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  • O-013 Intra-aneurysmal Flow Disruption: a New Approach for the Endovascular Treatment of Intracranial Aneurysms. French Clinical Experience

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O-013 Intra-aneurysmal Flow Disruption: a New Approach for the Endovascular Treatment of Intracranial Aneurysms. French Clinical Experience
  1. L Pierot1,
  2. A Januel2,
  3. H Raoult3,
  4. L Spelle4,
  5. C Papagiannaki5,
  6. H Desal6,
  7. P Courtheoux7,
  8. K. Krzysztof Kadziolka1,
  9. J Gauvrit3,
  10. J Moret4,
  11. D Herbreteau5,
  12. C Cognard2
  1. 1Radiology, Hôpital Maison-Blanche, Reims, France
  2. 2Neuroradiology, CHU Toulouse, Toulouse, France
  3. 3Neuroradiology, CHU Rennes, Rennes, France
  4. 4Neuroradiology, Hôpital Beaujon, Paris, France
  5. 5Neuroradiology, CHU Tours, Tours, France
  6. 6Neuroradiology, CHU Nantes, Nantes, France
  7. 7Neuroradiology, CHU Caen, Caen, France

Abstract

Purpose Standard coiling is now the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms and recanalisations. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device in the aneurysm sac. Preliminary clinical experience in French centres is presented.

Materials and Methods Computational fluid dynamics and pre-clinical testing (canine cross-over carotid bifurcation model) were used to develop an intra-saccular flow disrupter design, designated as WEB (Sequent, Aliso Viejo, CA).The WEB is a self-expanding, oblate, braided nitinol mesh, composed of an inner and outer braid held together by proximal, middle, and distal radio-opaque markers and creating two compartments: one distal and one proximal.Clinically, 39 patients (27F/12M, age: 37–75 years) harbouring ruptured, unruptured or recanalised aneurysms were treated between June 2011 and January 2013 in 7 French centres, using an intra-aneurysmal flow-disrupter (WEB).

Aneurysm location was middle cerebral artery (23 aneurysms), basilar artery (8), internal carotid artery (5), and anterior communicating artery (3). Aneurysm size was 10mm in 5 aneurysms. Neck size was > 4mm in 5 aneurysms and <4mm in 35 cases.

Results Clinically, the device was successfully deployed in all but 2 cases. Three thromboembolic events were observed with favourable outcome in both cases (mRS ≤2). No intraoperative rupture was observed. No delayed rupture or remote haematoma was observed. Additional coiling was performed in 4 cases. Mid-term follow-up results are presented.

Conclusion Intra-saccular flow disruption using WEB is a completely new endovascular approach to treat some types of aneurysm, particularly wide-neck bifurcation aneurysms. This preliminary clinical experience shows the safety and efficacy of the device when used in appropriately selected cases.

Disclosures L. Pierot: 2; C; Sequent. A. Januel: None. H. Raoult: None. L. Spelle: None. C. Papagiannaki: None. H. Desal: None. P. Courtheoux: None. K. Krzysztof Kadziolka1: None. J. Gauvrit: None. J. Moret: None. D. Herbreteau: None. C. Cognard: None.

https://doi.org/10.1136/neurintsurg-2013-010870.13

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