Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis
Interventional Neuroradiology
First Online:
Received:
Accepted:
- 1.1k Downloads
- 109 Citations
Abstract
Introduction
We report the experiences of 25 Italian centers, analyzing intra- and periprocedural complications of endovascular treatment of intracranial aneurysms using Silk (Balt Extrusion, Montmorency, France) and pipeline embolization devices (EV3 Inc, Irvine California).
Methods
Two hundred seventy-three patients with 295 cerebral aneurysms, enrolled in 25 centers in Italy and treated with the new flow-diverter devices, were evaluated; 142 patients were treated with Silk and 130 with pipeline (in one case, both devices were used). In 14 (5.2 %) cases devices were used with coils. Aneurysm size was >15 mm in 46.9 %, 5–15 mm in 42.2 %, and <5 mm in 10.8 %. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 163 cases (55.2 %), cavernous ICA in 76 (25.7 %), middle cerebral artery in 11 (3.7 %), PCoA in 6 (2 %), and ACoA in 2 (0.7 %); the vertebrobasilar system accounted for 32 cases (10.8 %) and PCA in 5 (1.7 %).
Results
Technical adverse events occurred with 59 patients (21.6 %); 5 patients died after ischemic events, 10 to hemorrhagic complications, and 1 from external ventricular drain positioning. At 1 month, morbidity and mortality rates were 3.7 % and 5.9 %, respectively
Conclusion
Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series.
Keywords
Flow diverter device Pipeline embolization device Silk embolization device Intracranial aneurysms Endovascular treatmentNotes
Conflict of interest
F. Briganti, E. Boccardi, M. Isalberti, N.P. Nuzzi, and L.P. Valvassori Bolgè serve as proctors for EV3 and receive modest remuneration. E. Boccardi and L.P Valvassori Bolgè serve as proctors for BALT and receive modest remuneration. E.C Cagliari serves as a proctor for EV3 without remuneration.
References
- 1.Augsburger L, Farhat M, Reymond P, Fonck E, Kulcsar Z, Stergiopulos N, Rufenacht DA (2009) Effect of flow diverter porosity on intraaneurysmal blood flow. Klin Neuroradiol 19(3):204–214. doi: 10.1007/s00062-009-9005-0 PubMedCrossRefGoogle Scholar
- 2.Byrne JV, Beltechi R, Yarnold JA, Birks J, Kamran M (2010) Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One 5 (9). doi:10.1371/journal.pone.0012492
- 3.Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38(5):1538–1544. doi: 10.1161/STROKEAHA.106.466987 PubMedCrossRefGoogle Scholar
- 4.Fiorella D, Albuquerque F, Gonzalez F, McDougall CG, Nelson PK (2010) Reconstruction of the right anterior circulation with the Pipeline embolization device to achieve treatment of a progressively symptomatic, large carotid aneurysm. J Neurointerv Surg 2(1):31–37. doi: 10.1136/jnis.2009.000554 PubMedCrossRefGoogle Scholar
- 5.Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up. Neurosurgery 56(6):1191–1201, discussion 1201-1192PubMedCrossRefGoogle Scholar
- 6.Fiorella D, Albuquerque FC, Woo H, Rasmussen PA, Masaryk TJ, McDougall CG (2010) Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-up. J Neurointerv Surg 2(1):16–22. doi: 10.1136/jnis.2009.000521 PubMedCrossRefGoogle Scholar
- 7.Fiorella D, Kelly ME, Albuquerque FC, Nelson PK (2009) Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device. Neurosurgery 64(2):212–217. doi: 10.1227/01.NEU.0000337576.98984.E4, discussion 217PubMedCrossRefGoogle Scholar
- 8.Fiorella D, Lylyk P, Szikora I, Kelly ME, Albuquerque FC, McDougall CG, Nelson PK (2009) Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms. J Neurointerv Surg 1(1):56–65. doi: 10.1136/jnis.2009.000083 PubMedCrossRefGoogle Scholar
- 9.Fiorella D, Woo HH, Albuquerque FC, Nelson PK (2008) Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62(5):1115–1120. doi: 10.1227/01.neu.0000325873.44881, discussion 1120-1111PubMedCrossRefGoogle Scholar
- 10.Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39(1):120–125. doi: 10.1161/STROKEAHA.107.495747 PubMedCrossRefGoogle Scholar
- 11.Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ (2007) A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke 38(8):2346–2352. doi: 10.1161/STROKEAHA.106.479576 PubMedCrossRefGoogle Scholar
- 12.Kis B, Weber W, Gotz F, Becker H, Berlit P, Kuhne D (2007) Endovascular treatment of cerebral aneurysms using the Leo stent: long term follow-up and expansion of indications. Clin Neuradiol 17:167–179Google Scholar
- 13.Kulcsar Z, Houdart E, Bonafe A, Parker G, Millar J, Goddard AJ, Renowden S, Gal G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rufenacht DA (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32(1):20–25. doi: 10.3174/ajnr.A2370 PubMedGoogle Scholar
- 14.Leonardi M, Cirillo L, Toni F, Dall'olio M, Princiotta C, Stafa A, Simonetti L, Agati R (2011) Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience. Interv Neuroradiol 17(3):306–315. doi: IN.v17.i3 PubMedGoogle Scholar
- 15.Lubicz B, Collignon L, Raphaeli G, Pruvo JP, Bruneau M, De Witte O, Leclerc X (2010) Flow-diverter stent for the endovascular treatment of intracranial aneurysms: a prospective study in 29 patients with 34 aneurysms. Stroke 41(10):2247–2253. doi: 10.1161/STROKEAHA.110.589911 PubMedCrossRefGoogle Scholar
- 16.Lylyk P, Ferrario A, Pasbon B, Miranda C, Doroszuk G (2005) Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102(2):235–241. doi: 10.3171/jns.2005.102.2.0235 PubMedCrossRefGoogle Scholar
- 17.Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64(4):632–642. doi: 10.1227/01.NEU.0000339109.98070.65, discussion 642-633; quiz N6PubMedCrossRefGoogle Scholar
- 18.Mocco J, Snyder KV, Albuquerque FC, Bendok BR, Alan SB, Carpenter JS, Fiorella DJ, Hoh BL, Howington JU, Jankowitz BT, Liebman KM, Rai AT, Rodriguez-Mercado R, Siddiqui AH, Veznedaroglu E, Hopkins LN, Levy EI (2009) Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. J Neurosurg 110(1):35–39. doi: 10.3171/2008.7.JNS08322 PubMedCrossRefGoogle Scholar
- 19.Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817. doi: 10.1016/S0140-6736(05)67214-5 PubMedCrossRefGoogle Scholar
- 20.Mustafa W, Kadziolka K, Anxionnat R, Pierot L (2010) Direct carotid-cavernous fistula following intracavernous carotid aneurysm treatment with a flow-diverter stent. A case report Interv Neuroradiol 16(4):447–450. doi: IN.v16.i4 Google Scholar
- 21.Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D (2011) The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 32(1):34–40. doi: 10.3174/ajnr.A2421 PubMedGoogle Scholar
- 22.Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41(1):110–115. doi: 10.1161/STROKEAHA.109.558114 PubMedCrossRefGoogle Scholar
- 23.Pumar JM, Garcia-Dorrego R, Nieto A, Vazquez-Herrero F, Blanco-Ulla M, Vazquez-Martin A (2010) Vascular reconstruction of a fusiform basilar aneurysm with the Silk embolization system. J Neurointerv Surg 2(3):242–244. doi: 10.1136/jnis.2010.002725 PubMedCrossRefGoogle Scholar
- 24.Sedat J, Chau Y, Mondot L, Vargas J, Szapiro J, Lonjon M (2009) Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results. Neuroradiology 51(6):401–409. doi: 10.1007/s00234-009-0502-2 PubMedCrossRefGoogle Scholar
- 25.Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol 33(1):159–163. doi: 10.3174/ajnr.A2719 PubMedCrossRefGoogle Scholar
- 26.Szikora I, Berentei Z, Kulcsar Z, Marosfoi M, Vajda ZS, Lee W, Berez A, Nelson PK (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31(6):1139–1147. doi: 10.3174/ajnr.A2023 PubMedCrossRefGoogle Scholar
- 27.Turowski B, Macht S, Kulcsar Z, Hanggi D, Stummer W (2011) Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts? Neuroradiology 53(1):37–41. doi: 10.1007/s00234-010-0676-7 PubMedCrossRefGoogle Scholar
- 28.van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21(4):589–624. doi: 10.1002/sim PubMedCrossRefGoogle Scholar
- 29.Wakhloo AK, Deleo MJ 3rd, Brown MM (2009) Advances in interventional neuroradiology. Stroke 40(5):e305–e312. doi: 10.1161/STROKEAHA.109.548438 PubMedCrossRefGoogle Scholar
- 30.Yang X, Wu Z, Mu S, Li Y, Lv M (2008) Endovascular treatment of giant and large intracranial aneurysms using the neuroform stent-assisted coil placement. Neurol Res 30(6):598–602. doi: 10.1179/174313208X319017 PubMedCrossRefGoogle Scholar
Copyright information
© Springer-Verlag 2012