title: Current Trends and Results of Endovascular Treatment of Unruptured Intracranial Aneurysms at a Single Institution in the Flow-Diverter Era.
abstract: During the past several years, the number of unruptured aneurysms treated with endovascular techniques has increased. Traditionally, coil embolization was the treatment of choice for these lesions; however, recently flow diversion has become a viable, and in some cases superior, treatment option. The current single-center study presents results and trends of endovascular treatment with flow diversion and coil embolization in an unselected group of patients with unruptured intracranial aneurysms in a "real world" setting during the flow-diverter era.
  
  
  
  Three hundred ten patients with 318 treated unruptured aneurysms from June 2009 to May 2015 were included. Patient demographics, clinical characteristics, aneurysm/treatment characteristics, and outcomes were collected prospectively. We studied the following: intensive care unit admission/reasons, perioperative and mid-/long-term complications, target aneurysm rupture, retreatment/recurrence rates, and long-term neurologic outcome using the mRS.
  
  
  
  The flow-diverter group had a larger mean aneurysm size (12.3 ± 8.6 mm versus 8.7 ± 6.3 mm, P < .0001). There were no significant differences in the immediate (P = .43) and mid-/long-term complication rates (P = .54) between groups. Periprocedural neurologic morbidity and mortality rates were 2.1% and 0.5% in the coiling group and 2.5% and 1.6% in the flow-diverter group. Patients with coiling were more likely to be retreated than those with flow diversion (14.8% versus 5.7%, P = .009). Worsening of the mRS due to the target aneurysm was noted in only 3.2% of patients.
  
  
  
  The endovascular treatment of unruptured aneurysms can be performed with very low rates of neurologic complications. Both flow-diverter and coil therapy were safe and effective.
authors.affiliation: From the Departments of Neurologic Surgery (O.P., G.L.) Department of Neurosurgery, (O.P.), Medical University, Innsbruck, Austria.
authors.forename: O
authors.identifier: 0000-0002-2258-1032
authors.initials: O
authors.lastname: Petr
authors.affiliation: Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota.
authors.forename: W
authors.identifier: 0000-0001-5271-5524
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota.
authors.forename: H
authors.identifier: 0000-0003-2590-3815
authors.initials: H
authors.lastname: Cloft
authors.affiliation: Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota.
authors.forename: D F
authors.identifier: 0000-0002-8495-0040
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: From the Departments of Neurologic Surgery (O.P., G.L.) Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota lanzino.giuseppe@mayo.edu.
authors.forename: G
authors.identifier: 0000-0003-1479-465X
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography; D003422:Critical Care; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D016896:Treatment Outcome; D055815:Young Adult