Abstract
Intracranial aneurysms rapture is a common cause of mortality or morbidity worldwide. For this reason, in case of rupture, early treatment of the aneurysm is mandatory. The evaluation of unruptured intracranial aneurysms continue to increased due to the improvements in invasive and non-invasive neuroimaging. Securing of this life-threatening condition, considering all demographical and procedural factors is necessary for improving treatment results and patients outcome. The endovascular treatment has become frontline therapy of cerebral aneurysms treatment during the last 20 years, and without a doubt its recent advances shifted this boundary even further. Nowadays endovascular armamentarium continues to grow rapidly. Neuro-interventional procedures have tremendously improved their efficiency and continue to improve device’s safety. However some types of aneurysms are not really easy to treat with ordinary endovascular technique as it can result in devastating consequence, Firstly, it is not always applicable to complex aneurysms or very large neck aneurysms. Secondly, durability of the of the aneurysm occlusion is not guaranteed in all cases even after usage of the remodeling technique or regular stenting. New devices are introduced to decrease these limits. Two new innovative techniques that are increasingly used for endovacular occlusion of the complex aneurysms are flow diversion and intrasaccular flow disruption. The objective of this review is to provide a comprehensive overview of novel paradigms and latest research of flow diversion and intrasaccular flow disruption devices, its current application, limitation and future prospective. The obvious advantages of these new technologies proved progressive expansion of their utilization to the extent that they will ultimately replace standard coiling in an increasing number of cases going forward. The future of the endovascular treatment of intracranial aneurysms is bright. Fast gro-wing improvement in vascular access, treatment modalities and device delivery continue to increase number of patients with intracranial aneurysms treated with endovascular approach versus surgical clipping.
Highlights
LAURENT PIEROT*Conflict of Interest Statement (We declare that we have no conflict of interest). *Заява про конфлікт інтересів (Ми заявляємо, що у нас немає ніякого конфлікту інтересів). *Заявление о конфликте интересов (Мы заявляем, что у нас нет никакого конфликта интересов)
The objective of this review is to provide a comprehensive overview of novel paradigms and latest research of flow diversion and intrasaccular flow disruption devices, its current application, limitation and future prospective
Flow direction is the endovascular technique that is associated with the highest rate of complete aneurysm occlusion in long-term followup with no aneurysm recanalization observed in the long term
Summary
*Conflict of Interest Statement (We declare that we have no conflict of interest). *Заява про конфлікт інтересів (Ми заявляємо, що у нас немає ніякого конфлікту інтересів). *Заявление о конфликте интересов (Мы заявляем, что у нас нет никакого конфликта интересов). Surpass flow diverter (Stryker Neurovascular, Fremont, CA, USA) was evaluated in a multicenter trial (SCENT = Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide Neck Aneurysms) that included 180 patients with 180 aneurysms. 12-month major ipsilateral stroke or neurological death rate was 8.3 % [29] These morbidity and mortality rates are clearly higher to what is reported with coiling (1.7 % and 1.4 %, respectively, in Analysis of Treatment by Endovascular Approach of Non ruptured Aneurysms [ARETA] study) [30]. Intrasaccular flow disruption Intrasaccular flow disruption (IS-FD) is an innovative approach that involves the placement of a self-expanding, roughly spherically-shaped, cage-like device within the aneurysm [44,45,46,47,48,49]
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