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Original research
Endovascular treatment with flow diverters of recanalized and multitreated aneurysms initially treated by endovascular approach
  1. Azzedine Benaissa1,
  2. Anne-Christine Januel2,
  3. Denis Herbreteau3,
  4. Jérôme Berge4,
  5. Mohamed Aggour5,
  6. Krzysztof Kadziolka1,
  7. Christophe Cognard2,
  8. Laurent Pierot1
  1. 1Department of Neuroradiology, Centres Hospitaliers Universitaires de Reims, Reims, France
  2. 2Department of Neuroradiology, Centres Hospitaliers Universitaires de Toulouse, Toulouse, France
  3. 3Department of Neuroradiology, Centres Hospitaliers Universitaires de Tours, Tours, France
  4. 4Department of Neuroradiology, Centres Hospitaliers Universitaires de Bordeaux, Bordeaux, France
  5. 5Department of Neuroradiology, Centres Hospitaliers Universitaires de Saint-Etienne, Saint-Etienne, France
  1. Correspondence to Professor Laurent Pierot, Service de neuroradiologie, Hopital Maison Blanche 45, rue Cognacq Jay, Reims cedex 51092, France; lpierot{at}gmail.com

Abstract

Purpose To evaluate the feasibility, safety and efficacy of endovascular treatment with flow diverters in patients with recanalized and multitreated aneurysms in a retrospective, multicenter, single-arm study.

Methods The study included 29 patients with 29 recanalized aneurysms who were treated by flow diverters (Silk or Pipeline devices). Pre- and post-procedural complications and morbidity and mortality rates were evaluated and functional outcomes (modified Rankin Score (mRS)) at 1 month (short-term) and 3–4 months (mid-term) were compared with preoperative mRS (before the procedure). Mid-term angiographic follow-up was performed assessing aneurysmal occlusion by the Montreal scale (complete occlusion, neck remnant, aneurysm remnant).

Results Placement of the flow diverters was achieved in all patients. Two misdeployments of the flow diverters necessitated balloon dilation in two patients, which was associated with stent delivery in one patient. Permanent morbidity related to treatment was 6.9% (2/29), transient morbidity was 10.3% (3/29) and there were no deaths resulting from the treatment. One patient died from a myocardial infarct 4 weeks after the procedure. 25/29 patients (86.2%) had a good final functional outcome, 26/29 (89.7%) had an unchanged functional outcome and 2/29 patients (6.9%) had clinical worsening. Angiographic follow-up showed complete occlusion in 17/28 patients (60.7%), neck remnants in 6/28 patients (21.4%) and residual aneurysms in 5/28 (17.9%).

Conclusions Flow diverter placement is feasible and safe in patients with recanalized and multitreated aneurysms. The procedure is associated with a high percentage of good functional outcomes as well as good mid-term anatomical results (82.1%).

  • Aneurysm

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