Purpose To report our experiences with the FRED, (Microvention) in the treatment of widenecked or fusiform intracranial aneurysms
Materials and methods Between April 2013–February 2015, 14 aneurysms in 12 patients were treated with 13 FRED flowdiverters. There were 10 women and two men, between 44 and 76 years. The locations of the aneurysms were as follows 11 on the ICA; 2 carotid termination, 2 in the ophthalmic region, 5 at the PCom region; 4 of fetal origin, 3 partially fusiform, 2 fusiform in the cavernous region, 3 on the MCA.
11 aneurysms were bifurcational. Two aneurysms were previously ruptured, treated with coils, where f u at 1 year showed significant recurrence. One of them had mass effect, the rest were accidental. Two of them were fusiform, 3 partially fusiform, the rest widenecked, berry. Two of them were giant, the rest small, <15 mm. All patients were premedicated with Clopidogrel and ASA, starting 5 days prior, and tested with VerifyNow one hour before the procedure. All procedures were performed under GA. The patients were partially or fully heparinized, depending on the result of the VerifyNow. The devices were deployed through 0,027” microcatheters, 7 of them were Headway (Microvention), the rest XT27 (Stryker). All devices could be tracked to the target lesion and deployed at the desired location, in optimal position. The partial resheathability of the device was a very valuable property during the deployment. In one case, the flow in the ACA, whose orifice was covered by the device, was temporarily sluggish. There were no other periprocedural complications.
Results The FRED had immediate, excellent FD-effect in all but one cases on the final angiogram. All patients were on dual antiplatelet medication for three months, and ASA for additional three months. All are clinically well. For the time being, 6 patients have angiographic f u at 9–15 months. 5 aneurysms are fully occluded, including a main M2 branch that originated from the sac, with no neurological deficit or MR evidence for ischemic lesion. One previously ruptured MCA aneurysm has shown some regression at one year. This was the case with no immediate FD-effect on the final angiogram, likely due to the suboptimal sizing of the device for the relatively small MCA.
Conclusion In our experience, the FRED has been easy to track to the target lesion, even in significantly tortuous vessels, and deploy at the desired location. Due to its partial resheathability, it could be deployed in optimal position in all cases. F u angiography in half of the cases showed excellent result in 83% and good in 17%. This result appears to come earlier than with the other FDs available on the market. These properties make it a promising tool in the endovascular treatment of widenecked and bifurcational aneurysms.
Disclosures G. Gál: None.
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