Early single centre experience of flow diverting stents for the treatment of cerebral aneurysms

Toma, Ahmed K; Robertson, Fergus; Wong, Ken; Joshi, Yogish; Haridas, Avinash; Grieve, Joan; Watkins, Laurence; Kitchen, Neil; Brew, Stefan

doi:10.3109/02688697.2013.793292

Cited by 14 publications

(7 citation statements)

References 20 publications

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“…et al [ 5 ] Early experience in the treatment of intracranial aneurysms by endovascular flow diversion: a multicenter prospective study PLoS ONE 2010 Prospective 20 20 Kulcsar, Z. et al [ 9 ] High-profile flow diverter (silk) implantation in the basilar artery: efficacy in the treatment of aneurysms and the role of the perforators Stroke 2010 Retrospective 12 12 Chalouhi, N. et al [ 3 ] Treatment of posterior circulation aneurysms with the pipeline embolization device Neurosurgery 2013 retrospective 7 7 Siddiqui, A.H. et al [ 12 ] Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms Neurosurgery 2012 Prospective 7 7 Toth, G. et al [ 14 ] Posterior circulation flow diversion: a single-center experience and literature review Journal of Neurointerventional Surgery 2015 Retrospective 6 7 Meckel, S. et al [ 7 ] Endovascular treatment of complex aneurysms at the vertebrobasilar junction with flow-diverting stents: initial experience Neurosurgery 2013 Retrospective 7 7 Toma, A.K. et al [ 6 ] Early single centre experience of flow diverting stents for the treatment of cerebral aneurysms British Journal of Neurosurgery 2013 Prospective 17 17 Monteith, S.J. et al [ 8 ] Endovascular treatment of fusiform cerebral aneurysms with the pipeline embolization device Neurosurgery 2014 Retrospective 7 7 Phillips, T.J. et al [ 2 ] Safety of the pipeline embolization device in treatmen...…”

Section: Resultsmentioning

confidence: 99%

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Flow diverter treatment of posterior circulation aneurysms. A meta-analysis

et al. 2016

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IntroductionTreatment of complex anterior circulation aneurysms with flow diverters (FDs) has become common practice in neurovascular centers. However, this treatment method for posterior circulation aneurysms (PCAs) still remains controversial.MethodsThrough searches for reports on the treatment of PCAs with FDs, we conducted a systematic review of the literature on its clinical efficacy and safety using random-effect binomial meta-analysis.ResultsWe included 14 studies, which reported on a total of 225 PCAs in 220 patients. Procedure-related good outcome rate was 79 % (95 % confidence interval (CI), 72–84), with significantly lower odds among patients with ruptured aneurysms and basilar artery aneurysms. Procedure-related mortality rate was 15 % (95 % CI 10–21), with significantly higher rates among patients with giant aneurysms and basilar artery aneurysms. The rate of complete aneurysm occlusion at 6-month digital subtraction angiography (DSA) was 84 %. Ischemic stroke rate was 11 %. Perforator infarction rate was 7 %. Postoperative subarachnoid hemorrhage (SAH) rate was 3 %. Intraparenchymal hemorrhage (IPH) rate was 4 %.ConclusionsFlow diverter treatment of PCAs is an effective method, which provides a high rate of complete occlusion at 6-month DSA. However, compared with anterior circulation aneurysms, patients with PCAs are at significantly higher risk of mortality, ischemic stroke and perforator infarction. Our findings indicate that, in most clinical centers, flow diverter treatment of PCAs should be conducted in carefully selected patients with poor natural history and no optimal treatment strategy. For ruptured and giant basilar artery aneurysms, there is still no good treatment option.

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Section: Resultsmentioning

confidence: 99%

“…In our meta-analysis, 79 % of the patients showed a good outcome. The rates ranged from 29 to 100 % [ 1 , 2 , 6 – 15 ], highlighted by significantly lower rates in the patients with ruptured and basilar artery aneurysms. Meanwhile, patients with basilar artery aneurysms had a higher mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Flow diverter treatment of posterior circulation aneurysms. A meta-analysis

et al. 2016

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“…Based on the results of the multicenter PITA 26 and PUFS 2 trials, as well as several other multicenter 4,17,20,28,47 and institutional 3,10,12,15,16,19,31,32,34,39 experiences, treatment of large and giant ICA aneurysms with the PED is becoming more widespread. Given that the PED only received CE Mark in Europe in 2009 and FDA approval in the United States in 2011, long-term experience with it is limited.…”

Section: Discussionmentioning

confidence: 99%

Pipeline for uncoilable or failed aneurysms: 3-year follow-up results

Becske

Potts

Shapiro

et al. 2017

Journal of Neurosurgery

175

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OBJECTIVE The long-term effectiveness of endovascular treatment of large and giant wide-neck aneurysms using traditional endovascular techniques has been disappointing, with high recanalization and re-treatment rates. Flow diversion with the Pipeline Embolization Device (PED) has been recently used as a stand-alone therapy for complex aneurysms, showing significant improvement in effectiveness while demonstrating a similar safety profile to stent-supported coil treatment. However, relatively little is known about its long-term safety and effectiveness. Here the authors report on the 3-year safety and effectiveness of flow diversion with the PED in a prospective cohort of patients with large and giant internal carotid artery aneurysms enrolled in the Pipeline for Uncoilable or Failed Aneurysms (PUFS) trial. METHODS The PUFS trial is a prospective study of 107 patients with 109 aneurysms treated with the PED. Primary effectiveness and safety end points were demonstrated based on independently monitored 180-day clinical and angiographic data. Patients were enrolled in a long-term follow-up protocol including 1-, 3-, and 5-year clinical and imaging follow-up. In this paper, the authors report the midstudy (3-year) effectiveness and safety data. RESULTS At 3 years posttreatment, 74 subjects with 76 aneurysms underwent catheter angiography as required per protocol. Overall, complete angiographic aneurysm occlusion was observed in 71 of these 76 aneurysms (93.4% cure rate). Five aneurysms were re-treated, using either coils or additional PEDs, for failure to occlude, and 3 of these 5 were cured by the 3-year follow-up. Angiographic cure with one or two treatments of Pipeline embolization alone was therefore achieved in 92.1%. No recanalization of a previously completely occluded aneurysm was noted on the 3-year angiograms. There were 3 (2.6%) delayed device- or aneurysm-related serious adverse events, none of which led to permanent neurological sequelae. No major or minor late-onset hemorrhagic or ischemic cerebrovascular events or neurological deaths were observed in the 6-month through 3-year posttreatment period. Among 103 surviving patients, 85 underwent functional outcome assessment in which modified Rankin Scale scores of 0-1 were demonstrated in 80 subjects. CONCLUSIONS Pipeline embolization is safe and effective in the treatment of complex large and giant aneurysms of the intracranial internal carotid artery. Unlike more traditional endovascular treatments, flow diversion results in progressive vascular remodeling that leads to complete aneurysm obliteration over longer-term follow-up without delayed aneurysm recanalization and/or growth. Clinical trial registration no.: NCT00777088 (clinicaltrials.gov).

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“…Overall, 22 included studies were retrospective series, 1,2,4,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] whereas 5 articles were prospective series (details in On-line Table 3). [29][30][31][32][33]…”

Section: Quality Of Studiesmentioning

confidence: 99%

Treatment of Unruptured Distal Anterior Circulation Aneurysms with Flow-Diverter Stents: A Meta-Analysis

Cagnazzo

Perrini²,

Dargazanli

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND: The safety and efficacy of flow diversion among distal anterior circulation aneurysms must be proved. PURPOSE: Our aim was to analyze the outcomes after flow diversion among MCA, anterior communicating artery, and distal anterior cerebral artery aneurysms. DATA SOURCES: A systematic search of 3 databases was performed for studies published from 2005 to 2018. STUDY SELECTION: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting flow diversion of distal anterior circulation aneurysms. DATA ANALYSIS: Random-effects meta-analysis was used to pool aneurysm occlusion and complication rates. From the individual patient data, univariate and multivariate analyses were used to test predictors of occlusion and complications. DATA SYNTHESIS: We included 27 studies (484 aneurysms). The long-term adequate occlusion rate (O'Kelly-Marotta scale, C-D) was 82.7% (295/364; 95% CI, 77.4%-87.9%; I 2 ϭ 52%). Treatment-related complications were 12.5% (63/410; 95% CI, 9%-16%%; I 2 ϭ 18.8%), with 5.4% (29/418; 95% CI, 3.2%-7.5%; I 2 ϭ 0%) morbidity. MCA location was an independent factor associated with lower occlusion (OR ϭ 0.5, P ϭ .03) and higher complication rates (OR ϭ 1.8, P ϭ .02), compared with anterior communicating artery and distal anterior cerebral artery aneurysms. The Pipeline Embolization Device (versus other stents) gave better occlusion rates (OR ϭ 2.6, P ϭ .002), whereas large/giant aneurysms were associated with higher odds of complications (OR ϭ 2.2, P ϭ .03). The rates of occlusion and narrowing of arteries covered by flow-diverter stents were 6.3% (29/283; 95% CI, 3.5%-9.1%; I 2 ϭ 4.2%) and 23.8% (69/283; 95% CI, 15.7%-32%; I 2 ϭ 80%), respectively. Symptoms related to occlusion and narrowing of the jailed arteries were 3.5% (6/269; 95% CI, 1.1%-5%; I 2 ϭ 0%) and 3% (6/245; 95% CI, 1%-4%; I 2 ϭ 0%), respectively. LIMITATIONS: We reviewed small and retrospective series. CONCLUSIONS: Flow diversion among distal anterior circulation aneurysms is effective, leading to adequate aneurysm occlusion in 83% of cases. However, this strategy has some limitations among MCA and larger lesions, especially related to the higher rate of complications. Compared with the other devices, the Pipeline Embolization Device seems to be associated with a higher occlusion rate.

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Early single centre experience of flow diverting stents for the treatment of cerebral aneurysms

Abstract: FDS should only be used following multidisciplinary discussion in selected patients. Further data is required regarding long-term safety, efficacy and indications.

Cited by 14 publications

References 20 publications

Flow diverter treatment of posterior circulation aneurysms. A meta-analysis

Flow diverter treatment of posterior circulation aneurysms. A meta-analysis

Pipeline for uncoilable or failed aneurysms: 3-year follow-up results

Treatment of Unruptured Distal Anterior Circulation Aneurysms with Flow-Diverter Stents: A Meta-Analysis

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