Morphologic and Clinical Outcome of Intracranial Aneurysms after Treatment Using Flow Diverter Devices: Mid-Term Follow-Up

Abstract

Flow diverters (FDs) are designed for the endovascular treatment of complex intracranial aneurysm configurations. From February 2009 to March 2013 28 patients (22 females, 6 males) were treated with FD; mean age was 57 years. Data, including aneurysm features, clinical presentation, history of previous bleeding, treatment, and follow-up results, are presented. Early postinterventional neurological deficits (transient: n = 3/enduring: n = 1) appeared in 4/28 patients (14%), and early improvement of neurological symptoms was observed in 7 patients with previous restriction of cranial nerve function. The overall occlusion rate was 20/26 (77%; 59% after 3 months). 77% achieved best results according to O'Kelly-Marotta score grade D with no contrast material filling (70% of those after 3 months). In 4/6 patients who did not achieve grade D, proximal and/or distal stent overlapping ≥5 mm was not guaranteed sufficiently. During follow-up we did not detect any aneurysm recurrence or haemorrhage. In-stent stenosis emerged as the most frequent complication (4/27; 15%) followed by 2 cases of vascular obliteration (AICA/VA). In conclusion endovascular reconstruction using a FD represents a modern and effective treatment in those aneurysms that are not suitable for conventional interventional or surgical treatment. The appearance of severe complications was rare.

Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

“…One study found that all patients were among the expected antiplatelet inhibition rate 33. The remaining studies did not report complications based on antiplatelet testing results, but 20 studies reported the action taken after abnormal results: two studies reported postponing procedures,34 35 three reported modification of the loading dose,36–38 eight reported switching to prasugrel/ticagrelor regimens,14 39–45 and seven studies reported switching to an alternative regimen 46–52. Another eight studies (335 patients) did not conduct antiplatelet testing at all and nine studies with 406 patients did not report the data on its usage (table 2).…”

Endovascular treatment of complex intracranial aneurysms

“…In doubtful cases, we suggest consideration of other invasive treatment methods, e.g. microsurgical clipping, bypass surgery, and other methods of proven efficacy, which might be beneficial for a patient [ 21 - 23 ].…”

Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure?

“…There is mounting evidence showing favorable technical success and safety profile of flow diversion, as well as emerging long-term data suggesting efficacy. 1,[6][7][8][9][10][11][12][13][14] However, the presence of a pre-existing stent 6 or an incorporated branch arising from the aneurysm [1][2][3][4] have been identified as potential factors for delayed or failed aneurysm occlusion. This study investigated branch artery relative size and geometry as risk factors for delayed aneurysmal occlusion.…”

“…Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED; Covidien-Medtronic, Irvine, CA) and the presence of an incorporated branch, regardless of aneurysmal location. [1][2][3][4][5] In some cases, however, flow diversion may still represent the preferred treatment modality, such as in cases of difficult surgical access or branch vessel incorporation into the aneurysm precluding standard or adjunctive coiling. In situations of delayed aneurysm occlusion with branch incorporation, careful inspection of the catheter angiograms often demonstrates the appearance of abnormal flow of contrast through the aneurysm body ''entry remnant'' and then into the incorporated branch.…”