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New devices and techniques
Original research
Flow diverter braid deformation following treatment of cerebral aneurysms: incidence, clinical relevance, and potential risk factors
  1. Dan Adrian Popica1,
  2. Jonathan Cortese1,2,3,
  3. Alexander A Oliver3,
  4. Vincent Plaforet1,
  5. Ignacio Molina Diaz1,
  6. Fernanda Rodriguez-Erazú1,4,
  7. Léon Ikka1,
  8. Cristian Mihalea1,5,
  9. Vanessa Chalumeau1,
  10. David F Kallmes3,
  11. Jildaz Caroff1,6,
  12. Laurent Spelle1,2
    1. 1Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicetre Hospital, Le Kremlin-Bicetre, France
    2. 2INSERM U1195, Paris-Saclay University Faculty of Medicine, Paris, France
    3. 3Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
    4. 4Department of Neurosurgery, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
    5. 5Department of Neurosurgery, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
    6. 6Haemostasis Inflammation Thrombosis, INSERM U1176, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
    1. Correspondence to Dr Jonathan Cortese; jonathan.cortese{at}aphp.fr

    Abstract

    Background Although flow diverters (FDs) have benefited from several technical improvements, recently concerns have arisen regarding the braid stability after implantation. Thus, we investigated frequency, predictive factors, and clinical impact of the phenomenon of FD braid deformation (FDBD).

    Methods Consecutive intracranial aneurysms (IAs) treated with various FDs, between January 2018 and July 2023, were reviewed to identify FDBD (defined as the deformation of a FD without any external force applied to it). Patient, aneurysm, procedural, and FD characteristics were retrieved and analyzed using univariate and multivariable analyses. Morbidity is defined as a score of +1 in the modified Rankin Scale at 3 months.

    Results In total, 245 FD procedures (271 FDs implanted; 25 multiple IAs treated with 1 FD) in 228 patients; FDBD was observed in 36/245 cases (14.7%), mainly at follow-up angiography (32/36, 88.9%); fish-mouthing was the most frequent FDBD. Morbidity was related to fish-mouthing and braid collapse and was significantly higher in the FDBD group after retreatment (p=0.04). Drawn filled tubing with platinum (DFT) (adjusted odds ratio (aOR)=7.0, 95% CI 3.0 to 17.5; p<0.001) and FD diameter (aOR=2.2, 95% CI 1.3 to 4.1; p<0.01) were identified as independent predictors of FDBD. The metal alloy composing the FD (p=0.13) and coated surfaces were not significantly associated with FDBD (p=0.54 in multivariable analysis).

    Conclusions FDBD is a frequent phenomenon observed in about 15% of cases, and it was responsible for higher morbidity. Only FD characteristics (DFT and FD diameter) were independent determinants of FDBD. Future research should focus on the impact of novel braid configurations and materials on braid stability.

    • Aneurysm
    • Flow Diverter
    • Angiography

    Data availability statement

    Data are available upon reasonable request. Study data are available from the corresponding author upon reasonable request by a qualified investigator, and after clearance by the local institutional review board.

    https://doi.org/10.1136/jnis-2024-022236

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      Data availability statement

      Data are available upon reasonable request. Study data are available from the corresponding author upon reasonable request by a qualified investigator, and after clearance by the local institutional review board.

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      Footnotes

      • DAP and JCo are joint first authors.

      • X @PopicaAdrian, @Alex___Oliver, @CRISTIANMIHALEA, @jildazz

      • Contributors DAP, JCo, JCa, and LS contributed to the conception and design of the studies and the interpretation of the data. DAP, JCo, VP, IMD, and FR-E contributed to the acquisition and/or the analysis of the data. All authors drafted the work or revised it for significant intellectual content; All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work, including its accuracy and integrity. JCo is the guarantor.

      • 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 JCo received research grants from Medtronic, Phenox, and Microvention; and received honoraria for lectures from Balt. DFK received research support from Cerenovus, Sensome, Neurogami Medical, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, MiVi, Stryker, and National Institutes of Health (NIH); royalties from Medtronic; is on the Data Safety Monitoring Board (DSMB) of NoNO Inc. and Vesalio; is a stockholder in Nested Knowledge, Superior Medical Experts, Marblehead Medical, and Conway Medical. JCa received honoraria from Balt, Cerenovus, and Medtronic for lectures. LS is a consultant for Microvention, Balt, Phenox, Stryker, and Medtronic; DSMB or Advisory Board for CHOICE Study, INSPIRE Study, CLEVER study, and COATING study; grant or contract from Philips with institution.

      • 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.