title: Flow diverters at and beyond the level of the circle of willis for the treatment of intracranial aneurysms.
abstract: OBJECTIVE
  Flow Diverters (FD) are a new emerging therapy for intracranial aneurysms. Initial reports focused on the treatment of proximally located aneurysms. We report our experience with FDs in the treatment of aneurysms at and beyond the circle of Willis.
  
  
  METHODS
  We treated 30 aneurysms at and beyond the circle of Willis with FDs (silk and pipeline). Aneurysms were treated with FDs alone in 73.3% (22/30) and with FDs and coils in 23.3% (7/30). One procedure was converted in parent vessel occlusion.
  
  
  RESULTS
  Thirty aneurysms (21/30, 70.0% saccular; 7/30, 23.3% fusiform; 2/30, 6.7% blister-like; sizes 1.2-19.6, mean 6.8 mm) were treated in 26 patients (17 women, 9 men; mean age, 49 years) during 27 procedures. Access site complication was noted in 3.7% (1/27). Reversible neurological complications were noted in 7.4% (2/27), permanent neurological complication in 3.7% (1/27). There was no mortality. No aneurysms bled or rebled after treatment. Aneurysms treated with FDs alone were significantly smaller than those treated with FDs and coils (5.7 and 10.0 mm, respectively; P=0.0174). Immediate angiographic occlusion was achieved in 18.2% (4/22) with FDs alone, in 0.0% (0/7) with FDs and coils. Twenty-four aneurysms (80.0%) had been followed (mean, 13 months). Fifteen of 19 aneurysms (78.9%) treated with FDs against 4 of 4 of aneurysms (100%) treated with FDs and coils were occluded. There was no angiographic recurrence of initially totally occluded aneurysms.
  
  
  CONCLUSIONS
  Aneurysms at and beyond the circle of Willis are amenable to selective treatment with FDs.
authors.affiliation: Service de Neuroradiologie Interventionnelle, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, 25-29 rue Manin, 75940 Paris Cedex 19, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pistocchi
authors.forename: Raphaël
authors.initials: R
authors.lastname: Blanc
authors.forename: Bruno
authors.initials: B
authors.lastname: Bartolini
authors.forename: Michel
authors.initials: M
authors.lastname: Piotin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002941:Circle of Willis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged