Francesco Briganti1, Manuela Napoli2, Giuseppe Leone3, Mariano Marseglia4, Giuseppe Mariniello5, Ferdinando Caranci6, Fabio Tortora7, Francesco Maiuri8. 1. Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: frabriga@unina.it. 2. Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: napoli.manuela@gmail.com. 3. Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: g.leonemd@gmail.com. 4. Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: mariano-marseglia@libero.it. 5. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: giuseppe.mariniello@unina.it. 6. Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: ferdinando.caranci@unina.it. 7. Chair of Neuroradiology, "Magrassi Lanzara" Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples, Italy. Electronic address: fabiotor@libero.it. 8. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: frmaiuri@unina.it.
Abstract
OBJECTIVES: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2-4 years) of this treatment from a single-center. METHODS: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10mm) in 32 cases (82%), large (11-25mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. RESULTS: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and time of complete occlusion were not correlated with the aneurysm size. MCA aneurysms mainly showed partial occlusion (2/3 cases). Besides, large-neck aneurysms and those with a vessel arising from the sac mainly showed late (>6 months) or partial occlusion. CONCLUSION: FDD are a safe and efficacious treatment of intracranial aneurysms, resulting in high occlusion rate and low incidence of complications. It should be the treatment of choice for the large-neck aneurysm of the ICA.
OBJECTIVES: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2-4 years) of this treatment from a single-center. METHODS: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10mm) in 32 cases (82%), large (11-25mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. RESULTS: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and time of complete occlusion were not correlated with the aneurysm size. MCAaneurysms mainly showed partial occlusion (2/3 cases). Besides, large-neck aneurysms and those with a vessel arising from the sac mainly showed late (>6 months) or partial occlusion. CONCLUSION:FDD are a safe and efficacious treatment of intracranial aneurysms, resulting in high occlusion rate and low incidence of complications. It should be the treatment of choice for the large-neck aneurysm of the ICA.
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