scholarly journals Flow diversion in anterior cerebral artery aneurysms

2021 ◽  
Vol 7 (4) ◽  
pp. 247
Author(s):  
JustinG Santarelli ◽  
Katarina Dakay ◽  
JaredBlaine Cooper ◽  
JacobD Greisman ◽  
Gurmeen Kaur ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Flow Diversion

Distal anterior cerebral artery aneurysms treated with flow diversion: experience of a large-volume center and systematic review of the literature

2020 ◽  
Vol 13 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Federico Cagnazzo ◽  
Andrea Fanti ◽  
Pierre-Henri Lefevre ◽  
Imad Derraz ◽  
Cyril Dargazanli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stent Thrombosis ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Univariate Analysis ◽  
Flow Diversion ◽  
Parent Artery ◽  
Review Of The Literature ◽  
Significant Difference ◽  
Distal Anterior Cerebral Artery

BackgroundEvidence about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms is scant. To provide further insight into flow diversion for aneurysms located at, or distal to, the A2 segment.MethodsConsecutive patients receiving flow diversion for DACA aneurysms were retrieved from our prospective database (2014–2020). A PRISMA guidelines-based systematic review of the literature was performed. Aneurysm occlusion (O’Kelly–Marotta=OKM) and clinical outcomes were evaluated.ResultsTwenty-three patients and 25 unruptured saccular DACA aneurysms treated with flow diversion were included. Aneurysm size ranged from 2 mm to 9 mm (mean size 4.5 mm, SD ±1.6). Mean parent artery diameter was 1.8 mm (range, 1.2–3 mm, SD ±0.39). Successful stent deployment was achieved in all cases. Angiographic adequate occlusion (OKM C–D) at follow-up (14 months) was 79% (19/24 available aneurysms). No cases of aneurysm rupture or retreatment were reported. Univariate analysis showed a significant difference in diameter among aneurysms with adequate (4 mm) vs incomplete occlusion (7 mm) (P=0.006).There was one transient perioperative in-stent thrombosis, and three major events causing neurological morbidity: two stent thromboses (one attributable to the non-adherence of the patient to the antiplatelet therapy); and one acute occlusion of a covered calloso-marginal artery.Results from systematic review (12 studies and 107 A2–A3 aneurysms) showed 78.6% (95% CI=70–86) adequate occlusion, 7.5% (95% CI=3.6–14) complications, and 2.8%, (3/107, 95% CI=0.6–8.2) morbidity.ConclusionsFlow diversion among DACA aneurysms is effective, especially among small lesions. However, potential morbidity related to in-stent thrombosis and covered side branches should be considered when planning this strategy.

scholarly journals Declining complication rates with flow diversion of anterior circulation aneurysms after introduction of the Pipeline Flex: analysis of a single-institution series of 568 cases

2018 ◽  
Vol 129 (6) ◽  
pp. 1475-1481 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Matthew T. Bender ◽  
Li-Mei Lin ◽  
Narlin Beaty ◽  
Justin M. Caplan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Flow Diversion ◽  
Single Institution ◽  
Anterior Circulation ◽  
Major Complications ◽  
Anterior Circulation Aneurysms

OBJECTIVEThe second-generation Pipeline embolization device (PED), Flex, has several design upgrades, including improved opening and the ability to be resheathed, in comparison with the original device (PED classic). The authors hypothesized that Flex is associated with a lower rate of major complications.METHODSA prospective, IRB-approved, single-institution database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion. The PED classic was used from August 2011 to January 2015, and the Pipeline Flex has been used since February 2015.RESULTSA total of 568 PED procedures (252 classic and 316 Flex) were performed for anterior circulation aneurysms. The average aneurysm size was 6.8 mm. Patients undergoing treatment with the Flex device had smaller aneurysms (p = 0.006) and were more likely to have undergone previous treatments (p = 0.001). Most aneurysms originated along the internal carotid artery (89% classic and 75% Flex) but there were more anterior cerebral artery (18%) and middle cerebral artery (7%) deployments with Flex (p = 0.001). Procedural success was achieved in 96% of classic and 98% of Flex cases (p = 0.078). Major morbidity or death occurred in 3.5% of cases overall: 5.6% of classic cases, and 1.9% of Flex cases (p = 0.019). On multivariate logistic regression, predictors of major complications were in situ thrombosis (OR 4.3, p = 0.006), classic as opposed to Flex device (OR 3.7, p = 0.008), and device deployment in the anterior cerebral artery or middle cerebral artery as opposed to the internal carotid artery (OR 3.5, p = 0.034).CONCLUSIONSFlow diversion of anterior circulation cerebral aneurysms is associated with an overall low rate of major complications. The complication rate is significantly lower since the introduction of the second-generation PED (Flex).

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