Original ArticleThe Use of Flow Diversion in Vessels ≤2.5 mm in Diameter–A Single-Center Experience
Introduction
Since their introduction, flow-diverting stents (FDS) have gained a broad acceptance as a viable treatment option for intracranial aneurysms. The PUFS (Pipeline for Uncoilable or Failed Aneurysms) study1 showed an aneurysm occlusion rate of 73.6% at 6 months and major ipsilateral stroke or neurologic death rate of 5.5%, whereas the PITA (Pipeline Embolization Device for the Intracranial Treatment of Aneurysms) study2 showed a 6-month aneurysm occlusion rate of 93.3% and ischemic stroke risk of 6.5%. More recently, the 5-year follow-up data for the PUFS study were reported and showed good long-term safety, with most patients having a good clinical outcome.3 Numerous meta-analyses and systematic reviews from a variety of different groups have also showed similar results.4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 However, despite the wealth of data, there is limited evidence on the use of these stents in small arteries (≤2.5 mm), with only 1 study addressing this question directly.23
We present our data on the use of FDS to treat aneurysms arising from parent vessels with maximum diameter ≤2.5 mm.
Section snippets
Patient Population
We performed a retrospective analysis of a prospectively maintained database to identify all patients with an aneurysm arising from a vessel ≤2.5 mm in diameter. Patients with both saccular and fusiform aneurysms were included. Ruptured aneurysms were excluded from the analysis as were patients who had adjunctive coiling at the time of flow diversion. We searched our database between September 2009 and January 2018.
For each patient, we recorded demographic data, clinical presentation, location
Results
We identified 29 patients (22 female, 76%) with average age of 56.2 ± 15.9 years (range, 21–83 years). Seventeen aneurysms (59%) were located on the right, with the remainder of the aneurysms located on the left. Most aneurysms were classified as saccular 21 (72.4%), with 7 fusiform aneurysms (24.2%) and 1 presumed dissecting aneurysm (3.4%). Of the saccular aneurysms, the average dome width was 5.3 ± 3.9 mm (range, 1.2–16 mm), the dome was 8.5 ± 9.7 mm (range, 1.3–39 mm), and the average neck
Discussion
Good aneurysm exclusion rates and long-term outcomes have been seen for aneurysms treated with flow diversion; however, the results for the use of these devices in small vessels is limited. We are aware of only a single study that has looked specifically at the use of the PED in vessels ≤2.5 mm in diameter. Puri et al.23 presented their results of aneurysms, all arising from the anterior circulation, with parent artery vessel diameter of ≤2.5 mm. They identified 7 patients (6 female) with a
Conclusions
The use of FDS in vessels ≤2.5 mm is technically feasible, with good aneurysm exclusion rates. The introduction of FDSs specifically designed for small vessels may help to make the treatment of distal aneurysms more feasible.
Acknowledgments
Author contributions: P.B., data gathering, manuscript preparation, study design, review, and editing; J.C., data gathering, data collection, and manuscript preparation; C.B., data gathering, data collection, and manuscript preparation; I.L., data gathering, data collection, and manuscript preparation; N.P., data gathering, data collection, and manuscript preparation; H.H., manuscript preparation and study design; and P.L., data gathering, editing, review, and guarantor.
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2024, Journal of Stroke and Cerebrovascular DiseasesTreatment of cerebral aneurysms with the FRED Jr flow-diverting stent: A case series and meta-analysis
2022, Clinical Neurology and NeurosurgeryCitation Excerpt :This null stroke rate, which was comparable to the studies in the literature review (pooled rate = 0.1 %), in addition to the 0 % mortality rate, highlights the safety profile of the FRED Jr. [5,10–15] This high rate of favorable clinical outcomes in our case series (100 %) compared to the literature (pooled rate= 90.1 %) may be attributed to the small sample size of our case series. 5,10–15Moreover, feasibility of FRED Jr was apparent in the 100 % rate of successful deployment in both our case series and the literature review [5,10–15]. With respect to outcomes, the rates of pooled complete occlusion (69.9 %) and complications (0 %) in our meta-analysis were comparable to those of other flow diverting stents in the literature ranging from 62 % to 100 % and 0–30 % respectively [16–19].
Flow Diverter Devices for Treatment of Intracranial Aneurysms in Small Parent Vessels—A Systematic Review of Literature
2022, World NeurosurgeryCitation Excerpt :Quality was assessed using the Newcastle-Ottawa scale. A total of 19 studies were included in the present review.12-30 The PRISMA flowchart for the selection of studies is shown in Figure 1.
Endovascular Management of Distal Anterior Cerebral Artery Aneurysms: A Multicenter Retrospective Review
2021, World NeurosurgeryCitation Excerpt :The concept of flow diverting stents can create further concerns due to the need for dual antiplatelet therapy in a complex patient population that frequently require further invasive procedures and thus are at higher risk of intracranial hemorrhage and poor outcomes.15-17 Furthermore, flow diversion is increasingly used to treat intracranial aneurysms in various locations, and hence, there is renewed interest in offering endovascular treatment options for DACAA with promising results.18-26 Most of the evidence evaluating endovascular management of DACAA stems from single institutional experience and is limited by small sample size.27-32
Conflict of interest statement: P.B. serves as a consultant and proctor for phenox and consultant for Neurvana Medical; J.C., I.L., C.B., and N.P. have no conflicts to declare; H.H. is cofounder and shareholder of phenox; and P.L. serves as a consultant for phenox.