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Case series
Derivo embolization device for intracranial aneurysms: a Spanish multicenter retrospective study
  1. Carlos Piñana1,
  2. Sebastian Remollo2,
  3. Joaquín Zamarro3,
  4. Mariano Werner4,
  5. Mariano Espinosa de Rueda3,
  6. Pedro Vega5,
  7. David Hernandez1,
  8. Eduardo Murias5,
  9. Eila Rivera1,6,
  10. Jorge Olier7,
  11. Luis San Roman4,
  12. Alfredo Páez-Carpio4,
  13. Manuel Requena1,8,
  14. Sonia Aixut9,
  15. Marta de Dios Lascuevas1,
  16. Manuel Moreu10,
  17. Santiago Rosati10,
  18. Laura Ludovica Gramegna11,12,
  19. Carlos Castaño2,
  20. Alejandro Tomasello1,6
  1. 1Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
  2. 2Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  3. 3Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
  4. 4Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
  5. 5Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
  6. 6Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
  7. 7Interventional Neuroradiology, Hospital de Navarra, Pamplona, Spain
  8. 8Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
  9. 9Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
  10. 10Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
  11. 11Department of Biomedical and Neuromotor Sciences (DIBINEM), Bologna, Italy
  12. 12Instituto delle Scienze Neurologiche di Bologna (IRCCS), Bologna, Italy
  1. Correspondence to Dr Alejandro Tomasello, Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain; alejandrotomasello{at}gmail.com

Abstract

Background Flow diverters have emerged in recent years as a safe and effective treatment for intracranial aneurysms, with expanding indications. The Derivo embolization device (DED) is a second-generation flow diverter with a surface finish that may reduce thrombogenicity. We report our multicenter experience evaluating its safety and efficacy.

Methods We retrospectively analyzed all patients treated with the DED in eight centers in Spain between 2016 and 2020. Demographics, clinical data, procedural complications, morbidity and aneurysm occlusion rates were collected.

Results A total of 209 patients with 250 aneurysms were treated (77.5% women). The majority of aneurysms were located in the internal carotid artery (86.8%) and most (69.2%) were small (<10 mm) with a median maximum diameter of 5.85 mm and median neck size of 4 mm. DED deployment was successful in all cases, despite two malfunctioning devices (1%). Major complications occurred in nine patients (4.3%), while mild neurologic clinical events were registered in 23 (11%); four patients died (1.9%). A total of 194 aneurysms had an angiographic follow-up at 6 months and showed complete aneurysm occlusion in 75% of cases. Twelve-month follow-up was available for 112 of the treated aneurysms, with a total occlusion rate of 83%.

Conclusion The DED is a second-generation surface-modified flow diverter that presents an option for treatment of intracranial aneurysms with comparable safety and efficacy to other available flow diverter devices. Nonetheless, risks are not negligible, and must be balanced against the natural history risk of cerebral aneurysms, considering the tendency to widen indications for treatment of smaller and less complex lesions in day-to-day use.

  • Aneurysm
  • Device
  • Flow Diverter

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Footnotes

  • Twitter @Sremollo, @pedrovegavaldes, @manumoreu

  • Collaborators Lucía Aja, Roger Barranco, Jordi Blasco, Víctor Cuba, Juan Chaviano, Óscar Chirife, Jose Díaz-Pérez, María Ángeles De Miquel, Gonzalo De Paco, Blanca García-Villalba, José David Guio, José María Jiménez, Alfonso López-Frías, Antonio López-Rueda, Guillermo Parrilla Reverter, Carlos Pérez-García, Isabel Rodríguez-Caamaño, Carmen Soriano.

  • Contributors Substantial contributions to the conception and design of the work: AT, CP. Acquisition, analysis, or interpretation of data for the work: all authors. Drafting the manuscript: AT, CP, ER, MR, LLG. Critical revision of the manuscript for relevant intellectual content: all authors. Final approval of the manuscript: all authors.

  • 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.

  • Competing interests AT has received personal fees from Anaconda Biomed, Balt, Medtronic, Perflow, and Stryker.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.