; MicroVention, Tustin, California) may be superior to other flow diverters, providing safer delivery and more effective occlusion of the aneurysm. [4][5][6][7][8][9] The FRED Jr (MicroVention) has a similar dual-layer design and is the first flow diverter dedicated to small vessels (ie, Յ3 mm). In the past, the flow diverter was not widely used in the treatment of distal circulation aneurysms due to their relatively superficial anatomy and good accessibility for microsurgical clipping.…”

mentioning

confidence: 99%

Multicenter Experience with FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms in Small Arteries

Möhlenbruch

Kızılkılıç

Killer‐Oberpfalzer

et al. 2017

AJNR Am J Neuroradiol

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“…However, flow diversion does not lead to immediate aneurysmal occlusion and complete aneurysm occlusion rates at 6 months and 1 year are about 75%–85%. [ 1 2 4 5 18 19 ] Residual aneurysms treated with flow diverters are still at a risk of rupture. Although the risk is, in general, small, it may be significant if there is residual opacification of the aneurysm dome on follow-up imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Complete aneurysm occlusion rates for different flow diverters in device-specific studies are reported to be between 56% and 71.4% at 3 months,[ 1 2 3 ] 66.6%–75% at 6 months,[ 1 3 4 5 6 ] and 77.8%–86.6% at 1 year follow-up. [ 1 2 4 5 ] A variety of techniques have been proposed to increase the efficacy of flow diverters. [ 7 ] The most popular of these is adjunctive coiling and to a lesser extent, a combination of a flow diverter with the woven endobridge device.…”

Section: Introductionmentioning

confidence: 99%

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

Öcal

Arat

2020

Asian J Neurosurg

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Background: Following flow diverter placement, approximately 20% of intracranial aneurysms remain as residual aneurysms at 1 year. Device malapposition is a cause of residual aneurysms after flow diversion. We present a new and straightforward technique (exchange-free technique [EFT]) to enhance apposition of the surpass flow diverter (SFD), the only over-the-wire flow diverter currently available. Materials and Methods: We deployed laser-cut mini stents through the inner deployment catheter of the SFD. This maneuver was performed simply by withdrawing the micro-guidewire from its lumen and replacing it with a mini-stent (stents deliverable through microcatheters with inner diameter of 0.0165 inches), without a need to re-cross the deployed SFD or an exchange maneuver. All aneurysms in which this technique was utilized were retrospectively reviewed. Results: Twenty-eight patients (20 females) with 30 treated aneurysms were identified. The mean aneurysm diameter was 10.2 ± 6.6 mm. Technical success rate was 96.6% (29/30 aneurysms). There was no mortality or permanent morbidity related to the procedures. Except for the patient treated for an iatrogenic, surgery-related internal carotid artery pseudoaneurysm who died secondary to consequences of multiple surgeries, no cases of mortality or permanent morbidity were noted. Complete aneurysm occlusion rates were 78.2%, 82.1%, and 95.2% at 0–3, 3–6, and 9–12 months, respectively. None of the patients were re-treated. Conclusion: EFT is a simple and fast technique which was not associated with adverse effects in our series. The higher aneurysm obliteration rate obtained with EFT is probably the result of better wall apposition of the SFD.

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Treatment of Intra- and Extracranial Aneurysms Using the Flow-Redirection Endoluminal Device: Multicenter Experience and Follow-Up Results

Cited by 35 publications

References 28 publications

Efficacy and safety of the dual-layer flow-diverting stent (FRED) for the treatment of intracranial aneurysms

Efficacy and safety of the dual-layer flow-diverting stent (FRED) for the treatment of intracranial aneurysms

Multicenter Experience with FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms in Small Arteries

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

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