Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center

OBJECTIVEFlow diversion has emerged as a viable treatment option for selected intracranial aneurysms and recently has been gaining traction. The aim of this study was to evaluate the safety and effectiveness of flow-diverter devices (FDDs) over a long-term follow-up period.METHODSThe authors retrospectively reviewed all cerebral aneurysm cases that had been admitted to the Division of Neurosurgery of the Università degli Studi di Napoli between November 2008 and November 2015 and treated with an FDD. The records of 60 patients (48 females and 12 males) harboring 69 cerebral aneurysms were analyzed. The study end points were angiographic evidence of complete aneurysm occlusion, recanalization rate, occlusion of the parent artery, and clinical and radiological evidence of brain ischemia. The occlusion rate was evaluated according to the O’Kelly-Marotta (OKM) Scale for flow diversion, based on the degree of filling (A, total filling; B, subtotal filling; C, entry remnant; D, no filling). Postprocedural, midterm, and long-term results were strictly analyzed.RESULTSComplete occlusion (OKM D) was achieved in 63 (91%) of 69 aneurysms, partial occlusion (OKM C) in 4 (6%), occlusion of the parent artery in 2 (3%). Intraprocedural technical complications occurred in 3 patients (5%). Postprocedural complications occurred in 6 patients (10%), without neurological deficits. At the 12-month follow-up, 3 patients (5%) experienced asymptomatic cerebral infarction. No further complications were observed at later follow-up evaluations (> 24 months). There were no reports of any delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, ischemic complications, or procedure- or device-related deaths.CONCLUSIONSEndovascular treatment with an FDD is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. In the present study, the authors observed effective and stable aneurysm occlusion, even at the long-term follow-up. Data in this study also suggest that ischemic complications can occur at a later stage, particularly at 12–18 months. On the other hand, no other ischemic or hemorrhagic complications occurred beyond 24 months.

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

Interventional Neuroradiology ◽

10.1177/15910199211024056 ◽

2021 ◽

pp. 159101992110240

Author(s):

Andreas Simgen ◽

Christine Mayer ◽

Michael Kettner ◽

Ruben Mühl-Benninghaus ◽

Wolfgang Reith ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Complication Rates ◽

Long Term Follow Up ◽

Aneurysm Growth ◽

Short And Long Term ◽

Aneurysm Occlusion ◽

Unruptured Cerebral Aneurysms

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

Journal of Neurosurgery ◽

10.3171/2012.10.jns112222 ◽

2013 ◽

Vol 118 (2) ◽

pp. 408-416 ◽

Cited By ~ 86

Author(s):

Mariangela Piano ◽

Luca Valvassori ◽

Luca Quilici ◽

Guglielmo Pero ◽

Edoardo Boccardi

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Long Term Results ◽

Maximum Diameter ◽

Consecutive Series ◽

Flow Diverter Devices

Object The introduction of flow diverter devices is revolutionizing the endovascular approach to cerebral aneurysms. Midterm and long-term results of angiographic, cross-sectional imaging and clinical follow-up are still lacking. The authors report their experience with endovascular treatment of intracranial aneurysms using both the Pipeline embolization device and Silk stents. Methods From October 2008 to July 2011 a consecutive series of 104 intracranial aneurysms in 101 patients (79 female, 22 male; average age 53 years) were treated. Three of the 104 aneurysms were ruptured and 101 were unruptured. Silk stents were implanted in 47 of the aneurysms and Pipeline stents in the remaining 57. In 14 cases a combination of flow diverter devices and coils were used to treat larger aneurysms (maximum diameter > 15 mm). Patients underwent angiographic follow-up examination at 6 months after treatment, with or without CT or MRI, and at 1 year using CT or MRI, with or without conventional angiography. Results In all cases placement of flow diverter stents was technically successful. The mortality and morbidity rates were both 3%. Adverse events without lasting clinical sequelae occurred in 20% of cases. Angiography performed at 6 months after treatment showed complete aneurysm occlusion in 78 of 91 cases (86% of evaluated aneurysms) and subocclusion in 11 (12%); only in 2 cases were the aneurysms unchanged. Fifty-three aneurysms were evaluated at 1 year after treatment. None of these aneurysms showed recanalization, and 1 aneurysm, which was incompletely occluded at the 6-month follow-up examination, was finally occluded. Aneurysmal sac shrinkage was observed in 61% of assessable aneurysms. Conclusions Parent artery reconstruction using flow diverter devices is a feasible, safe, and successful technique for the treatment of endovascular treatment of cerebral aneurysms.

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Abstract 1122‐000103: FlowDiverter:A Study Safety and Efficacy in a Consecutive Group of 53 Patient and 60 Aneurysm

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000103 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Marcelo Bolcato ◽

ana Carolina Dalmonico ◽

Leo Ditzel ◽

Savio Machareti ◽

Thiago Yoshida ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Consecutive Series ◽

Safety And Efficacy ◽

Grading Scale ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Flow Diverters

Introduction : Endovascular flow diverters are increasingly used for the treatment of cerebral aneurysms. We assessed the safety and efficacy of the Flow Diverters in a consecutive series of 53 patients and 60 aneurysms. Methods : Inclusion criteria were wide‐neck, blister‐like, or fusiform aneurysms independent of size, treated with the FRED, PIPELINE and SILK between December 2014 and Junho 2021. Assessment criteria were aneurysm occlusion, manifest ischemic stroke, bleeding, or death. The occlusion rate was assessed at 6 months and 1 year with DSA by using the Raymond classification and the O'Kelly‐Marotta grading scale. Results : Fifty three patients (mean age 54.3 years;81.1% female) with 60 aneurysms were treated with 9 Silk, 38 FREDs and 13 Pipeline. Aneurysm size ranged from 2.5 to 30 mm. Deployment of the Flow diverters was successful in 52 aneurysms. Three patient developed mild stroke symptoms that fully receded within days, 4 patients occlusion total carotid because resistant antiagregation and another patient’s development Swelling syndrome. There has been one death. Initial follow‐up at 6 months showed complete occlusion in 90% of the overall study group and 93,33% at 1 year. Conclusions : The flow diverter is a safe device for the treatment of cerebral aneurysms of various types. Our data reveal high occlusion rates at 6 months and 1 year. Long‐term occlusion rates are expected.

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Timing and Spectrum of Neurological Complications After Flow Diverter Implantation for Intracranial Aneurysms

Frontiers in Neurology ◽

10.3389/fneur.2021.590383 ◽

2021 ◽

Vol 12 ◽

Author(s):

Guillaume Charbonnier ◽

Jean-Philippe Desilles ◽

Simon Escalard ◽

Benjamin Maier ◽

Gabriele Ciccio ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Neurological Complication ◽

Neurological Complications ◽

Flow Diverter ◽

Factors Associated ◽

Long Term Follow Up ◽

Ischemic Complications ◽

Ischemic Events

Background and Purpose: The aim of this study was to characterize neurological complications after flow diverter (FD) treatment on a long follow-up cohort and identify predictive factors associated with these complications.Methods: This study was conducted on a monocentric cohort of patients treated for intracranial aneurysms by FD.Results: Between September 2008 and July 2018, 413 patients were treated for 514 aneurysms: 18% of the patients presented with at least one neurological complication during a median follow-up of 446 days (IQR 186–1,210). Sixty-one patients presented with ischemic complications, 13 with hemorrhagic ones and 10 with compressive processes. Among 89 neurological complications 64.5% were peri-operative (occurring within the 30 days following the procedure) and 35.5% were delayed after 1 month.Conclusions: Overall, neurological complications after FD implantation were overrepresented by cerebrovascular ischemic events occurring during the peri-operative period, but also in a delayed manner after 1 year. Long-term follow-up is relevant after aneurysm intervention using FD.

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Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results

Journal of Neurosurgery ◽

10.3171/2014.1.jns131442 ◽

2014 ◽

Vol 120 (5) ◽

pp. 1158-1171 ◽

Cited By ~ 50

Author(s):

Naci Kocer ◽

Civan Islak ◽

Osman Kizilkilic ◽

Burak Kocak ◽

Muzaffer Saglam ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Short Term ◽

Radiological Data ◽

Procedural Complication ◽

Long Term Follow Up ◽

Permanent Morbidity ◽

Additional Device

Object Flow diverter (FD) stents are relatively new and important devices in the treatment of cerebral aneurysms. The Flow Re-Direction Endoluminal Device has been recently released for clinical use. The authors' aim in this paper is to report their initial single-center FRED experience with short-term results. Methods Between February 2012 and May 2013, 33 patients with 37 aneurysms (35 unruptured and 2 previously ruptured aneurysms) were treated with the FRED. Clinical and radiological data of the patients were retrospectively reviewed. Results In all patients only 1 device was used without any additional device or material, such as a stent or coil. All procedures were successfully performed. The procedural complication rate was 3% (1 of 33). Thirty patients underwent clinical and radiological follow-up. During the follow-up period, changes in stent morphology, such as “fish mouth” and “foreshortening” phenomena, occurred in 5 patients. The mortality and permanent morbidity rates were 0%. The complete occlusion rates were 32% (6 of 19) at 0–1 month, 67% (8 of 12) at 2–3 months, 80% (4 of 5) at 4–6 months, and 100% (8 of 8) at 7–12 months. The rates for some aneurysms were assessed at more than one time point. Conclusions The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid- and long-term follow-up results of multicenter large series.

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Two- to five-year follow-up of 78 patients after treatment with the Flow Redirection Endoluminal Device

Interventional Neuroradiology ◽

10.1177/1591019919878551 ◽

2019 ◽

Vol 26 (1) ◽

pp. 38-44 ◽

Cited By ~ 1

Author(s):

Hannes Luecking ◽

Arnd Doerfler ◽

Philipp Goelitz ◽

Philip Hoelter ◽

Tobias Engelhorn ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Recurrence Rates ◽

Distal Internal Carotid Artery ◽

Aneurysm Growth ◽

Aneurysm Occlusion ◽

One Year ◽

Related Mortality

Background and purpose Flow-diverter stents are well-established for the treatment of cerebral aneurysms. Flow Redirection Endoluminal Device differs from other flow-diverter stents by its dual-layer design and has proved equality to other devices in numerous short-term surveys. However, follow-up data covering substantially more than one year are still limited for this device. We present our long-term experience with Flow Redirection Endoluminal Device. Materials and methods Seventy-eight patients harboring distal internal carotid artery (91%) or vertebrobasilar (9%) cerebral aneurysms treated with Flow Redirection Endoluminal Device with or without adjunctive coiling met the inclusion criteria. All cases were evaluated for aneurysm occlusion (according to Modified Raymond Roy Classification, MRRC), for flow-diverter stents patency and configuration and for procedure- and device-related morbidity and mortality. Results Mean follow-up interval was 36.9 ± 9.5 months (<30 months: n = 18; 31–42 months: n = 31; >42 months: n = 24). Total and subtotal aneurysm occlusion after six months was assessed in 92.0% (MRRC1 = 77.3%, MRRC2 = 14.7%, MRRC3a =2.7%, MRRC3b = 4.1%) and increased to 95.9% (MRRC1 = 90.5%, MRRC2 = 5.4%, MRRC3a = 2.7%). There was one case of aneurysm growth requiring early re-treatment. Procedure-related morbidity was observed in three cases (3.8%; one transient hemiparesis, one suspected foreign-body reaction, and one micro-wire perforation). There was no procedure- or device-related mortality. In-stent stenosis due to intimal hyperplasia was observed in two cases and fish-mouthing in three cases. Conclusions Our long-term data covering two to five years after flow diversion confirm that Flow Redirection Endoluminal Device is a safe and effective device for the treatment of cerebral aneurysms with progressive high aneurysm occlusion rates; recurrence rates were very low. Overall device-related morbidity was low and was not observed later than six months after intervention.

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Flow-diverter stents for endovascular management of non-fetal posterior communicating artery aneurysms—analysis on aneurysm occlusion, vessel patency, and patient outcome

Interventional Neuroradiology ◽

10.1177/1591019918759735 ◽

2018 ◽

Vol 24 (4) ◽

pp. 363-374 ◽

Cited By ~ 9

Author(s):

Anna Luisa Kühn ◽

Guilherme Dabus ◽

Peter Kan ◽

Ajay K Wakhloo ◽

Ajit S Puri

Keyword(s):

Flow Diverter ◽

Aneurysm Rupture ◽

Posterior Communicating Artery ◽

Flow Diversion ◽

New Findings ◽

Vessel Patency ◽

Long Term Follow Up ◽

Aneurysm Occlusion

Background Use of flow-diversion technology in the treatment of incidental and recanalized posterior communicating artery (PComA) aneurysms. Methods Patients treated with the Pipeline embolization device (PED) for PComA aneurysms were identified and included in our retrospective analysis. We evaluated aneurysm characteristics, modified Rankin Scale score (mRS) on admission, angiography follow-up, and patient clinical outcome at discharge, at three to nine months, and at 12–18 months. Results We included 56 patients with a mean age of 56 years. Median mRS on admission was 0. All aneurysms involved the PComA and were either new findings or found to have shown recanalization at angiography follow-up from previous coil embolization or surgical clipping. Intraprocedural device foreshortening was observed in one case requiring additional placement of a self-expanding stent. One intraprocedural aneurysm rupture occurred because of a broken distal wire. This patient had an mRS of 4 after the procedure. Three- to nine-month and 12- to 18-month follow-up angiography showed near complete or complete aneurysm occlusion in most cases. Minimal to mild intimal hyperplasia was seen in five cases at three to nine months. PComA patency over time showed 29 of 46 initially patent vessels still patent at six months. Thirteen and seven PComAs showed progressive decrease in flow at three to nine months and 12–18 months, respectively. Median mRS remained 0 for all patients at three- to nine-month and 12- to 18-month follow-up. Conclusions Our preliminary results show that flow-diversion technology is an effective and safe treatment option. Larger studies with long-term follow-up are needed to validate our promising results.

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Endovascular Parent Artery Occlusion for Intracranial Aneurysms is a Viable, Cost-Effective Alternative: An Institutional Experience from Northeast India

Acta medica Lituanica ◽

10.15388/amed.2021.28.2.6 ◽

2021 ◽

Vol 28 (2) ◽

pp. 6

Author(s):

Pranjal Phukan ◽

Kalyan Sarma ◽

Donboklang Lynser ◽

Barun Kumar Sharma ◽

Deb Kumar Baruah ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Parent Artery ◽

Complete Occlusion ◽

Parent Artery Occlusion ◽

Long Term Follow Up

Purpose. Endovascular parent artery occlusion (PAO) may be an alternative approach for complex intracranial aneurysm with potentially life-threatening complications. Moreover, the long-term follow-up of the PAO for an intracranial aneurysm is reported sparingly, limited to the case series. It is therefore important to carry out more research on long-term follow-up of the implication of PAO of intracranial aneurysm. The aim of the study was to analyses our experience of PAO for intracranial aneurysms with emphasis on long-term follow-up.Materials and Methods. The data of patients treated with PAO for intracranial aneurysms were reviewed. The outcome was evaluated based on aneurysmal occlusion on immediate angiography, follow-up magnetic resonance angiography (MRA), and complications. The modified Rankin score (mRS) was used to evaluate the functional outcome during the last follow-up. The mean, range, and standard deviation were reported for other variables – the patient’s age, number, and percentage.Results. Endovascular treatment was performed in 178 patients including PAO in 18 patients. Of these 18 (eighteen) patients, there were 13 dissecting aneurysms, 4 mycotic aneurysms, and one traumatic aneurysm.10 (ten) patients underwent PAO for proximal intracranial artery aneurysm and 8 (eight) patients for distal cerebral aneurysms. Complete occlusion of the aneurysm was achieved in 16patients (88.89%) and retrograde filling of the aneurysm was seen in 2 (11.11%) patients. One patient had intraprocedural coil migration resulting in a major infarct with an mRS of 2. Another patient (5.56%) had recanalization of the aneurysm and presented with rupture and intracranial hemorrhage with an mRS score of 4. The mRS of the other 16 patients (88.89%) was zero.Conclusions. Endovascular PAO for cerebral aneurysms was highly feasible and achieved complete occlusion. The morbidity and mortality rates were at the long-term follow-up also acceptable with negligible complications.

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Endovascular Treatment of Anterior Circulation Aneurysms With the p64 Flow Modulation Device: Mid- and Long-Term Results in 617 Aneurysms From a Single Center

Operative Neurosurgery ◽

10.1093/ons/opaa425 ◽

2021 ◽

Author(s):

Marta Aguilar Pérez ◽

Elina Henkes ◽

Victoria Hellstern ◽

Carmen Serna Candel ◽

Christina Wendl ◽

...

Keyword(s):

Intracranial Aneurysms ◽

High Rate ◽

Long Term Results ◽

Effective Treatment Option ◽

Anterior Circulation ◽

Acute Hemorrhage ◽

Unruptured Aneurysms ◽

Long Term Follow Up

Abstract BACKGROUND Flow diverters have become an important tool in the treatment of intracranial aneurysms, especially when dealing with difficult-to-treat or complex aneurysms. The p64 is the only fully resheathable and mechanically detachable flow diverter available for clinical use. OBJECTIVE To evaluate the safety and effectiveness of p64 for the treatment of intracranial saccular unruptured aneurysms arising from the anterior circulation over a long-term follow-up period. METHODS We retrospectively reviewed our prospectively maintained database to identify all patients who underwent treatment for an intracranial saccular (unruptured or beyond the acute hemorrhage phase) aneurysm arising from the anterior circulation with ≥1 p64 between December 2011 and December 2019. Fusiform aneurysms and dissections were excluded. Aneurysms with prior or concomitant saccular treatment (eg, coiling and clipping) were included. Aneurysms with parent vessel implants other than p64 were excluded. Anatomic features, intraprocedural complications, clinical outcome, as well as clinical and angiographic follow-ups were all recorded. RESULTS In total, 530 patients (388 females; median age 55.9 yr) with 617 intracranial aneurysms met the inclusion criteria. The average number of devices used per aneurysm was 1.1 (range 1-3). Mean aneurysm dome size was 4.8 mm (range 1-27 mm). Treatment-related morbimortality was 2.4%. Early, mid-term, and long-term angiographic follow-up showed complete or near-complete aneurysm occlusion in 76.8%, 89.7%, and 94.5%, respectively. CONCLUSION Treatment of intracranial saccular unruptured aneurysms of the anterior circulation using p64 is a safe and effective treatment option with high rate of occlusion at long-term follow-up and low morbimortality.

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Long Term Angiographical Follow-up of Cerebral Aneurysms after Coil Embolization

Interventional Neuroradiology ◽

10.1177/15910199010070s122 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 149-154 ◽

Cited By ~ 4

Author(s):

Y. Kaku ◽

K. Hayashi ◽

M. Sawada ◽

N. Sakai

Keyword(s):

Special Reference ◽

Coil Embolization ◽

Cerebral Aneurysms ◽

Complete Obliteration ◽

Long Term Follow Up ◽

Platinum Coils

We evaluated long-term angiographical follow-up of cerebral aneurysms treated with detachable platinum coils with special reference to the long-term morphological outcomes of incompletely obliterated aneurysms. Serial long-term follow-up cerebral angiograms (>1 year) were obtained in 47 cases out of 134 cases treated with GDCs or IDCs from 1994 to 1999. In 47 patients, intial angiographical results demonstrated ten complete aneurysmal occlusion, seven aneurysms with a small neck remnant, twenty aneurysms with body filling and ten aneurysms with both of neck remnant and body filling. In the ten completely obliterated aneurysms, follow-up angiograms revealed no aneurysmal recanalization. In seven aneurysms with neck remnant, three remained unchanged, four showed enlargement of contrast filling in the part of the neck of the aneurysm. In twenty aneurysms with body filling, five had developed into complete obliteration, three remained unchanged, 11 had recanalization, and one aneurysm displayed regrowth. In ten aneurysms with both of neck remnant and body filling, two remained unchanged, five had recanalization, and three aneurysms displayed regrowth. Long-term angiographical follow-up results are less satisfactory in cases involving incompletely obliterated lesions. A higher incidence of recanalizations were promoted in cases with neck remnant and/or body filling. Strict follow-up angiography is mandatory when a complete obliteration is not achieved.

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