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New devices and techniques
Braid stability after flow diverter treatment of intracranial aneurysms: a systematic review and meta-analysis
  1. Santiago Ortega-Gutierrez1,
  2. Aaron Rodriguez-Calienes2,3,
  3. Juan Vivanco-Suarez2,
  4. H Saruhan Cekirge4,5,
  5. Ricardo A Hanel6,
  6. Mahmoud Dibas2,
  7. Saleh Lamin7,
  8. Hal Rice8,
  9. Isil Saatci9,
  10. David Fiorella10,11,
  11. Pedro Lylyk12,
  12. Feyyaz Baltacioglu13,
  13. Ivan Lylyk14,
  14. Vitor Mendes Pereira15,16,
  15. Matthew J Gounis17,
  16. Jens Fiehler18
  1. 1Departmenf of Neuroloy, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  3. 3Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
  4. 4Radiology, Private American Hospital, Ankara, Turkey
  5. 5Private Office, Saruhan Cekirge, Ankara, Turkey
  6. 6Department of Neurosurgery, Baptist Medical Center, San Antonio, Texas, USA
  7. 7Department of Interventional Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  8. 8Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
  9. 9Koru Health Group, Ankara, Turkey
  10. 10Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  11. 11SUNY SB, New York, New York, USA
  12. 12Interventional Neuroradiology, Clinical Institute ENERI, Buenos Aires, Argentina
  13. 13Neuroradiology, American Hospital, Istanbul, Sisli, Turkey
  14. 14Clínica La Sagrada Familia, Buenos Aires, Argentina
  15. 15Division of Neuroradiology, Department of Medical Imaging, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
  16. 16Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
  17. 17New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
  18. 18Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Santiago Ortega-Gutierrez, Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; santy-ortega{at}uiowa.edu

Abstract

Background The aim of this study was to evaluate the overall rates of braid changes associated with flow diverter (FD) treatment for intracranial aneurysms (IAs). Additionally, we sought to provide an overview of the currently reported definitions related to these complications.

Methods A systematic search was conducted from the inception of relevant literature up to April 2023, encompassing six databases. The included studies focused on patients with IAs treated with FDs. We considered four main outcome measures as FD braid changes: (1) fish-mouthing, (2) device braid narrowing, (3) device braid collapsing, and (4) device braid deformation. The data from these studies were pooled using a random-effects model.

Results A total of 48 studies involving 3572 patients were included in the analysis. Among them, 14 studies (39%) provided definitions for fish-mouthing. However, none of the included studies offered specific definitions for device braid narrowing, collapsing, or deformation, despite reporting rates for these complications in six, five, and three studies, respectively. The pooled rates for braid changes were as follows: 3% (95% CI 2% to 4%, I2=27%) for fish-mouthing, 7% (95% CI 2% to 20%, I2=85%) for narrowing, 1% (95% CI 0% to 3%, I2=0%) for collapsing, and 1% (95% CI 1% to 4%, I2=0%) for deformation.

Conclusion The findings of this study suggest that FD treatment for IAs generally exhibits low rates of fish-mouthing, device braid narrowing, collapsing, and deformation. However, the lack of standardized definitions hinders the ability to compare device outcomes objectively, emphasizing the need for uniform definitions for FD braid changes in future prospective studies on FD.

  • flow diverter
  • device
  • complication
  • aneurysm
  • intervention

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-021120

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @CerebrovascLab, @AaronCalienes, @jsvivanco1, @eneri_neuro, @VitorMendesPer1, @Fie0815

    • Contributors All contributors met the following criteria for authorship: substantial contributions to the conception or design of the work; involvement in the acquisition, analysis, or interpretation of data for the work; participation in drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SOG is responsible for the overall content as the guarantor of the study.

    • 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 SO-G: grants from NIH, Stryker, Medtronic, Microvention, MEthinks, IschemiaView, Viz.ai, Siemens; consulting fees from Medtronic and Stryker. HSC receives consulting fees from Medtronic and MicroVention and holds stock or stock options in Neuravention Inc, Vesalio Inc, Bend It Tech, Syncron, Prometheus Inc, Piraeus Inc, Sim Research Support: Microvention, Stryker, Balt USA, Siemens; Scientific Advisory Boards: Scientia Medical, NVMed, Perfuze; holds stock in: MENTICE-Vascular Simulations, Neurogami, Marblehead, Scientia Medical, NVMed, Perfuze. PL receives consulting fees from Medtronic, Cerevasc, and Phenox GmbH (paid to his institution); honoraria from Medtronic (paid to him); and support for attending meetings and/or travel from Cerevasc, Medtronic, and Philips (paid to him); and participates on the Cerevasc data safe monitoring board. VMP is an unpaid consultant for Siemens Healthinners Endovascular Robotics. JF reported compensation from Acandis, Cerenovus, MicroVention, Medtronic, Penumbra, Phenox, Roche, Stryker, Tonbridge and stock holdings in Eppdata GmbH and Tegus Medical outside the submitted work.

    • 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.