title: Flow Diversion for Intracranial Aneurysm Management: A New Standard of Care.
abstract: Endovascular treatment of intracranial aneurysms with complex morphologies such as giant, wide-necked, or fusiform aneurysms is challenging. Stent-assisted coiling and balloon-assisted coiling are alternative techniques to treat such complex aneurysms, but studies have shown less-than-expected efficacy, as suggested by their high rate of recanalization. The management of complex aneurysms via microsurgery or conventional neuroendovascular strategies has traditionally been poor. However, over the last few years, flow-diverting stents (FDS) have revolutionized the treatment of such aneurysms. FDS are implanted within the parent artery rather than the aneurysm sac. By modifying intra-aneurysmal and parent-vessel flow dynamics at the aneurysm/parent vessel interface, FDS trigger a cascade of gradual intra-aneurysmal thrombosis. As endothelialization of the FDS is complete, the parent vessel reconstructs while preserving the patency of normal perforators and side branch vessels. As with any intervention, the practice and application of flow-diversion technology is inherent, with risks that include vessel rupture or perforation, in-stent thrombosis, perforator occlusion, procedural and delayed hemorrhages, and perianeurysmal edema. Herein, we review the devices, their mechanisms of actions, clinical applications, complications, and ongoing studies.
authors.affiliation: Department of Neurosurgery, Rutgers University School of Medicine, Newark, NJ, USA. fa299@njms.rutgers.edu.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: Department of Neurosurgery, Rutgers University School of Medicine, Newark, NJ, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Amuluru
authors.affiliation: Department of Neurosurgery, Rutgers University School of Medicine, Newark, NJ, USA.|Department of Neurology, Rutgers University School of Medicine, Newark, NJ, USA.|Department of Radiology, Rutgers University School of Medicine, Newark, NJ, USA.
authors.forename: Chirag D
authors.initials: CD
authors.lastname: Gandhi
authors.affiliation: Department of Neurosurgery, Rutgers University School of Medicine, Newark, NJ, USA.|Department of Neurology, Rutgers University School of Medicine, Newark, NJ, USA.|Department of Radiology, Rutgers University School of Medicine, Newark, NJ, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Prestigiacomo
mesh_terms: D002986:Clinical Trials as Topic; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000188:drug therapy / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Cerebral aneurysm; Coil embolization; Endovascular; Flow diversion; Subarachnoid hemorrhage