Simone Peschillo1, Alessandro Caporlingua2, Maria Chiara Resta3, Jo Peter Paul Peluso4, Nicola Burdi5, Nader Sourour6, Francesco Diana7, Giulio Guidetti7, Frédéric Clarençon6, Gijs Coenraad Bloemsma4, Federico Di Maria6, Massimo Donatelli5, Maurizio Resta5. 1. Department of Neurology and Psychia-try, Endovascular Neurosurgery/Interven-tional Neuroradiology, 'Sapienza' Univers-ity of Rome, Rome, Italy. 2. Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy. 3. Department of Neuroradiology, Policlinico of Bari, University of Bari, Bari, Italy. 4. Department of Radiology, Sint Elisa-beth Ziekenhuis, Tilburg, the Netherlands. 5. Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy. 6. Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France. 7. Department of Neurology and Psychiatry, Interven-tional Neuroradiology, 'Sapienza' Univers-ity of Rome, Rome, Italy.
Abstract
BACKGROUND: Although flow diverters (FDs) have been widely accepted by neurointerventionists, their safety has yet to be fully defined. Stratification by aneurysm size and location is essential for correct evaluation of treatment outcomes and risks of flow diversion. OBJECTIVE: To compare neurological and anatomic outcomes and evaluate the risk of complications after endovascular treatment of large or giant internal carotid artery (ICA) aneurysms with FD/FDs alone or together with coil embolization. METHODS: We reviewed all patients with large or giant, ruptured or unruptured ICA aneurysms who underwent endovascular treatment with flow diversion alone (group A) or with concomitant coiling (group B) in 4 international institutions between 2010 and 2015. Anatomic outcome was evaluated using the Byrne scale on digital subtraction angiography and/or angioMRI and/or angioCT scans 3, 6, 12, and 24 months postoperatively. RESULTS: We collected 44 patients with large or giant ICA aneurysms. Four patients (9%) presented with aneurysmal subarachnoid hemorrhage (SAH). FD/FDs were used alone in 26 patients and in combination with coil embolization in the 18 remaining patients. The mortality rate due to procedure-related and/or neurological complications was 2.2%. Twelve months after the procedure, 88.6% (n = 39) of patients had a favorable neurological outcome. One year after the procedure, the aneurysm was completely occluded in 72.7% of patients: 61.5% (16/18) in group A and 88.9% (16/26) in group B. CONCLUSION: Clinical outcomes and rates of intraoperative and postoperative complications did not differ significantly between the groups. Better anatomic results using FD/FDs combined with coils were documented 6 months after the procedure; this option seems to provide a higher aneurysm occlusion rate and reduce the need for retreatment.
BACKGROUND: Although flow diverters (FDs) have been widely accepted by neurointerventionists, their safety has yet to be fully defined. Stratification by aneurysm size and location is essential for correct evaluation of treatment outcomes and risks of flow diversion. OBJECTIVE: To compare neurological and anatomic outcomes and evaluate the risk of complications after endovascular treatment of large or giant internal carotid artery (ICA) aneurysms with FD/FDs alone or together with coil embolization. METHODS: We reviewed all patients with large or giant, ruptured or unruptured ICA aneurysms who underwent endovascular treatment with flow diversion alone (group A) or with concomitant coiling (group B) in 4 international institutions between 2010 and 2015. Anatomic outcome was evaluated using the Byrne scale on digital subtraction angiography and/or angioMRI and/or angioCT scans 3, 6, 12, and 24 months postoperatively. RESULTS: We collected 44 patients with large or giant ICA aneurysms. Four patients (9%) presented with aneurysmal subarachnoid hemorrhage (SAH). FD/FDs were used alone in 26 patients and in combination with coil embolization in the 18 remaining patients. The mortality rate due to procedure-related and/or neurological complications was 2.2%. Twelve months after the procedure, 88.6% (n = 39) of patients had a favorable neurological outcome. One year after the procedure, the aneurysm was completely occluded in 72.7% of patients: 61.5% (16/18) in group A and 88.9% (16/26) in group B. CONCLUSION: Clinical outcomes and rates of intraoperative and postoperative complications did not differ significantly between the groups. Better anatomic results using FD/FDs combined with coils were documented 6 months after the procedure; this option seems to provide a higher aneurysm occlusion rate and reduce the need for retreatment.
Authors: Kaitlyn Tidwell; Seth Harriet; Vishal Barot; Andrew Bauer; Melville B Vaughan; Mohammad R Hossan Journal: Bioengineering (Basel) Date: 2021-11-12