Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis

Briganti, Francesco; Napoli, Manuela; Tortora, Fabio; Solari, Domenico; Bergui, Mauro; Boccardi, Edoardo; Cagliari, Enrico; Castellan, Lucio; Causin, Francesco; Ciceri, Elisa; Cirillo, Luigi; Blasi, Roberto De; Delehaye, Luigi; Paola, Francesco Di; Fontana, Andrea; Gasparotti, Roberto; Guidetti, Giulio; Divenuto, Ignazio; Iannucci, Giuseppe; Isalberti, Maurizio; Leonardi, Marco; Lupo, F.A.; Mangiafico, Salvatore; Manto, Andrea; Menozzi, Roberto; Muto, Mario; Nuzzi, Nunzio Paolo; Papa, Rosario; Petralia, Benedetto; Piano, Mariangela; Resta, M.; Padolecchia, Riccardo; Saletti, Andrea; Sirabella, G.; Bolgè, Luca Piero Valvassori

doi:10.1007/s00234-012-1047-3

Cited by 163 publications

(111 citation statements)

References 30 publications

(31 reference statements)

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“…8,14 Treatment of fusiform aneurysms with endovascular flow diversion has been limited to a discussion in small case series or as a subgroup in larger series of all aneurysm types. 2,4,7,17,19,21 In a series by Siddiqui et al, 22 7 patients underwent flow diversion for large or giant fusiform vertebro- basilar aneurysms. The PED was used in 6 patients, and the Silk (Balt Extrusion) device was used in 1 patient.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Monteith

Tsimpas²,

Dumont³

et al. 2014

JNS

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Object. Despite advances in surgical and endovascular techniques, fusiform aneurysms remain a therapeutic challenge. Introduction of flow-diverting stents has revolutionized the treatment of aneurysms with wide necks and of complex morphology. The authors report their experience with the endovascular treatment of fusiform aneurysms using the Pipeline Embolization Device.Methods. A retrospective review of 146 patients with cerebral aneurysms treated with the Pipeline Embolization Device between June 2011 and January 2013 was performed. Twenty-four patients were identified as having fusiform aneurysms. Twenty-four aneurysms in these 24 patients were treated. The mean patient age was 59 years. There were 9 men and 15 women. Angiographic and clinical data (including the modified Rankin Scale [mRS] score) were recorded at the time of treatment and at follow-up. The aneurysms were located in the internal carotid artery in 8 patients (33.3%), middle cerebral artery in 8 patients (33.3%), anterior cerebral artery in 1 patient (4%), and vertebrobasilar circulation in 7 patients (29%). The aneurysms were smaller than 10 mm in 3 patients, 10-25 mm in 16 patients, and larger than 25 mm in 5 patients. The mean largest dimension diameter was 18 mm.Results. Stent deployment was successful in all cases. The minor procedural morbidity was 4% (1 case). Morbidity and mortality related to aneurysm treatment were 4.2% and 4.2%, respectively. The mean mRS scores preoperatively and at clinical follow-up (median 6.0 months, mean 6.9 months) were 0.71 and 1.2, respectively (91.7% presented with an mRS score of 2 or better, and 79.2% had an mRS score of 2 or better at the 6.0-month follow-up). At clinical follow-up, 82.6% of patients were stable or had improved, 13.0% worsened, and 4.2% had died. Twentytwo (91.7%) of 24 patients had follow-up angiography available (mean follow-up time 6.3 months); 59% had excellent angiographic results (> 95% or complete occlusion), 31.8% had complete aneurysm occlusion, 27.3% had greater than 95% aneurysm occlusion, 18.2% had a moderate decrease in size (50%-95%), 4.5% had a minimal decrease in size (< 50%), 13.6% had not changed, and 4.5% had an increase in size.Conclusions. This series demonstrates that endovascular treatment of fusiform cerebral aneurysms with flow diversion was a safe and effective treatment. Procedural complications were low. Long-term morbidity and mortality rates were acceptable given the complex nature of these lesions.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Monteith

Tsimpas²,

Dumont³

et al. 2014

JNS

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“…9 Another review and meta-analysis of flow diversion demonstrated an all-comer late complication rate of 2.4%. 22 Few studies have subset analyses specific to cavernous segment aneurysms, but in a multicenter Italian study, Briganti et al 23 reported a 4% mortality rate for treatment of cavernous segment aneurysms with flow diverters, but this comprised 3 total cases (of 76): Two patients experienced fatal ICA thrombosis, and the other experienced a fatal ICA perforation, all during treatment of giant cavernous aneurysms. The mortality rate reported in the Italian study differs from that in both the subset analysis in the recent Canadian study 12 and in this series (both with 0% overall morbidity and mortality, 70 total combined cavernous aneurysms).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cavernous Sinus Aneurysms with Flow Diversion: Results in 44 Patients

Puffer¹,

Piano

Lanzino

et al. 2013

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Aneurysms of the cavernous segment of the ICA are difficult to treat with standard endovascular techniques, and ICA sacrifice achieves a high rate of occlusion but carries an elevated level of surgical complications and risk of de novo aneurysm formation. We report rates of occlusion and treatment-related data in 44 patients with cavernous sinus aneurysms treated with flow diversion.

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“…[1][2][3][4] The bare metal construct of the PED serves as a scaffold for neointimal proliferation, thereby excluding the aneurysm sac from the parent artery. 5,6 A number of previous studies have demonstrated that the PED is associated with high rates of aneurysm occlusion with relatively low complication rates.…”

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confidence: 99%

Risk Factors for Hemorrhagic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the International Retrospective Study of the Pipeline Embolization Device

Brinjikji¹,

Lanzino

Cloft

et al. 2015

AJNR Am J Neuroradiol

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Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis

Abstract: Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series.

Cited by 163 publications

References 30 publications

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Treatment of Cavernous Sinus Aneurysms with Flow Diversion: Results in 44 Patients

Risk Factors for Hemorrhagic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the International Retrospective Study of the Pipeline Embolization Device

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