Introduction Endovascular devices now allow management of complex cerebrovascular disease previously considered to be untreatable. Flow-diversion (FD) treats diseased vessels including blister, dissecting and fusiform type aneurysms in addition to those with favorable dome to neck ratios. Less common uses include the treatment of carotid-cavernous fistulas. FD reconstructs the vessel wall while preserving flow into the parent vessel and adjacent branches. We hypothesize that FD is a safe and efficacious technology for the treatment of complex cerebrovascular disease with low morbidity and mortality.
Methods We retrospectively analyzed all cases with cranial FD at our facility through 6/2014. Patients had a minimum of 6 month clinical and radiographic (cerebral angiography) follow-up. No case was excluded including: aborted procedures, retrieved devices, and failed deployments. Aneurysms are defined by formal cerebral angiography, not MRA or CTA.
Results The study includes 74 patients with 88 aneurysms (84 anterior, 4 posterior circulation) treated using 100 FDs. Twenty three patients were lost to follow up. The average age was 58 with a BMI of 27.8. Mean procedure time was 2 h with an average of 33.8 min of fluoroscopy. There was a decline in average procedure and fluoroscopy time between the first and last 50 FDs deployed of 5 and 9 min respectively. Intraprocedural complication rate was 9.25% including: mechanical failure of device deployment requiring parent vessel sacrifice (2) or open clipping (1), dissection (2), FD thrombosis (2) and ICH (1). Neurological complications included speech abnormalities and hemiparesis in 16% of patients, one third of these deficits resolved prior to discharge. In patients available for follow-up, pre-procedure modified Rankin scale (mRS) showed an improvement from baseline at 6 months in 17.6% of patients. Ninety-four percent of patients had a mRS of 2 or less at the six month follow-up. The 6 month aneurysm occlusion rate was 80.4%. Three percent of the FDs showed intimal hyperplasia at 6 months requiring further antiplatelet therapy. There were no mortalities during the study period.
Conclusion FD is effective in the treatment of complicated cerebrovascular disease including classical, fusiform, dissecting and blister type aneurysms, with a six month occlusion rate of 80.4% in this series. It has an acceptable safety profile with a morbidity rate of 5.4% at 6 months and no fatalities. It is likely that as operators gain experience with FD devices, this safety profile will improve as did the procedure length and fluoroscopy time.
Disclosures Y. Zhang: None. R. Scranton: None. G. Britz: None. O. Diaz: None. R. Klucznik: None.
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