Abstract
Endovascular therapy is now the treatment of choice for intracranial aneurysms (IAs) for its efficacy and safety profile. The use of flow diversion (FD) has recently expanded to cover many types of IAs in various locations. Some institutions even attempt FD as first line treatment for unruptured IAs. The most widely used devices are the pipeline embolization device (PED), the SILK flow diverter (SFD), the flow redirection endoluminal device (FRED), and Surpass. Many questions were raised regarding the long-term complications, the optimal regimen of dual antiplatelet therapy, and the durability of treatment effect. We reviewed the literature to address these questions as well as other concerns on FD when treating IAs.
Highlights
Endovascular therapy is the treatment of choice for intracranial aneurysms (IAs) for its efficacy and safety profile
We reviewed the literature to address these questions as well as other concerns on FD when treating IAs
Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) were alternative techniques developed to deal with such complex aneurysms, but studies have shown their less than expected efficacy given their high rate of recanalization [2,3,4,5]
Summary
Endovascular therapy is the treatment of choice for intracranial aneurysms (IAs) for its efficacy and safety profile. We reviewed the literature to address these questions as well as other concerns on FD when treating IAs. FLOW-DIVERSION METHOD The FD technique relies on a concept of endoluminal reconstruction of the parent artery and the aneurysm neck by excluding the aneurysm from the circulation. The increased turbulence along with the lytic enzymes released from platelet aggregation predisposes to a possible lysis of the aneurysmal wall that can usually occur in the following days post-op [10]. This may lead to rupture and SAH if the aneurysm is not completely thrombosed. Dual APT is envisioned for at least 6 months, followed by lifelong monotherapy of aspirin (81 mg)
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