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O-028 Endovascular Treatment of Small-Unruptured Cerebral Aneurysms with Flow Diverters
  1. M Piotin,
  2. B Bartolini,
  3. H Redjem,
  4. S Pistocchi,
  5. R Blanc
  1. Interventional Neuroradiology, Fondation Rothschild, Paris, France

Abstract

Purpose To assess the safety and efficacy issues of Flow Diverters (FD) in the treatment of small unruptured cerebral aneurysms.

Methods Retrospective review of a prospectively gathered database of endovascularly treated aneurysms since the introduction of FD. From September 2008 (when treatment aneurysms with FD was initiated at our institution) to January 2014, 519 small (<10 mm), unruptured aneurysms were treated by endovascular means. Four treatment modalities were individualised: simple coiling, balloon-assisted coiling, stent-assisted coiling and aneurysm neck coverage with FD.

Results (87/519) 16.8% (mean sac size: 5.0 mm, 70.1.4% bifurcation) of aneurysms were simply coiled.

(189/519) 36.4% (mean sac size: 4.9 mm, 54.5% bifurcation) of aneurysms were coiled with balloon assistance.

(166/519) 32.0% (mean sac size: 6.1 mm, 75.3% bifurcation) of aneurysms were coiled with stent-assistance.

(77/519) 14.8% (mean sac size: 5.0 mm, 14.5% bifurcation) aneurysms were treated with FD.

Procedural perioperative and delayed (up to 180 days) permanent neurological complications were 0.0%, 4.0%, 10.1% and 3.1% respectively, with a marked trend for more complications with stent-assisted coiling (P = 0.0037). Total immediate aneurysm occlusion was obtained in 49.4% (43/87), 53.4% (101/189), 59.0% (98/166) and 3.9% (3/77) respectively, with a marked trend toward better occlusion with stent-assisted coiling technique (P < 0.0001). At a mean angiographic follow-up of 16 months for aneurysms treated with FD and 23 months for the others, total aneurysm occlusion was 59.2% (32/54), 70.4% (88/125), 85.4% (111/130) and 70.7% (41/58) respectively, with a trend toward better occlusion with stent-assisted coiling (P = 0.0011).

Conclusions FD for the treatment of small-unruptured aneurysms confer a good safety profile that compares favorably with those of balloon-assisted technique, but are mostly indicated for sidewall aneurysms. Occlusion rates at follow-up are better with stent-assisted-coiling than FD but with higher morbidity.

Disclosures M. Piotin: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect. B. Bartolini: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. H. Redjem: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. S. Pistocchi: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. R. Blanc: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect.

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