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Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment

A Three Center Retrospective Study

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Abstract

Purpose

The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of FDS placement in anterior and posterior circulation aneurysms with parent arteries ≤ 2 mm in a real-world representative setting.

Methods

We retrospectively reviewed patients treated with FDS at the three participating university hospitals between 2009 and 2021. The inclusion criteria were the placement of at least one FDS in a parent vessel with a maximum diameter of 2 mm or less. The primary clinical safety endpoint was the absence of death, major or minor symptomatic stroke, transient ischemic attack and procedure-related intracranial hemorrhage. Clinical outcome was assessed using the modified Rankin Scale (mRS) score at the follow-up visit at 1 year. The primary efficacy endpoint was defined as complete and near-complete occlusion at the 1‑year follow-up.

Results

We identified 55 patients harboring 56 aneurysms. The primary clinical safety endpoint was obtained in 93% of cases. The hemorrhagic and thromboembolic complication rates were 4% and 9%, respectively. No patient died or had a relevant discrepancy (> 1 point) at the pre-mRS and post-mRS. The primary efficacy endpoint was reached in 80% of cases.

Conclusion

The use of FDS in vessels < 2 mm is technically feasible with good aneurysm occlusion rates and an acceptable safety profile. Nevertheless, it is essential to be aware of the of the main complications associated when operating in small diameter vessels.

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Funding

There was no financial or material support for this study.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany

    Sophia Hohenstatt, Dominik F. Vollherbst, Niclas Schmitt & Markus A. Möhlenbruch

  2. Neuroradiology Unit, University Hospital A.O.U. “G. Martino” Messina, Italy—Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy

    Sergio L. Vinci

  3. Neuroradiology Unit, University Hospital A.O.U. Policlinico “G. Martino”—Messina, Messina, Italy

    Agostino Tessitore, Antonio Pitrone, Antonio A. Caragliano & Mariano Velo

  4. Operative Unit of Neuroradiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy

    Aldo Paolucci

Authors
  1. Sophia Hohenstatt
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  2. Sergio L. Vinci
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  3. Dominik F. Vollherbst
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  4. Agostino Tessitore
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  9. Markus A. Möhlenbruch
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  10. Aldo Paolucci
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Corresponding author

Correspondence to Agostino Tessitore.

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Conflict of interest

S. Hohenstatt, S.L. Vinci, D.F. Vollherbst, A. Tessitore, N. Schmitt, A. Pitrone, A.A. Caragliano, M. Velo, M.A. Möhlenbruch and A. Paolucci declare that they have no competing interests.

Supplementary Information

62_2022_1187_MOESM1_ESM.docx

Table 1. Detailed aneurysm and procedure related characteristics. F female, M male, FDS flow diverter stent, ACA anterior cerebral artery, MCA middle cerebral artery, PCA posterior cerebral artery, VA vertebral artery, AcomA anterior communicating artery, SAH subarachnoid hemorrhage, IPH intraparenchymal hemorrhage

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Hohenstatt, S., Vinci, S.L., Vollherbst, D.F. et al. Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment. Clin Neuroradiol 33, 99–105 (2023). https://doi.org/10.1007/s00062-022-01187-6

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  • DOI: https://doi.org/10.1007/s00062-022-01187-6

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