Flow diversion for treatment of intracranial aneurysms: Mechanism and implications

Chua, Melissa; Silveira, Luke; Moore, Justin M.; Pereira, Vítor Mendes; Thomas, Ajith J.; Dmytriw, Adam A

doi:10.1002/ana.25484

Cited by 19 publications

(20 citation statements)

References 69 publications

(235 reference statements)

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“…Flow diverters (FDs) are a well-established treatment for selected intra- or extracranial aneurysms 1 2. Their safety and efficacy have been demonstrated in large and giant anterior circulation aneurysms, sidewall aneurysms of <12 mm, distal lesions, and selected ruptured aneurysms 3–8…”

Section: Introductionmentioning

confidence: 99%

First clinical experience with the new Surpass Evolve flow diverter: technical and clinical considerations

Orrù

Rice

Villiers

et al. 2020

J NeuroIntervent Surg

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ObjectiveTo describe the results in patients treated with the Surpass Evolve (SE) device, the new generation of Surpass flow diverters.MethodsTwenty-five consecutive patients (20 women, average age 58 years), with anterior or posterior circulation aneurysms treated with SEs in two early-user centers, were included. Device properties and related technical properties, imaging and clinical follow-up data, and intraprocedural, early (<30 days) and delayed (>30 days) neurological complications, further divided into minor (silent/non-permanent) and major (permanent) complications, were recorded and analyzed.ResultsTwenty-nine SEs were successfully implanted in all subjects to treat 26 aneurysms using an 0.027" microcatheter with an average of 1.2 stents per patient. No intraprocedural thromboembolic or hemorrhagic complications were seen. At clinical follow-up, 24/25 (96%) patients had a modified Rankin Score of 0–2. Mortality was 0%. Imaging follow-up, available in 22/25 (88%) patients (median follow-up time 4 months), showed a complete aneurysm occlusion in 13/23 (57%) imaged lesions. Minor, transitory neurological deficits were recorded in 5/25 (20%) patients. One (4%) major complication was seen in one patient (4%) with a left-sided hemispheric stroke on postprocedural day 4 due to an acute stent thrombosis.ConclusionsPreliminary experience in patients demonstrates a good performance of the SE. This newly designed implant maintains the engineering characteristics of Surpass flow diverters, including precise placement due to its lower foreshortening and a high mesh density, yet can be deployed through a significantly lower-profile delivery system.

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Section: Introductionmentioning

confidence: 99%

First clinical experience with the new Surpass Evolve flow diverter: technical and clinical considerations

Orrù

Rice

Villiers

et al. 2020

J NeuroIntervent Surg

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“…With the appropriate indications and medical management, the use of flow diverter stents (FDS) can result in high rates of complete and permanent aneurysmal occlusion, a feature that has always been a major drawback of traditional endovascular treatment [2][3][4][5]. The low porosity and high mesh density of FDS facilitate aneurysmal occlusion by reducing the blood flow into the aneurysms and by serving as a scaffold for endothelialization across the aneurysm neck leading to progressive occlusion and reduced rates of recanalization of the treated aneurysm [6]. The use of FDS in the acute phase for the treatment of acutely ruptured aneurysms has been limited by the need for dual antiplatelet therapy (DAPT) and is usually considered as a last resort option if other modalities are not available or suitable [7].…”

Section: Introductionmentioning

confidence: 99%

Flow Diversion for Treatment of Acutely Ruptured Intracranial Aneurysms

et al. 2019

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Background Reports about the use of flow diverter stents (FDS) in the acute setting of subarachnoid hemorrhage (SAH) are limited. This article presents a single center experiences based on 45 consecutive cases with emphasis on complication rates and clinical and radiologic outcomes. Methods A prospectively maintained database of all cases treated with FDS as a stand-alone or adjunct device was retrospectively reviewed. All patients treated within 30 days of SAH were included. Records were made of clinical presentation, details of endovascular treatment, procedural complications, clinical outcome, and degree of occlusion on follow-up. Results In this study 45 patients (48.9% females; mean age 58.8 ± 12.4 years) were included. Flow diversion was performed after a median of 4 days. The procedural complication rate was 13.3% resulting in 2.2% permanent morbidities and 4.4% mortalities. No major hemorrhagic complications related to antiplatelet therapy were recorded. Immediate complete occlusion was achieved in 13.3%. Among survivors, complete occlusion was achieved in 94.6%. Excellent clinical outcome was recorded in 68.9% and 81.6% of the total population and survivors, respectively. There were no records of rebleeding from the target lesions. Conclusion Flow diversion is an attractive alternative strategy for management of acutely ruptured aneurysms with high rates of delayed complete occlusion and acceptable complication rates.

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“…Flow diverters are a new treatment strategy for intracranial aneurysms. The flow diverter had a strong hemodynamic effect to reduce the flow of aneurysm, further gradually occludes with thrombus organized and neointima formation ( 9 ). Flow diverter treatment has a lower probability of recurrence than conventional coiling, even in lesions vulnerable to recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…With advances in endovascular technology, flow diverters have become an increasingly established treatment in the management of complex intracranial aneurysms. Compared with other endovascular treatment, the higher aneurysm occlusion rate and lower aneurysm recurrence rates was found (6)(7)(8)(9). Recurrent aneurysm carries a persistent risk of regrowth and rupture, and retreatment is considered necessary to avoid bleeding or rebleeding (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Retreatment With Flow Diverters and Coiling for Recurrent Aneurysms After Initial Endovascular Treatment: A Propensity Score-Matched Comparative Analysis

Zhu

Sun

et al. 2021

Front. Neurol.

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Background: Flow diverters and conventional coiling are established modalities for the retreatment of intracranial recurrent aneurysms after initial endovascular treatment. We aimed to compare the efficacy of these techniques.Methods: We retrospectively analyzed data for patients with recurrent aneurysms after initial endovascular treatment retreated in our center with either a pipeline embolization device (PED) or conventional coil embolization from January 2012 to July 2020. We performed 1:2 propensity score matching (PSM) using the nearest neighbor method. We controlled for: initial treatment strategy, aneurysm size, neck diameter, symptom presentation, history of aneurysm rupture, age, sex, fusiform-dissecting aneurysm, bifurcation aneurysm, and aneurysm location. The clinical and morphological factors of all patients at initial treatment and the angiographic and clinical results at the second treatment were collected and compared between the propensity-matched pairs.Results: A total of 105 intracranial aneurysms were identified; 18 patients (17.1%) were treated with a PED, and 87 (82.9%) were treated via conventional coil embolization. PSM resulted in 12 matched pairs (12 patients in the PED group and 24 in the coiling group). There was no significant difference of ischemic and hemorrhagic complications between the groups, the obliteration rate of branches covered by stent, or modified Rankin Scale scores at the last clinical follow-up. Importantly, the retreatment strategy in the PED group provided significantly different results vs. the coiling group (P < 0.001), with a lower recurrence rate (0.0 vs. 29.2%, respectively; P = 0.037). However, the procedural failure rate and the parent artery stenosis were more frequently in PED group compared with coiling group (both were 16.7 vs. 0.0%; P = 0.040).Conclusions: Endovascular retreatment for recurrent aneurysms after initial endovascular treatment might be safe and effective. Flow diverters might be associated with reduced risk of recanalization and an increased risk of procedural failure and mild parent artery stenosis.

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Flow diversion for treatment of intracranial aneurysms: Mechanism and implications

Cited by 19 publications

References 69 publications

First clinical experience with the new Surpass Evolve flow diverter: technical and clinical considerations

First clinical experience with the new Surpass Evolve flow diverter: technical and clinical considerations

Flow Diversion for Treatment of Acutely Ruptured Intracranial Aneurysms

Retreatment With Flow Diverters and Coiling for Recurrent Aneurysms After Initial Endovascular Treatment: A Propensity Score-Matched Comparative Analysis

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