Midterm and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience

Piano, Mariangela; Valvassori, Luca; Quilici, Luca; Pero, Guglielmo; Boccardi, Edoardo

doi:10.3171/2012.10.jns112222

Cited by 114 publications

(92 citation statements)

References 27 publications

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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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“…Some of the patients reported were enrolled in the Pipeline for Uncoilable or Failed Aneurysms Study 9 or were reported as part of a large series on flow diversion. 10 Demographic information, indication for treatment, type and number of flow diverters placed, treatment outcome, complications (technical or clinical, with 1-sided confidence intervals), and clinical/imaging follow-up data were collected and analyzed. The 5 main operators performing these procedures each had at least 10 years of independent practice, and many of the procedures were performed with 2 experienced operators present.…”

Section: Methodsmentioning

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][5][6] The relative safety and high efficacy of flow diversion in saccular aneurysms presenting with mass effect have been reported. 1,7,8 However, a high rate of thromboembolic and hemorrhagic complications has been found in giant fusiform aneurysms (GFAs), particularly in those located in the posterior fossa.…”

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confidence: 99%

Evolution of Flow-Diverter Endothelialization and Thrombus Organization in Giant Fusiform Aneurysms after Flow Diversion: A Histopathologic Study

Szikora

Turányi

Marosfői

2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Treatment of giant fusiform aneurysms with flow diverters has been associated with a relatively high rate of complications. Our goal was to study the evolution of flow-diverter endothelialization and thrombus organization at different time points after flow-diverter treatment in giant fusiform aneurysms to better understand reasons for flow-diverter thrombosis and delayed aneurysm ruptures.

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Midterm and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience

Abstract: Parent artery reconstruction using flow diverter devices is a feasible, safe, and successful technique for the treatment of endovascular treatment of cerebral aneurysms.

Cited by 114 publications

References 27 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

Evolution of Flow-Diverter Endothelialization and Thrombus Organization in Giant Fusiform Aneurysms after Flow Diversion: A Histopathologic Study

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