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

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  • Department of Neuroradiology, Niguarda Hospital, Milan, Italy
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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.

Abbreviations used in this paper:ACA = anterior cerebral artery; ACoA = anterior communicating artery; BA = basilar artery; CN = cranial nerve; ICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCA = posterior cerebral artery; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage; SCA = superior cerebellar artery; TIA = transient ischemic attack; VA = vertebral artery.

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Contributor Notes

Address correspondence to: Mariangela Piano, M.D., Neuroradiologia, Padiglione Rossini, Ospedale Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy. email: mariangela.piano@gmail.com.

Please include this information when citing this paper: published online November 23, 2012; DOI: 10.3171/2012.10.JNS112222.

  • 1

    Byrne JV, , Beltechi R, , Yarnold JA, , Birks J, & Kamran M: Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One 5:e12492, 2010

    • Search Google Scholar
    • Export Citation
  • 2

    Gao X, , Liang G, , Li Z, , Qu H, & Wei X: Stent-assisted coil embolization of wide-necked intracranial aneurysms using a semi-deployment technique: angiographic and clinical outcomes in 31 consecutive patients. Interv Neuroradiol 16:385393, 2010

    • Search Google Scholar
    • Export Citation
  • 3

    Hwang G, , Park H, , Bang JS, , Jin SC, , Kim BC, & Oh CW, : Comparison of 2-year angiographic outcomes of stent- and nonstent-assisted coil embolization in unruptured aneurysms with an unfavorable configuration for coiling. AJNR Am J Neuroradiol 32:17071710, 2011

    • Search Google Scholar
    • Export Citation
  • 4

    Kallmes DF, , Ding YH, , Dai D, , Kadirvel R, , Lewis DA, & Cloft HJ: A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke 38:23462352, 2007

    • Search Google Scholar
    • Export Citation
  • 5

    Kallmes DF, , Ding YH, , Dai D, , Kadirvel R, , Lewis DA, & Cloft HJ: A second-generation, endoluminal, flow-disrupting device for treatment of saccular aneurysms. AJNR Am J Neuroradiol 30:11531158, 2009

    • Search Google Scholar
    • Export Citation
  • 6

    Kulcsár Z, , Ernemann U, , Wetzel SG, , Bock A, , Goericke S, & Panagiotopoulos V, : High-profile flow diverter (silk) implantation in the basilar artery: efficacy in the treatment of aneurysms and the role of the perforators. Stroke 41:16901696, 2010

    • Search Google Scholar
    • Export Citation
  • 7

    Kulcsár Z, , Houdart E, , Bonafé A, , Parker G, , Millar J, & Goddard AJ, : Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:2025, 2011

    • Search Google Scholar
    • Export Citation
  • 8

    Lv X, , Li Y, , Xinjian Y, , Jiang C, & Wu Z: Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: a single center experience. Eur J Radiol 81:11791183, 2012

    • Search Google Scholar
    • Export Citation
  • 9

    Lylyk P, , Miranda C, , Ceratto R, , Ferrario A, , Scrivano E, & Luna HR, : Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632643, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Maldonado IL, , Machi P, , Costalat V, , Mura T, & Bonafé A: Neuroform stent-assisted coiling of unruptured intracranial aneurysms: short- and midterm results from a single-center experience with 68 patients. AJNR Am J Neuroradiol 32:131136, 2011

    • Search Google Scholar
    • Export Citation
  • 11

    Moret J, , Cognard C, , Weill A, , Castaings L, & Rey A: The “remodelling technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 3:2135, 1997

    • Search Google Scholar
    • Export Citation
  • 12

    Nelson PK, , Lylyk P, , Szikora I, , Wetzel SG, , Wanke I, & Fiorella D: The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 32:34 40, 2011

    • Search Google Scholar
    • Export Citation
  • 13

    Piotin M, , Pistocchi S, , Bartolini B, & Blanc R: Intracranial aneurysm coiling with PGLA-coated coils versus bare platinum coils: long-term anatomic follow-up. Neuroradiology 54:345 348, 2012

    • Search Google Scholar
    • Export Citation
  • 14

    Piotin M, , Spelle L, , Mounayer C, , Loureiros C, , Ghorbani A, & Moret J: Intracranial aneurysms coiling with matrix: immediate results in 152 patients and midterm anatomic follow-up from 115 patients. Stroke 40:321323, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Raphaeli G, , Collignon L, , De Witte O, & Lubicz B: Endovascular treatment of posterior circulation fusiform aneurysms: single-center experience in 31 patients. Neurosurgery 69:274283, 2011

    • Search Google Scholar
    • Export Citation
  • 16

    Ries T, , Siemonsen S, , Thomalla G, , Grzyska U, , Zeumer H, & Fiehler J: Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR Am J Neuroradiol 28:17551761, 2007

    • Search Google Scholar
    • Export Citation
  • 17

    Sadasivan C, , Cesar L, , Seong J, , Rakian A, , Hao Q, & Tio FO, : An original flow diversion device for the treatment of intracranial aneurysms: evaluation in the rabbit elastase-induced model. Stroke 40:952958, 2009

    • Search Google Scholar
    • Export Citation
  • 18

    Smith MJ, , Mascitelli J, , Santillan A, , Brennan JS, , Tsiouris AJ, & Riina HA, : Bare platinum vs matrix detachable coils for the endovascular treatment of intracranial aneurysms: a multivariate logistic regression analysis and review of the literature. Neurosurgery 69:557565, 2011

    • Search Google Scholar
    • Export Citation
  • 19

    Szikora I, , Berentei Z, , Kulcsar Z, , Marosfoi M, , Vajda ZS, & Lee W, : Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31:11391147, 2010

    • Search Google Scholar
    • Export Citation
  • 20

    Thornton J, , Debrun GM, , Aletich VA, , Bashir Q, , Charbel FT, & Ausman J: Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:239250, 2002

    • Search Google Scholar
    • Export Citation
  • 21

    Trager AL, , Sadasivan C, , Seong J, & Lieber BB: Correlation between angiographic and particle image velocimetry quantifications of flow diverters in an in vitro model of elastase-induced rabbit aneurysms. J Biomech Eng 131:034506, 2009

    • Search Google Scholar
    • Export Citation
  • 22

    Turowski B, , Macht S, , Kulcsár Z, , Hänggi D, & Stummer W: Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts?. Neuroradiology 53:3741, 2011

    • Search Google Scholar
    • Export Citation
  • 23

    Wanke I, & Forsting M: Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology 50:991998, 2008

  • 24

    White PM, , Lewis SC, , Gholkar A, , Sellar RJ, , Nahser H, & Cognard C, : Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet 377:1655 1662, 2011

    • Search Google Scholar
    • Export Citation
  • 25

    Xu F, , Qin X, , Tian Y, , Gu Y, , Leng B, & Song D: Endovascular treatment of complex intracranial aneurysms using intra/extra-aneurysmal stent. Acta Neurochir (Wien) 153:923930, 2011

    • Search Google Scholar
    • Export Citation

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