title: Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms.
abstract: Flow-diverting stents, including the Pipeline embolization device (PED) and Silk, have been beneficial in the treatment of aneurysms previously unable to be approached via endovascular techniques. Recurrent aneurysms for which stent-assisted embolization has failed are a therapeutic challenge, given the existing intraluminal construct with continued blood flow into the aneurysm. We report our experience using flow-diverting stents in the repair of 25 aneurysms for which stent-assisted embolization had failed. Nineteen (76%) of these aneurysms at the 12-month follow-up showed improved Raymond class occlusion, with 38% being completely occluded, and all aneurysms demonstrated decreased filling. One patient developed a moderate permanent neurologic deficit. Appropriate stent sizing, proximal and distal construct coverage, and preventing flow diverter deployment between the previously deployed stent struts are important considerations to ensure wall apposition and prevention of endoleak. Flow diverters are shown to be a reasonable option for treating previously stented recurrent cerebral aneurysms.
authors.affiliation: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Heiferman
authors.affiliation: Department of Neurosurgery, University of Florida-Orlando Health, Orlando, Florida, USA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Billingsley
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Kasliwal
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Johnson
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Kiffon M
authors.initials: KM
authors.lastname: Keigher
authors.affiliation: Division of Neurosurgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Michel E
authors.initials: ME
authors.lastname: Frudit
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Roham
authors.initials: R
authors.lastname: Moftakhar
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Demetrius K
authors.initials: DK
authors.lastname: Lopes
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000295:instrumentation / Q000379:methods*; D015607:Stents / Q000706:statistics & numerical data*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Aneurysm; Angiography; Flow Diverter; Intervention