gms | German Medical Science

Objective: Flow diverters are considered as promising tool for endovascular treatment of intracranial aneurysms. Background of this study is to evaluate our experience with flow diverters in the treatment of intracranial aneurysms.

Method: Retrospective analysis of a series of 27 aneurysms of the anterior and posterior circulation, treated endovascularly using a flow diverter stent between 09/2009 and 11/2013. Angiographic aneurysm properties, complications and outcome were analysed on the basis of angiographic imaging data and patient charts.

Results: The series comprises 27 ruptured and unruptured aneurysms (17 anterior, 10 posterior circulation). The anterior circulation group includes one ruptured blisterlike ACI, one ruptured carotid bifurcation giant, one ruptured, partially thrombosed and calcified giant ACM, one fusiform space-occupying M1 and 13 fusiform space-occupying intracavernous and paraophthalmic aneurysms. Posterior circulation aneurysms included 5 ruptured dissecting VA, one symptomatic, space-occupying saccular BA-side-wall and 4 symptomatic, space-occupying arteriosclerotic fusiform VA/BA aneurysms. Angiographic follow-up examinations for anterior circulation aneurysms revealed complete occlusion in 9 (53%), flow reduction and aneurysm residual in 8 patients (47%). One major complication with persistent neurological deficit due to complete in-stent thrombosis and consecutive media infarction occurred (fusiform M1-aneurysm). In posterior circulation aneurysms 2 patients showed significant aneurysm growth on follow-up (1 fusiform VA/BA aneurysm, 1 dissecting VA-aneurysm) with consecutive repeated flow-diverter treatment. There was good response to flow-diverter treatment in 4 patients with dissecting VA-aneurysms, and BA-side wall aneurysm, respectively. 3 patients showed flow reduction and partial residual. 1 patient (fusiform VA/BA aneurysm, repeated flow diverter treatment) died due to delayed in-stent thrombosis (fusiform space-occupying VA/BA aneurysm).

Conclusions: The concept of flow diversion in aneurysm treatment seems appealing but there is a considerable rate of severe complications, especially in arteriosclerotic fusiform aneurysms of the posterior circulation and distally located aneurysms! Flow-diverter treatment in aneurysms warrants strict indications considering alternative treatment options, the natural course of the disease and strict anticoagulation management.