Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

Limbucci, Nicola; Leone, Giuseppe; Renieri, Leonardo; Nappini, Sergio; Cagnazzo, Fédérico; Laiso, Antonio; Muto, Mario; Mangiafico, Salvatore

doi:10.1093/neuros/nyz334

Cited by 52 publications

(51 citation statements)

References 85 publications

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“…investigating the efficacy and safety of FDS, excellent results were obtained, and these studies led to increased utilization of FDSs in a wide range of aneurysm types. 18,19 In addition to the intracranial complex, wide-necked large and giant, fusiform, blister and bifurcation aneurysms, 8,10,12,20,21 another accepted FDS indication of the aneurysm treatment, the efficacy and safety of which were shown by some studies, is the recanalized and residual aneurysms previously treated with other techniques, coiling or stentassisted coiling. 13,15,16,[22][23][24] When complete aneurysm occlusion is obtained with FDSs, recanalization is rare.…”

Section: Discussionmentioning

confidence: 99%

Flow diverter stents in the treatment of recanalized intracranial aneurysms

et al. 2021

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Background We assessed the safety and efficacy of flow diverter stents (FDSs) in the treatment of recanalized or residual intracranial aneurysms treated endovascularly. Materials & Methods Patients whose recanalized or residual aneurysms were treated with FDSs in five tertiary hospitals were reviewed retrospectively. The patients’ demographic data, aneurysm characteristics, types of previous treatment, and clinical complications, or serious adverse events associated with FDSs, as well as the results of neurological and angiographic follow-up assessments, were recorded. Results Eighty-six patients (37 males) with 87 aneurysms were included in this study. Eighty (91.9%) aneurysms were in the anterior and seven (8.1%) in the posterior circulation. The initial treatment methods were the primary coiling or balloon remodeling technique in 69 (79.3%) and stent-assisted coiling in 18 (20.7%) aneurysms. The endovascular procedure was successful in all patients. Complications occurred in four patients, for a total complication rate of 4.6%. A technical complication developed in one patient (1.2%). An in-stent thrombosis treated with tirofiban was seen in two cases. Late in-stent stenosis exceeding 50% was treated with balloon angioplasty in one patient. The mean length of follow-up was 21.0 months. The first angiographic follow-up (3–6 months) revealed the complete occlusion of 74 aneurysms (85.1%). While 76 aneurysms (87.4%) were occluded at the last angiographic follow-up (mean: 26.0 months), 11 aneurysms (12.6%) were still filling. Morbimortality was zero. Conclusion The drawback of endovascular treatment is aneurysmal remnants or recurrences, which is safely and durably amenable to flow diversion.

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Section: Discussionmentioning

confidence: 99%

Flow diverter stents in the treatment of recanalized intracranial aneurysms

et al. 2021

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“…The proven efficacy of flow diverters has led to the expansion of indications for the treatment of complex or even non-complex IAs [82]. At present, flow diverters are indicated for the treatment of small-or medium-sized aneurysms [83][84][85][86][87] and fusiform aneurysms up to the ICA bifurcation, although the last indication remains challenging.…”

Section: Flow Diversionmentioning

confidence: 99%

Endovascular Treatment of Intracranial Aneurysms

Adamou

Alexandrou

Roth

et al. 2021

Life

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Traditionally, surgical clipping was the only available treatment modality for intracranial aneurysms. However, in the last few decades, the endovascular therapy of intracranial aneurysms (IAs) has seen a tremendous evolution and development. From coiling to flow diversion and flow disruptor devices, endovascular treatment modalities have increased in number and received broader indications throughout the years. In this review article, the treatment modalities for the endovascular management of IAs are presented, emphasizing newer devices and technologies.

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“…Subsequently initial indications were focused on large and giant unruptured ICA aneurysms as well as recanalized or residual aneurysms. 18 The great effi cacy of this treatment demonstrated in further studies (see below) and the development of new-generation fl ow diverters including small diameters devices (FRED/FREDJr, Microvention, Aliso Viejo, CA, USA; p64/p46-MW/p64-MW, phenox, Bochum, Germany) was leading to the progressive enlargement of indications to small aneurysms, distal aneurysms, and bifurcation aneurysms [19,20]. One major limitation in the use of fl ow diverters is the need of using dual antiplatelet treatment (DAPT) preoperatively and in the months (usually 3 to 6 months) following the procedure (see below).…”

Section: Ia Coiling: Limits and Additional Techniques (Balloon-assistmentioning

confidence: 99%

Editorial: What is the future of the endovascular treatment of intracranial aneurysms?

Piérot¹

2020

Endovasc. Neurorad.

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Intracranial aneurysms rapture is a common cause of mortality or morbidity worldwide. For this reason, in case of rupture, early treatment of the aneurysm is mandatory. The evaluation of unruptured intracranial aneurysms continue to increased due to the improvements in invasive and non-invasive neuroimaging. Securing of this life-threatening condition, considering all demographical and procedural factors is necessary for improving treatment results and patients outcome. The endovascular treatment has become frontline therapy of cerebral aneurysms treatment during the last 20 years, and without a doubt its recent advances shifted this boundary even further. Nowadays endovascular armamentarium continues to grow rapidly. Neuro-interventional procedures have tremendously improved their efficiency and continue to improve device’s safety. However some types of aneurysms are not really easy to treat with ordinary endovascular technique as it can result in devastating consequence, Firstly, it is not always applicable to complex aneurysms or very large neck aneurysms. Secondly, durability of the of the aneurysm occlusion is not guaranteed in all cases even after usage of the remodeling technique or regular stenting. New devices are introduced to decrease these limits. Two new innovative techniques that are increasingly used for endovacular occlusion of the complex aneurysms are flow diversion and intrasaccular flow disruption. The objective of this review is to provide a comprehensive overview of novel paradigms and latest research of flow diversion and intrasaccular flow disruption devices, its current application, limitation and future prospective. The obvious advantages of these new technologies proved progressive expansion of their utilization to the extent that they will ultimately replace standard coiling in an increasing number of cases going forward. The future of the endovascular treatment of intracranial aneurysms is bright. Fast gro-wing improvement in vascular access, treatment modalities and device delivery continue to increase number of patients with intracranial aneurysms treated with endovascular approach versus surgical clipping.

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Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

Cited by 52 publications

References 85 publications

Flow diverter stents in the treatment of recanalized intracranial aneurysms

Flow diverter stents in the treatment of recanalized intracranial aneurysms

Endovascular Treatment of Intracranial Aneurysms

Editorial: What is the future of the endovascular treatment of intracranial aneurysms?

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