Article Text
Abstract
Endovascular treatment of intracranial aneurysms (IAs) has evolved considerably over the past decades. The technological advances have been driven by the experience that coils fail to completely exclude all IAs from the blood circulation, the need to treat the diseased parent vessel segment leading to the aneurysm formation, and expansion of endovascular therapy to treat more complex IAs. Stents were initially developed to support the placement of coils inside wide neck aneurysms. However, early work on stent-like tubular braided structure led to a more sophisticated construct that then later was coined as a flow diverter (FD) and found its way into clinical application. Although FDs were initially used to treat wide-neck large and giant internal carotid artery aneurysms only amenable to surgical trap with or without a bypass or endovascular vessel sacrifice, its use in other types of IAs and cerebrovascular pathology promptly followed. Lately, we have witnessed an explosion in the application of FDs and subsequently their modifications leading to their ubiquitous use in endovascular therapy. In this review we aim to compile the available FD technology, evaluate the devices’ peculiarities from the authors’ perspective, and analyze the current literature to support initial and expanded indications, recognizing that this may be outdated soon.
- flow diverter
- aneurysm
- device
- fistula
Statistics from Altmetric.com
Footnotes
Twitter @Doctorgaldamez
SD and AM-R contributed equally.
Contributors All authors contributed to the conception, data gathering, and drafting of the manuscript, along with manuscript oversight and administrative support. All authors critically reviewed the manuscript and approved its final submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer Mario Martinez-Galdamez is a consultant for Medtronic, Balt Extrusion and Stryker Neurovascular. Juan Macho is a consultant for Stryker Neurovascular. Ajay K Wakhloo is a consultant for Stryker Neurovascular. Vitor M Pereira is a consultant for Balt Extrusion and Stryker Neurovascular. Santiago Ortega-Gutierrez is a consultant for Medtronic and Stryker Neurovascular. Sudeepta Dandapat, Alan Mendez-Ruiz, Gustavo Foa Torres and Anil Arat do not have a financial interest in any of the procedures, drugs or devices described in this article.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.