Purpose Flow diverters are the latest technology in the treatment of difficult/so far untreatable aneurysms. As with all new technologies, there is lots of “hype” factor for flow diverters as well. For a beginner in the field of interventional neuroradiology, it is usually not advisable to venture into the difficult cases in the beginning of the carrier. However for a new technology, every body is a beginner. The purpose of this presentation is to discuss important points that a beginner in the field should know about how to proceed for the SILK flow diverter technology.
Materials and Method We treated a total of seven patients with aneurysms which were branded as non-treatables or extremely difficult to treat with the conventional treatment techniques. Before actually starting the treatment, the most important point is to educate and make a consensus among the vascular neurosurgeons and interventional neuroradiology. Organizing an in-service with the company is helpful in this. Getting approval from healthcare regulatory agency (Health Canada) and proctorship are the next steps. The most important part for a new technology is proper case selection. Management of the patient per se starts with talking with the patient about the technology, the rationale for its use and lack of its long term outcome. This is followed by the periprocedural management most important being the anti-platelet medications and steroids. Eventually the follow-up is the most important step to maintain the credibility of both the new treatment and the new operator.
Result The aneurysms in our patient group were located at cavernous/ophthalimic segment of internal carotid artery (n=5), basilar trunk (n=1) and A2 segment of anterior cerebral artery (n=1). Five of these patients were done under the guidance of the proctor and last two patients were done independently. We had 100% technical success. No technical complications. One patient had mild hemiparesis which improved over a period of next 5 days. Another patient had spontaneous occlusion of her parent artery 2 months after the treatment as she stopped taking antiplatelet drugs. Other patient had no complications. All patients were followed up using CEMRA to begin with and the confirmation of complete occlusion was validated using DSA. We had an average follow-up of 3 months (0 to 7 months). One patient had confirmed exclusion of his aneurysm on MRI 3 months after the initial treatment and other patient had occlusion of her parent artery 2 months after the initial treatment.
Conclusion Education, proper training, proper case selection, patience and team support are the most important factors to consider when venturing into a relatively new territory in the first year of your carrier.
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Disclosures J Shankar: None. R Vandorpe: None. G Pickett: None. I Fleetwood: None. M Schmidt: None. W Maloney: None.
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