Abstract
Background: Hemodynamic flow is one of the major factors in the progression and rupture of intracranial aneurysms (IA). Flow diverter devices (FD) reduce blood flow in the aneurysm sac, allow gradual stagnation, thrombosis and neointimal remodeling while maintain outflow in the side branches and perforators. Objectives: We present our experience and long-term follow-up on endovascular reconstruction of complexes IA using flow diverter device. Particularly we analyze our experience with (Pipeline endovascular device) PED. Methods: Since March 2006 to July 2015, 1000 patients (pt) with IA were treated with FD or FD/coils. Of this group 633 pt were with PED, 113 Surpass (SNEG), 111 P64, 78 Cardiatis, 40 WEB and others 25. Angiographic follow-up was performed at 3, 6, 12 months and yearly until 8 y Fup. An inclusion criteria was unfavorable anatomy for coil, dome to neck ratio ≥ 2, Neck ≥ 4 mm and recurrence following previous treatment. Results: We treated 633 Pt with 704 IA with 932 PED. (77 % female); mean age 55 y (range 7-88). History of SAH was present in 18,5%; 81,5% were unruptured IA; mass effect in 125 pt; incidental IA 96 pts; headache 77 pts, others 23 pts. Large/giant IA were present in 51,2%, and wide neck (>4mm) 65%. The technical success was 98,4%. Occlusion rate at 1yr was 90 % and 8 yr 100 %, without recurrences. Peri-procedural (30 days) morbi-mortality rate was 5.9%: 2.7% had definitive neurologic defects; death rate was 3.2%. Conclusion: Endovascular treatment of complex IA with FD is a safe, effective and stable procedure, with an acceptable morbi-mortality rate. Abbreviations: AICA, anterior inferior cerebellar artery • BA, basilar artery • DSA, digital subtraction angiography • IA, intracranial aneurysm • ICA, internal carotid artery • MRA, MR angiography • PcomA, posterior communicating artery • PED, Pipeline • SNEG, Surpass •Embolization Device • SAH, subarachnoid hemorrhage • SCA, superior cerebellar artery
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