Sedat Giray Kandemirli1, Feyyaz Baltacioglu2,3, Jessica Jesser4, Osman Kizilkilic5, Civan Islak5, Markus Möhlenbruch4, Naci Kocer6. 1. Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, USA. 2. Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey. 3. Department of Radiology, VKV American Hospital, Istanbul, Turkey. 4. Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany. 5. Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey. 6. Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey. nkocer@istanbul.edu.tr.
Abstract
PURPOSE: Flow diverter stents are gaining wider use in the treatment of complex intracranial aneurysms; however, there are limited data on occlusion and complication rates of flow diverters in very large and giant aneurysms. This study assessed the safety and efficacy of flow redirection endoluminal device (FRED) and FRED Jr. stents in aneurysms ≥ 20 mm. METHODS: We retrospectively analyzed all aneurysms ≥ 20 mm treated with FRED/FRED Jr. between January 2010 and June 2020 from three centers. Endpoints for clinical safety were absence of major stroke, aneurysmal rupture, or death and complete or near-complete occlusion for efficacy. RESULTS: A total of 45 patients with very large (28 cases) and giant aneurysms (17 cases) were treated with FRED (41 cases), and FRED Jr. (4 cases) stents. The majority of the aneurysms (40/45, 88.9%) were in the anterior circulation. Adjunctive aneurysm coiling was performed in 21 aneurysms (46.7%). Technical complications were encountered in 4 procedures (8.9%). Ischemic and hemorrhagic complication rates were 6.7% and 8.9%, respectively. There was no case with major stroke. The mortality rate was 8.9%, and all cases were due to hemorrhagic complications from aneurysmal rupture. Median angiographic follow-up was 21.5 months (range 3-60 months). Complete occlusion was achieved in 32 aneurysms (71.1%), and near-complete occlusion in 5 cases (11.1%). CONCLUSION: The use of FRED/FRED Jr. for the treatment of aneurysms ≥ 20 mm achieved a long-term aneurysm occlusion rate and a safety profile comparable to the large series reported with other flow diverter stents.
PURPOSE: Flow diverter stents are gaining wider use in the treatment of complex intracranial aneurysms; however, there are limited data on occlusion and complication rates of flow diverters in very large and giant aneurysms. This study assessed the safety and efficacy of flow redirection endoluminal device (FRED) and FRED Jr. stents in aneurysms ≥ 20 mm. METHODS: We retrospectively analyzed all aneurysms ≥ 20 mm treated with FRED/FRED Jr. between January 2010 and June 2020 from three centers. Endpoints for clinical safety were absence of major stroke, aneurysmal rupture, or death and complete or near-complete occlusion for efficacy. RESULTS: A total of 45 patients with very large (28 cases) and giant aneurysms (17 cases) were treated with FRED (41 cases), and FRED Jr. (4 cases) stents. The majority of the aneurysms (40/45, 88.9%) were in the anterior circulation. Adjunctive aneurysm coiling was performed in 21 aneurysms (46.7%). Technical complications were encountered in 4 procedures (8.9%). Ischemic and hemorrhagic complication rates were 6.7% and 8.9%, respectively. There was no case with major stroke. The mortality rate was 8.9%, and all cases were due to hemorrhagic complications from aneurysmal rupture. Median angiographic follow-up was 21.5 months (range 3-60 months). Complete occlusion was achieved in 32 aneurysms (71.1%), and near-complete occlusion in 5 cases (11.1%). CONCLUSION: The use of FRED/FRED Jr. for the treatment of aneurysms ≥ 20 mm achieved a long-term aneurysm occlusion rate and a safety profile comparable to the large series reported with other flow diverter stents.
Authors: Tibor Becske; Waleed Brinjikji; Matthew B Potts; David F Kallmes; Maksim Shapiro; Christopher J Moran; Elad I Levy; Cameron G McDougall; István Szikora; Giuseppe Lanzino; Henry H Woo; Demetrius K Lopes; Adnan H Siddiqui; Felipe C Albuquerque; David J Fiorella; Isil Saatci; Saruhan H Cekirge; Aaron L Berez; Daniel J Cher; Zsolt Berentei; Miklós Marosfoi; Peter K Nelson Journal: Neurosurgery Date: 2017-01-01 Impact factor: 4.654
Authors: Tibor Becske; David F Kallmes; Isil Saatci; Cameron G McDougall; István Szikora; Giuseppe Lanzino; Christopher J Moran; Henry H Woo; Demetrius K Lopes; Aaron L Berez; Daniel J Cher; Adnan H Siddiqui; Elad I Levy; Felipe C Albuquerque; David J Fiorella; Zsolt Berentei; Miklós Marosfoi; Saruhan H Cekirge; Peter K Nelson Journal: Radiology Date: 2013-02-15 Impact factor: 11.105
Authors: M Killer-Oberpfalzer; N Kocer; C J Griessenauer; H Janssen; T Engelhorn; M Holtmannspötter; J H Buhk; T Finkenzeller; G Fesl; J Trenkler; W Reith; A Berlis; K Hausegger; M Augustin; C Islak; B Minnich; M Möhlenbruch Journal: AJNR Am J Neuroradiol Date: 2018-03-15 Impact factor: 3.825
Authors: F Cagnazzo; D Mantilla; A Rouchaud; W Brinjikji; P-H Lefevre; C Dargazanli; G Gascou; C Riquelme; P Perrini; D di Carlo; A Bonafe; V Costalat Journal: AJNR Am J Neuroradiol Date: 2018-03-15 Impact factor: 3.825
Authors: David O Wiebers; J P Whisnant; J Huston; I Meissner; R D Brown; D G Piepgras; G S Forbes; K Thielen; D Nichols; W M O'Fallon; J Peacock; L Jaeger; N F Kassell; G L Kongable-Beckman; J C Torner Journal: Lancet Date: 2003-07-12 Impact factor: 79.321
Authors: Nimer Adeeb; Christoph J Griessenauer; Hussain Shallwani; Hakeem Shakir; Paul M Foreman; Justin M Moore; Adam A Dmytriw; Raghav Gupta; Adnan H Siddiqui; Elad I Levy; Kenneth Snyder; Mark R Harrigan; Christopher S Ogilvy; Ajith J Thomas Journal: World Neurosurg Date: 2017-06-01 Impact factor: 2.104