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Long-term follow-up in the endovascular treatment of intracranial aneurysms with flow-diverter stents: update of a single-centre experience

  • NEURORADIOLOGY
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Abstract

Introduction

Flow-diverter stents are becoming a useful tool in treating patients with intracranial aneurysms with suitable anatomical feature. Purpose of this study was to evaluate effectiveness and safety of endovascular treatment with flow-diverting stents (FD) in unruptured intracranial aneurysms.

Methods

From May 2009 and May 2014, we treated 49 patients with a total of 58 aneurysms, with FD technique. All patients were treated electively, under general anesthesia and were administered single antiplatelet drug 5 days before the procedure and double antiplatelet therapy for 3 months afterwards. Fifteen of the patients were asymptomatic, eight had headache, thirteen patients presented symptoms due to mass effect of the aneurysm on CNS structures, twelve were treated due to a post-surgical relapse and one patient presented relapsing TIAs due to distal embolization from the aneurysm dome. Choice of FD treatment was done according to aneurysm anatomy (fusiform over saccular, dome/neck ratio < 2) and whenever conventional treatment (coil embolization) appeared difficult (eg. Large aneurysm neck, fusiform aneurysms or difficult sac catheterization). We considered a dome/neck ratio > 2 as the only exclusion criteria.

Results

Successful stent deployment was achieved in 50 procedures out of 52 (94.34%) while overall mortality was 2% (1/49). Forty-eight patients were evaluated at long-term follow-up for a total of 56 treated aneurysms. At 3 months, follow-up 75% (42/56) of the aneurysms were excluded from intracranial circulation, at 6 months 80.35% (45/56) and at 12 months 84% (47/56). Stent patency was observed in 100% of patients at short and long-term follow-up, with only two cases of intimal hyperplasia at 3 months, without any further complications.

Conclusions

According to our study FD repair of unruptured intracranial aneurysms appeared to be a safe and effective technique, especially in selected patients with hostile anatomy for traditional embolization.

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Authors and Affiliations

  1. Unità di Radiologia Interventistica, SC Radiodiagnostica, Azienda Ospedaliero-Universitaria “Maggiore della Carità”, Corso Mazzini 18, 28100, Novara, Italy

    Giuseppe Guzzardi, Carmelo Stanca, Paolo Cerini, Bruno Del Sette, Alessandro Carriero & Alessandro Stecco

  2. Unità di Neuroradiologia, Istituto Humanitas, Rozzano, MI, Italy

    Ignazio Divenuto

  3. UOC Neuroradiologia, Ospedale Maurizio Bufalini, Cesena, Italy

    Emanuele Malatesta

Authors
  1. Giuseppe Guzzardi
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  2. Carmelo Stanca
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  3. Paolo Cerini
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  4. Bruno Del Sette
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  5. Ignazio Divenuto
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  6. Emanuele Malatesta
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  7. Alessandro Carriero
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  8. Alessandro Stecco
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Correspondence to Giuseppe Guzzardi.

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All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Guzzardi, G., Stanca, C., Cerini, P. et al. Long-term follow-up in the endovascular treatment of intracranial aneurysms with flow-diverter stents: update of a single-centre experience. Radiol med 123, 449–455 (2018). https://doi.org/10.1007/s11547-018-0857-8

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  • DOI: https://doi.org/10.1007/s11547-018-0857-8

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