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Original research
Flow diverter device for the treatment of small middle cerebral artery aneurysms
  1. Francesco Briganti1,
  2. Luigi Delehaye2,
  3. Giuseppe Leone1,
  4. Carmine Sicignano2,
  5. Giuseppe Buono2,
  6. Mariano Marseglia1,
  7. Ferdinando Caranci1,
  8. Fabio Tortora3,
  9. Francesco Maiuri4
  1. 1Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
  2. 2Unit of Interventional Neuroradiology, San Giovanni Bosco Hospital, Naples, Italy
  3. 3“Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Naples, Italy
  4. 4Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
  1. Correspondence to
    Professor Francesco Briganti, Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, Naples 80131, Italy; frabriga{at}unina.it

Abstract

Purpose Experience with the endovascular treatment of middle cerebral artery (MCA) aneurysms by flow diverter devices (FDD) is still limited. This study examines the results and complications of FDD for small aneurysms at this location.

Methods From February 2010 to December 2013, 14 patients (10 women; mean age 59 years) with 15 small MCA aneurysms were treated with FDD. All procedures were performed with the Pipeline embolization device (PED).

Results Complete occlusion was obtained in 12/15 aneurysms (80%) and partial occlusion in 3 (20%). Among 13 aneurysms with a side branch, this was patent at the angiographic control in 4 cases, showed decreased filling in 6, and was occluded in 3 (with neurological deficits in 2). All PEDs were patent at follow-up. Post-procedural ischemic complications occurred in 4 (27%) procedures with permanent neurological deficit (modified Rankin score 2) in 3 (21%). No early or delayed aneurysm rupture, no subarachnoid or intraparenchymal hemorrhage and no deaths occurred.

Conclusions Endovascular treatment with FDD is a relatively safe treatment for small MCA aneurysms resulting in a high occlusion rate. The findings of this study suggest that complete occlusion after endovascular treatment with FDD can be delayed (>6 months). Ischemic complications may occur as early or delayed, particularly at clopidogrel interruption.

  • Flow Diverter
  • Aneurysm
  • Angiography
  • Intervention

https://doi.org/10.1136/neurintsurg-2014-011460

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