title: Treatment of intracranial aneurysms by flow diverter devices: long-term results from a single center.
abstract: OBJECTIVE
  Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2-4 years) of this treatment from a single-center.
  
  
  METHODS
  From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10mm) in 32 cases (82%), large (11-25mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated.
  
  
  RESULTS
  Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and time of complete occlusion were not correlated with the aneurysm size. MCA aneurysms mainly showed partial occlusion (2/3 cases). Besides, large-neck aneurysms and those with a vessel arising from the sac mainly showed late (>6 months) or partial occlusion.
  
  
  CONCLUSIONS
  FDD are a safe and efficacious treatment of intracranial aneurysms, resulting in high occlusion rate and low incidence of complications. It should be the treatment of choice for the large-neck aneurysm of the ICA.
authors.affiliation: Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: frabriga@unina.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Briganti
authors.affiliation: Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: napoli.manuela@gmail.com.
authors.forename: Manuela
authors.initials: M
authors.lastname: Napoli
authors.affiliation: Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: g.leonemd@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Leone
authors.affiliation: Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: mariano-marseglia@libero.it.
authors.forename: Mariano
authors.initials: M
authors.lastname: Marseglia
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: giuseppe.mariniello@unina.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mariniello
authors.affiliation: Department of Advanced Biomedical Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: ferdinando.caranci@unina.it.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Caranci
authors.affiliation: Chair of Neuroradiology, "Magrassi Lanzara" Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples, Italy. Electronic address: fabiotor@libero.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tortora
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Via S.Pansini 5., 80131 Naples, Italy. Electronic address: frmaiuri@unina.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maiuri
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery; D015901:Angiography, Digital Subtraction / Q000379:methods; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Endovascular treatment; Flow diverter devices; Intracranial Aneurysm; Pipeline embolization devices; Silk embolization devices