Skip to main content
Erschienen in: Neuroradiology 10/2012

01.10.2012 | Interventional Neuroradiology

Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis

verfasst von: Francesco Briganti, Manuela Napoli, Fabio Tortora, Domenico Solari, Mauro Bergui, Edoardo Boccardi, Enrico Cagliari, Lucio Castellan, Francesco Causin, Elisa Ciceri, Luigi Cirillo, Roberto De Blasi, Luigi Delehaye, Francesco Di Paola, Andrea Fontana, Roberto Gasparotti, Giulio Guidetti, Ignazio Divenuto, Giuseppe Iannucci, Maurizio Isalberti, Marco Leonardi, Fernando Lupo, Salvatore Mangiafico, Andrea Manto, Roberto Menozzi, Mario Muto, Nunzio Paolo Nuzzi, Rosario Papa, Benedetto Petralia, Mariangela Piano, Maurizio Resta, Riccardo Padolecchia, Andrea Saletti, Giovanni Sirabella, Luca Piero Valvassori Bolgè

Erschienen in: Neuroradiology | Ausgabe 10/2012

Einloggen, um Zugang zu erhalten

Abstract

Introduction

We report the experiences of 25 Italian centers, analyzing intra- and periprocedural complications of endovascular treatment of intracranial aneurysms using Silk (Balt Extrusion, Montmorency, France) and pipeline embolization devices (EV3 Inc, Irvine California).

Methods

Two hundred seventy-three patients with 295 cerebral aneurysms, enrolled in 25 centers in Italy and treated with the new flow-diverter devices, were evaluated; 142 patients were treated with Silk and 130 with pipeline (in one case, both devices were used). In 14 (5.2 %) cases devices were used with coils. Aneurysm size was >15 mm in 46.9 %, 5–15 mm in 42.2 %, and <5 mm in 10.8 %. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 163 cases (55.2 %), cavernous ICA in 76 (25.7 %), middle cerebral artery in 11 (3.7 %), PCoA in 6 (2 %), and ACoA in 2 (0.7 %); the vertebrobasilar system accounted for 32 cases (10.8 %) and PCA in 5 (1.7 %).

Results

Technical adverse events occurred with 59 patients (21.6 %); 5 patients died after ischemic events, 10 to hemorrhagic complications, and 1 from external ventricular drain positioning. At 1 month, morbidity and mortality rates were 3.7 % and 5.9 %, respectively

Conclusion

Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series.
Literatur
2.
Zurück zum Zitat Byrne JV, Beltechi R, Yarnold JA, Birks J, Kamran M (2010) Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One 5 (9). doi:10.1371/journal.pone.0012492 Byrne JV, Beltechi R, Yarnold JA, Birks J, Kamran M (2010) Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One 5 (9). doi:10.​1371/​journal.​pone.​0012492
3.
Zurück zum Zitat Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38(5):1538–1544. doi:10.1161/STROKEAHA.106.466987 PubMedCrossRef Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38(5):1538–1544. doi:10.​1161/​STROKEAHA.​106.​466987 PubMedCrossRef
4.
Zurück zum Zitat Fiorella D, Albuquerque F, Gonzalez F, McDougall CG, Nelson PK (2010) Reconstruction of the right anterior circulation with the Pipeline embolization device to achieve treatment of a progressively symptomatic, large carotid aneurysm. J Neurointerv Surg 2(1):31–37. doi:10.1136/jnis.2009.000554 PubMedCrossRef Fiorella D, Albuquerque F, Gonzalez F, McDougall CG, Nelson PK (2010) Reconstruction of the right anterior circulation with the Pipeline embolization device to achieve treatment of a progressively symptomatic, large carotid aneurysm. J Neurointerv Surg 2(1):31–37. doi:10.​1136/​jnis.​2009.​000554 PubMedCrossRef
5.
Zurück zum Zitat Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up. Neurosurgery 56(6):1191–1201, discussion 1201-1192PubMedCrossRef Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up. Neurosurgery 56(6):1191–1201, discussion 1201-1192PubMedCrossRef
6.
Zurück zum Zitat Fiorella D, Albuquerque FC, Woo H, Rasmussen PA, Masaryk TJ, McDougall CG (2010) Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-up. J Neurointerv Surg 2(1):16–22. doi:10.1136/jnis.2009.000521 PubMedCrossRef Fiorella D, Albuquerque FC, Woo H, Rasmussen PA, Masaryk TJ, McDougall CG (2010) Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-up. J Neurointerv Surg 2(1):16–22. doi:10.​1136/​jnis.​2009.​000521 PubMedCrossRef
8.
Zurück zum Zitat Fiorella D, Lylyk P, Szikora I, Kelly ME, Albuquerque FC, McDougall CG, Nelson PK (2009) Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms. J Neurointerv Surg 1(1):56–65. doi:10.1136/jnis.2009.000083 PubMedCrossRef Fiorella D, Lylyk P, Szikora I, Kelly ME, Albuquerque FC, McDougall CG, Nelson PK (2009) Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms. J Neurointerv Surg 1(1):56–65. doi:10.​1136/​jnis.​2009.​000083 PubMedCrossRef
10.
Zurück zum Zitat Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39(1):120–125. doi:10.1161/STROKEAHA.107.495747 PubMedCrossRef Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39(1):120–125. doi:10.​1161/​STROKEAHA.​107.​495747 PubMedCrossRef
12.
Zurück zum Zitat Kis B, Weber W, Gotz F, Becker H, Berlit P, Kuhne D (2007) Endovascular treatment of cerebral aneurysms using the Leo stent: long term follow-up and expansion of indications. Clin Neuradiol 17:167–179 Kis B, Weber W, Gotz F, Becker H, Berlit P, Kuhne D (2007) Endovascular treatment of cerebral aneurysms using the Leo stent: long term follow-up and expansion of indications. Clin Neuradiol 17:167–179
13.
Zurück zum Zitat Kulcsar Z, Houdart E, Bonafe A, Parker G, Millar J, Goddard AJ, Renowden S, Gal G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rufenacht DA (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32(1):20–25. doi:10.3174/ajnr.A2370 PubMed Kulcsar Z, Houdart E, Bonafe A, Parker G, Millar J, Goddard AJ, Renowden S, Gal G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rufenacht DA (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32(1):20–25. doi:10.​3174/​ajnr.​A2370 PubMed
14.
Zurück zum Zitat Leonardi M, Cirillo L, Toni F, Dall'olio M, Princiotta C, Stafa A, Simonetti L, Agati R (2011) Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience. Interv Neuroradiol 17(3):306–315. doi:IN.v17.i3 PubMed Leonardi M, Cirillo L, Toni F, Dall'olio M, Princiotta C, Stafa A, Simonetti L, Agati R (2011) Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience. Interv Neuroradiol 17(3):306–315. doi:IN.​v17.​i3 PubMed
15.
Zurück zum Zitat Lubicz B, Collignon L, Raphaeli G, Pruvo JP, Bruneau M, De Witte O, Leclerc X (2010) Flow-diverter stent for the endovascular treatment of intracranial aneurysms: a prospective study in 29 patients with 34 aneurysms. Stroke 41(10):2247–2253. doi:10.1161/STROKEAHA.110.589911 PubMedCrossRef Lubicz B, Collignon L, Raphaeli G, Pruvo JP, Bruneau M, De Witte O, Leclerc X (2010) Flow-diverter stent for the endovascular treatment of intracranial aneurysms: a prospective study in 29 patients with 34 aneurysms. Stroke 41(10):2247–2253. doi:10.​1161/​STROKEAHA.​110.​589911 PubMedCrossRef
17.
Zurück zum Zitat Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64(4):632–642. doi:10.1227/01.NEU.0000339109.98070.65, discussion 642-633; quiz N6PubMedCrossRef Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64(4):632–642. doi:10.​1227/​01.​NEU.​0000339109.​98070.​65, discussion 642-633; quiz N6PubMedCrossRef
18.
Zurück zum Zitat Mocco J, Snyder KV, Albuquerque FC, Bendok BR, Alan SB, Carpenter JS, Fiorella DJ, Hoh BL, Howington JU, Jankowitz BT, Liebman KM, Rai AT, Rodriguez-Mercado R, Siddiqui AH, Veznedaroglu E, Hopkins LN, Levy EI (2009) Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. J Neurosurg 110(1):35–39. doi:10.3171/2008.7.JNS08322 PubMedCrossRef Mocco J, Snyder KV, Albuquerque FC, Bendok BR, Alan SB, Carpenter JS, Fiorella DJ, Hoh BL, Howington JU, Jankowitz BT, Liebman KM, Rai AT, Rodriguez-Mercado R, Siddiqui AH, Veznedaroglu E, Hopkins LN, Levy EI (2009) Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. J Neurosurg 110(1):35–39. doi:10.​3171/​2008.​7.​JNS08322 PubMedCrossRef
19.
Zurück zum Zitat Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817. doi:10.1016/S0140-6736(05)67214-5 PubMedCrossRef Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817. doi:10.​1016/​S0140-6736(05)67214-5 PubMedCrossRef
20.
Zurück zum Zitat Mustafa W, Kadziolka K, Anxionnat R, Pierot L (2010) Direct carotid-cavernous fistula following intracavernous carotid aneurysm treatment with a flow-diverter stent. A case report Interv Neuroradiol 16(4):447–450. doi:IN.v16.i4 Mustafa W, Kadziolka K, Anxionnat R, Pierot L (2010) Direct carotid-cavernous fistula following intracavernous carotid aneurysm treatment with a flow-diverter stent. A case report Interv Neuroradiol 16(4):447–450. doi:IN.​v16.​i4
21.
Zurück zum Zitat Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D (2011) The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 32(1):34–40. doi:10.3174/ajnr.A2421 PubMed Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D (2011) The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 32(1):34–40. doi:10.​3174/​ajnr.​A2421 PubMed
22.
23.
Zurück zum Zitat Pumar JM, Garcia-Dorrego R, Nieto A, Vazquez-Herrero F, Blanco-Ulla M, Vazquez-Martin A (2010) Vascular reconstruction of a fusiform basilar aneurysm with the Silk embolization system. J Neurointerv Surg 2(3):242–244. doi:10.1136/jnis.2010.002725 PubMedCrossRef Pumar JM, Garcia-Dorrego R, Nieto A, Vazquez-Herrero F, Blanco-Ulla M, Vazquez-Martin A (2010) Vascular reconstruction of a fusiform basilar aneurysm with the Silk embolization system. J Neurointerv Surg 2(3):242–244. doi:10.​1136/​jnis.​2010.​002725 PubMedCrossRef
24.
Zurück zum Zitat Sedat J, Chau Y, Mondot L, Vargas J, Szapiro J, Lonjon M (2009) Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results. Neuroradiology 51(6):401–409. doi:10.1007/s00234-009-0502-2 PubMedCrossRef Sedat J, Chau Y, Mondot L, Vargas J, Szapiro J, Lonjon M (2009) Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results. Neuroradiology 51(6):401–409. doi:10.​1007/​s00234-009-0502-2 PubMedCrossRef
25.
Zurück zum Zitat Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol 33(1):159–163. doi:10.3174/ajnr.A2719 PubMedCrossRef Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol 33(1):159–163. doi:10.​3174/​ajnr.​A2719 PubMedCrossRef
26.
Zurück zum Zitat Szikora I, Berentei Z, Kulcsar Z, Marosfoi M, Vajda ZS, Lee W, Berez A, Nelson PK (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31(6):1139–1147. doi:10.3174/ajnr.A2023 PubMedCrossRef Szikora I, Berentei Z, Kulcsar Z, Marosfoi M, Vajda ZS, Lee W, Berez A, Nelson PK (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31(6):1139–1147. doi:10.​3174/​ajnr.​A2023 PubMedCrossRef
27.
Zurück zum Zitat Turowski B, Macht S, Kulcsar Z, Hanggi D, Stummer W (2011) Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts? Neuroradiology 53(1):37–41. doi:10.1007/s00234-010-0676-7 PubMedCrossRef Turowski B, Macht S, Kulcsar Z, Hanggi D, Stummer W (2011) Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts? Neuroradiology 53(1):37–41. doi:10.​1007/​s00234-010-0676-7 PubMedCrossRef
28.
Zurück zum Zitat van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21(4):589–624. doi:10.1002/sim PubMedCrossRef van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21(4):589–624. doi:10.​1002/​sim PubMedCrossRef
Metadaten
Titel
Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis
verfasst von
Francesco Briganti
Manuela Napoli
Fabio Tortora
Domenico Solari
Mauro Bergui
Edoardo Boccardi
Enrico Cagliari
Lucio Castellan
Francesco Causin
Elisa Ciceri
Luigi Cirillo
Roberto De Blasi
Luigi Delehaye
Francesco Di Paola
Andrea Fontana
Roberto Gasparotti
Giulio Guidetti
Ignazio Divenuto
Giuseppe Iannucci
Maurizio Isalberti
Marco Leonardi
Fernando Lupo
Salvatore Mangiafico
Andrea Manto
Roberto Menozzi
Mario Muto
Nunzio Paolo Nuzzi
Rosario Papa
Benedetto Petralia
Mariangela Piano
Maurizio Resta
Riccardo Padolecchia
Andrea Saletti
Giovanni Sirabella
Luca Piero Valvassori Bolgè
Publikationsdatum
01.10.2012
Verlag
Springer-Verlag
Erschienen in
Neuroradiology / Ausgabe 10/2012
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-012-1047-3

Weitere Artikel der Ausgabe 10/2012

Neuroradiology 10/2012 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.