Response to Letter Regarding Article “Flow-Diverter Stent for the Endovascular Treatment of Intracranial Aneurysms: A Prospective Study in 29 Patients With 34 Aneurysms”
In response to Pierot,1 we would offer the following:
We agree with the author about most comments. However, we believe that several points must be emphasized:
There are only 2 other series that have evaluated the use of the Silk flow-diverter stent.2,3 In both studies, the overall complication rate is quite high and is comparable to ours. Kulcsár et al3 have reported a 33% complication rate with 1 acute parent artery thrombosis and 3 delayed thromboembolic events in 12 patients. Byrne et al3 have reported 21% of stent deployment difficulties, 11% of parent artery thrombosis, and an overall permanent morbidity plus mortality rate of 12%. Although we agree that definitive conclusions cannot be made, it seems that this stent is more difficult to use than conventional self-expandable stents. Moreover, patients must be informed about the risk of delayed complications that almost never occur with conventional stent-assisted coiling.
Although there is a huge interest for flow-diverter stents in the last 2 to 3 years, very limited data have been published about their use and their results. In contrast, many neurointerventionalists have reported unexpected rates of procedural and delayed complications (thrombo-embolic or bleeding) at different international meetings. We all know that physicians are less enthusiastic to publish suboptimal results, and this might partially explain the very low number of publications on the subject. Larger series with long-term follow-up or even randomized studies are thus mandatory to learn about the real efficacy and safety of these devices.
During the last decade, many innovative new devices (eg, 3D coils, remodeling balloons, and self-expandable stents) have been released, and they have enlarged the indications for embolization. Many authors have shown the safety and efficacy of these new techniques with low morbidity and mortality rates. Our duty as physicians is to continue to be increasingly demanding with companies when they release new devices because our common aim is to offer the best and safest treatment to our patients.
Boris Lubicz, MD, PhD
Department of Diagnostic and Interventional Neuroradiology
Erasme University Hospital
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- © 2011 American Heart Association, Inc.
- Pierot L
- Kulcsár Z,
- Ernemann U,
- Wetzel SG,
- Bock A,
- Goericke S,
- Panagiotopoulos V,
- Forsting M,
- Ruefenacht D,
- Wanke I