Abstract W P75: Endovascular Treatment of Small Unruptured Cerebral Aneurysms with Flow Diverters
Purpose: To assess the safety and efficacy issues of Flow Diverters (FD) in the treatment of small unruptured cerebral aneurysms.
Methods: Retrospective review of a prospectively gathered database of endovascularly treated aneurysms since the introduction of FD. From September 2008 (when treatment aneurysms with FD was initiated at our institution) to August 2013, 538 small (≤ 12 mm), unruptured aneurysms were treated by endovascular means. Four treatment modalities were individualized: simple coiling, balloon-assisted coiling, stent-assisted coiling and aneurysm neck coverage with FD.
Results: 15.1% (mean sac size: 5.3 mm, 65.4% bifurcation) of aneurysms were simply coiled. 33.6% (mean sac size: 5.3 mm, 53.0% bifurcation) of aneurysms were coiled with balloon assistance. 31.4% (mean sac size: 6.4 mm, 75.1% bifurcation) of aneurysms were coiled with stent-assistance. 19.9% (mean sac size: 5.9 mm, 18.7% bifurcation) aneurysms were treated with FD. Procedural perioperative and delayed (up to 30 days) neurological complications were 0.0%, 3.5%, 9.9% and 3.4% respectively, with a marked trend for more complications with stent-assisted coiling (P=0.034). Total immediate aneurysm occlusion was obtained in 49.4%, 53.0%, 60.3% and 11.2% respectively, with a marked trend toward better occlusion with stent-assisted coiling technique (P<0.0001). At a mean follow-up of 17 months for aneurysms treated with FD and 19 months for the others (not significant), total aneurysm occlusion was 60.4%, 69.8%, 93.4% and 78.4% respectively, with a trend toward better occlusion with stent-assisted coiling (P=0.0011).
Conclusions: FD for the treatment of small unruptured aneurysms confer a good safety profile that compares favorably with those of balloon-assisted technique, but are mostly indicated for sidewall aneurysms. Occlusion rates at follow-up are better with stent-assisted-coiling than FD but with higher morbidity.
Author Disclosures: M. Piotin: Ownership Interest; Modest; stock options Lazarus Effect. Consultant/Advisory Board; Modest; covidien, stryker, balt, Lazarus Effect. B. Bartolini: Consultant/Advisory Board; Modest; covidien, stryker. S. Pistocchi: Consultant/Advisory Board; Modest; covidien, stryker. H. Redjem: None. R. Blanc: Ownership Interest; Modest; stock option Lazazus Effect. Consultant/Advisory Board; Modest; covidien, stryker, balt, Lazarus Effect.
- © 2014 by American Heart Association, Inc.