Endovascular Treatment of Large and Giant Carotid Aneurysms with Flow-Diverter Stents Alone or in Combination with Coils: A Multicenter Experience and Long-Term Follow-up

Peschillo, Simone; Caporlingua, Alessandro; Resta, Mario; Peluso, J.P.; Burdi, Nicola; Sourour, Nader; Diana, Francesco; Guidetti, Giulio; Clarençon, Frédéric; Bloemsma, G; Maria, Federico Di; Donatelli, Massimo; Resta, M.

doi:10.1093/ons/opx032

Cited by 43 publications

(27 citation statements)

References 14 publications

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“…Flow diversion seems to be useful for the treatment of wide necked and/or sidewall aneurysms, fusiform, and dissecting aneurysms, as well as for large and giant aneurysms. For the latter, additional coiling should be considered in order to reduce the risk for subacute rupture and to enhance stable long-term occlusion (Kulcsár et al 2011;Peschillo et al 2017). Flow diversion can be used as an alternative to coiling Fig.…”

Section: Discussionmentioning

confidence: 99%

Posterior Cerebral Artery Aneurysm: Endovascular Treatment of a Fusiform, Partially Thrombosed P2-Aneurysm with a Dual-Layer Flow-Diverting Stent (FRED) in a Young Patient with Good Clinical Outcome

Vollherbst

Möhlenbruch

2020

The Aneurysm Casebook

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A 15-year-old male patient presented with a fusiform, partially thrombosed aneurysm located in the P2 segment of the right posterior cerebral artery (PCA). The aneurysm had become clinically apparent 6 months before treatment as a small hemorrhage in the right cerebral peduncle caused transient paresis in the patient's left hand. Endovascular treatment was performed with a dual-layer Flow-Redirection Intraluminal Device (FRED Jr.; MicroVention) flow diverter. During the follow-up period, the aneurysm substantially decreased in size until it had completely thrombosed. The treatment of intracranial aneurysms using dual-layer flow diverters (FRED and FRED Jr.; MicroVention) is the main topic of this chapter.

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Section: Discussionmentioning

confidence: 99%

Posterior Cerebral Artery Aneurysm: Endovascular Treatment of a Fusiform, Partially Thrombosed P2-Aneurysm with a Dual-Layer Flow-Diverting Stent (FRED) in a Young Patient with Good Clinical Outcome

Vollherbst

Möhlenbruch

2020

The Aneurysm Casebook

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“…A single-center study (19) suggested that treatment with Pipeline and coils resulted in a higher embolization rate compared with Pipeline alone for aneurysms <10 mm. Peschillo et al (20) also reported that, for large and giant carotid aneurysms, treatment with flow-diverter stents in combination with coils may provide a higher aneurysm occlusion rate and reduce the requirement for retreatment compared with the use of flow-diverter stents alone. However, to date, there is no objective method for determining the appropriate degree of packing coils for giant aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Giant aneurysm of the bilateral vertebrobasilar junction treated by pipeline and coils: A case report and literature review

et al. 2020

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Giant aneurysm of the posterior circulation is associated with a higher risk of rupture compared with that of the anterior circulation. Furthermore, surgical clipping and interventional embolization for giant aneurysm of the posterior circulation are more difficult and complex to perform. The present study reported on the case of a 26-year-old female who exhibited a giant spherical aneurysm of the vertebrobasilar junction (VBJ) with a maximum diameter of ~35 mm that caused cervical discomfort. In addition, the patient experienced symptoms including left-sided walking and hoarseness caused by the compression of the brainstem and the posterior cranial nerves. The risks associated with performing surgery in this area are high and the prognosis is mainly poor. The patient of the present study was treated using the Pipeline Flex device with coil embolization. As a giant aneurysm of the VBJ simultaneously affects the bilateral vertebral arteries (VAs) and basilar artery, it is a unique condition and the treatment strategy must be personalized. Based on an analysis of the hemodynamic influence on the aneurysm in the present case, the Pipeline was placed through the left VA, the coils were packed through the right VA, and finally, the right VA was proximally occluded. At 7 months after embolization, the patient's modified Rankin scale score was 1 point. Upon analysis of the hemodynamic influence on the aneurysm of the VBJ, the VA with the larger shear force on the wall of the aneurysm was selected for occlusion to simplify the treatment of the aneurysm and to maximize the probability to achieve recovery.

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“…The choice of this method is entirely based on the individual judgement of the neurointerventionist. Combined PED and coil embolization can speed up the complete embolization of aneurysms and reduce the recurrence rate of aneurysms (12,26). At the same time, it also increases the complexity of the operation, while there is no consensus on whether it increases the overall complication of the operation (13).…”

Section: Ped With Adjunctive Coilsmentioning

confidence: 99%

“…Therefore, there are still no firmly accepted therapeutic methods for using PED. Previous studies (12) have reported that PED combined with coils may be appropriate for some larger aneurysms, and this treatment strategy has worked in the anterior circulation. However, because of the rarity of large or giant vertebrobasilar aneurysm (LGVBA) cases, there is still little experience of PED treatment for LGVBAs.…”

Section: Introductionmentioning

confidence: 99%

Pipeline Embolization Device With Adjunctive Coils for the Treatment of Unruptured Large or Giant Vertebrobasilar Aneurysms: A Single-Center Experience

Zhou

Tian

et al. 2020

Front. Neurol.

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Objective: To evaluate effectiveness and safety of Pipeline embolization device (PED) for large or giant verterbrobasilar aneurysms (LGVBAs), and to compare the therapeutic effects of PED with and without adjunctive coils. Methods: We retrospectively analyzed 21 cases of unruptured LGVBAs who were treated in our hospital with PED. These cases were divided into "PED group" and "PED with adjunctive coils group." We compared the aneurysm characteristics and treatment outcomes between the two groups. Results: The overall neurological complication rate was 28.6% (6/21) and the mortality rate was 4.8% (1/21). There were 12 patients in the PED group and nine in the PED with adjunctive coils group. There were no significant differences in age, smoking, hypertension, aneurysm size, aneurysm location, or operation time between the two groups. The complete aneurysm embolization rate and favorable outcome rate (modified Rankin Scale = 0,1) of the PED with adjunctive coils group was 78% (7/9) and 100% (9/9), respectively, which were both better compared with the PED group with 63.6% (7/11) and 83% (10/12), respectively. However, these differences were not statistically significant. Conclusion: The effectiveness and safety of PED for LGVBAs is acceptable. Treatment results did not differ between the PED and PED with adjunctive coils groups; therefore, whether coils should be used may depend the operator. Our results suggest that correct use of the coils does not increase complications. We suggest that PED with adjunctive coils should be used for some selected LGVBAs.

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Endovascular Treatment of Large and Giant Carotid Aneurysms with Flow-Diverter Stents Alone or in Combination with Coils: A Multicenter Experience and Long-Term Follow-up

Cited by 43 publications

References 14 publications

Posterior Cerebral Artery Aneurysm: Endovascular Treatment of a Fusiform, Partially Thrombosed P2-Aneurysm with a Dual-Layer Flow-Diverting Stent (FRED) in a Young Patient with Good Clinical Outcome

Posterior Cerebral Artery Aneurysm: Endovascular Treatment of a Fusiform, Partially Thrombosed P2-Aneurysm with a Dual-Layer Flow-Diverting Stent (FRED) in a Young Patient with Good Clinical Outcome

Giant aneurysm of the bilateral vertebrobasilar junction treated by pipeline and coils: A case report and literature review

Pipeline Embolization Device With Adjunctive Coils for the Treatment of Unruptured Large or Giant Vertebrobasilar Aneurysms: A Single-Center Experience

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