The FRED for Cerebral Aneurysms of the Posterior Circulation: A Subgroup Analysis of the EuFRED Registry

Griessenauer, Christoph J.; Möhlenbruch, Markus; Hendrix, Philipp; Ulfert, Christian; Işlak, Civan; Sonnberger, Michael; Engelhorn, Tobias; Müller-Thies-Broussalis, Erasmia; Finkenzeller, Thomas; Holtmannspoetter, Markus; Buhk, Jan‐Hendrik; Reith, Wolfgang; Simgen, Andreas; Janssen, Hendrik; Koçer, Naci; Killer‐Oberpfalzer, Monika

doi:10.3174/ajnr.a6447

Cited by 14 publications

(13 citation statements)

References 14 publications

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“…25 Few studies have explored the use of flow diversion in the posterior circulation. Grissenauer et al 21 performed a subgroup analysis of the European FRED (EuFRED) study 13 of patients treated with the FRED for posterior circulation aneurysms. Complete occlusion at last follow up was 78.2%, which is comparable to occlusion rates seen in the studies presented in this review.…”

Section: Discussionmentioning

confidence: 99%

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Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

et al. 2021

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Introduction The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data. Methods The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed. Results Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies). Conclusion This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.

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Section: Discussionmentioning

confidence: 99%

“…Twenty-two studies published between January 1, 2013 and April 30, 2021 are included in this review. [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] One study published results in 2 separate papers. 2,3 Table 1 outlines the characteristics of each study.…”

Section: Study Characteristicsmentioning

confidence: 99%

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

et al. 2021

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“…The most common aneurysm type was saccular and favorable safety results were shown, but thromboembolic complications were more frequent in non-saccular aneurysms. 21) The therapeutic results of mid/distal-basilar and holobasilar aneurysm involving AICA showed the worst neurological outcome. 22) Conversely, if holobasilar aneurysms or aneurysms with a large amount of thrombus were not involved, the treatment outcome was reported to be excellent.…”

Section: Discussionmentioning

confidence: 96%

Short-segment Internal Trapping for Symptomatic Thrombosed Large Fusiform Vertebral Artery Aneurysms (Bird’s Nest Trapping): A Technical Note

Nishihori

Izumi

Tsukada

et al. 2021

Neurol. Med. Chir.(Tokyo)

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Internal trapping with coils is an established treatment of symptomatic large non-branching thrombosed fusiform vertebral artery aneurysms (VAA). However, when perforators arise near the aneurysm neck, parent artery occlusion has a high risk of causing medullary infarction. As an alternative treatment, we performed short-segment internal trapping of the artery using n-butyl-2-cyanoacrylate (NBCA) and coils (bird’s nest trapping). Before treatment, perianeurysmal perforators are carefully detected using high-resolution three-dimensional rotational angiography (3DRA). Double microcatheters are advanced to the distal portion of the aneurysm through a balloon guiding catheter where coils are deployed without tight packing. Then, NBCA is injected into the coil mass, taking care to preserve perforators and significant branches. The same maneuver is repeated in the proximal portion of the aneurysm. Coil placement is avoided within the middle of the aneurysm; however, if necessary, only a small number of coils are placed to prevent worsening of mass effect. Two quinquagenarian males presented with a large thrombosed fusiform VAA that caused symptoms due to mass effect. In each case, perforators arose from the parent artery and short-segment internal trapping with NBCA and coils was performed. Symptoms improved after treatment and follow-up imaging confirmed aneurysm shrinkage with no long-time recurrence. In symptomatic large fusiform VAAs where the distance from the lesion to important perforators is extremely short, internal trapping using a combination of NBCA and coils can be more useful than conventional internal trapping.

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“…[1][2][3] Current studies have even shown that the risk profile of such devices has decreased compared to the early years. [4][5][6][7][8][9][10] By diverting blood flow away from the aneurysm, they aim to alter the dynamics of intra-aneurysmal flow to induce thrombosis that leads to the occlusion of the aneurysm over time. This is one of the few methods in the treatment of cerebral aneurysms where complete reconstruction of the original vessel wall and thus complete healing of the parent vessel is possible.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion

et al. 2021

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Purpose Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past years. Complete aneurysm occlusion is a process that often takes a certain amount of time and is usually difficult to predict. Our aim was to investigate different syngo iFlow parameters in order to predict aneurysm occlusion. Methods Between 2014 and 2018 patients with unruptured cerebral aneurysms treated with a FD were reviewed. Aneurysm occlusion and complication rates have been assessed. In addition, various quantitative criteria were assessed using syngo iFlow before, after the intervention, and after short and long-term digital subtraction angiography (DSA). Results A total of 66 patients hosting 66 cerebral aneurysms were included in this study. 87.9% (n = 58) aneurysms in the anterior and 12.1% (n = 8) in the posterior circulation were treated. Adequate aneurysm occlusion at long-term follow-up (19.05 ± 15.1 months) was achieved in 90.9% (n = 60). Adequately occluded aneurysm revealed a significantly greater peak intensity delay (PI-D, p = 0.008) and intensity decrease ratio (ID-R, p < 0.001) compared to insufficiently occluded aneurysms. Increased intra-aneurysmal contrast agent intensity (>100%) after FD implantation resulted in an ID-R < 1, which was associated with aneurysm growth during follow-up DSA. Retreatment with another FD due to foreshortening and/or aneurysm growth was performed in 10.6% (n = 7). Overall morbidity and mortality rates were 1.5% (n = 1) and 0%. Conclusion The applied syngo iFlow parameters were found to be useful in predicting adequate aneurysm occlusion and foresee aneurysm growth, which might indicate the implantation of another FD.

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The FRED for Cerebral Aneurysms of the Posterior Circulation: A Subgroup Analysis of the EuFRED Registry

Cited by 14 publications

References 14 publications

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

Short-segment Internal Trapping for Symptomatic Thrombosed Large Fusiform Vertebral Artery Aneurysms (Bird’s Nest Trapping): A Technical Note

Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion

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