Endovascular treatment with flow diverters of recanalized and multitreated aneurysms initially treated by endovascular approach.
OBJECTIVE
To evaluate the feasibility, safety and efficacy of endovascular treatment with flow diverters in patients with recanalized and multitreated aneurysms in a retrospective, multicenter, single-arm study.


METHODS
The study included 29 patients with 29 recanalized aneurysms who were treated by flow diverters (Silk or Pipeline devices). Pre- and post-procedural complications and morbidity and mortality rates were evaluated and functional outcomes (modified Rankin Score (mRS)) at 1 month (short-term) and 3-4 months (mid-term) were compared with preoperative mRS (before the procedure). Mid-term angiographic follow-up was performed assessing aneurysmal occlusion by the Montreal scale (complete occlusion, neck remnant, aneurysm remnant).


RESULTS
Placement of the flow diverters was achieved in all patients. Two misdeployments of the flow diverters necessitated balloon dilation in two patients, which was associated with stent delivery in one patient. Permanent morbidity related to treatment was 6.9% (2/29), transient morbidity was 10.3% (3/29) and there were no deaths resulting from the treatment. One patient died from a myocardial infarct 4 weeks after the procedure. 25/29 patients (86.2%) had a good final functional outcome, 26/29 (89.7%) had an unchanged functional outcome and 2/29 patients (6.9%) had clinical worsening. Angiographic follow-up showed complete occlusion in 17/28 patients (60.7%), neck remnants in 6/28 patients (21.4%) and residual aneurysms in 5/28 (17.9%).


CONCLUSIONS
Flow diverter placement is feasible and safe in patients with recanalized and multitreated aneurysms. The procedure is associated with a high percentage of good functional outcomes as well as good mid-term anatomical results (82.1%).
Department of Neuroradiology, Centres Hospitaliers Universitaires de Reims, Reims, France.
Azzedine
A
Benaissa
Department of Neuroradiology, Centres Hospitaliers Universitaires de Toulouse, Toulouse, France.
Anne-Christine
AC
Januel
Department of Neuroradiology, Centres Hospitaliers Universitaires de Tours, Tours, France.
Denis
D
Herbreteau
Department of Neuroradiology, Centres Hospitaliers Universitaires de Bordeaux, Bordeaux, France.
Jérôme
J
Berge
Department of Neuroradiology, Centres Hospitaliers Universitaires de Saint-Etienne, Saint-Etienne, France.
Mohamed
M
Aggour
Department of Neuroradiology, Centres Hospitaliers Universitaires de Reims, Reims, France.
Krzysztof
K
Kadziolka
Department of Neuroradiology, Centres Hospitaliers Universitaires de Toulouse, Toulouse, France.
Christophe
C
Cognard
Department of Neuroradiology, Centres Hospitaliers Universitaires de Reims, Reims, France.
Laurent
L
Pierot
D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation / Q000502:physiology*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011859:Radiography
Aneurysm