Abstract
Background and Purpose: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. In this retrospective multicenter study, we analyzed the safety and efficacy of the treatment of intracranial, unruptured, or previously treated but recanalized aneurysms using Flow Re-Direction Endoluminal Device (FRED) Jr with emphasis on midterm results.Materials and Methods: Clinical and radiological records of 150 patients harboring 159 aneurysms treated with FRED Jr at six centers between October 2014 and February 2020 were reviewed and consecutively included. Clinical outcome was measured by using the modified Rankin Scale (mRS). Anatomical results were assessed according to the O'Kelly-Marotta (OKM) scale and the Cekirge-Saatci Classification (CSC) scale.Results: The overall complication rate was 24/159 (16%). Thrombotic-ischemic events occurred in 18/159 treatments (11%). These resulted in long-term neurological sequelae in two patients (1%) with worsening from pre-treatment mRS 0–2 and mRS 4 after treatment. Complete or near-complete occlusion of the treated aneurysm according to the OKM scale was reached in 54% (85/158) at 6-month, in 68% (90/133) at 1-year, and in 83% (77/93) at 2-year follow-up, respectively. The rates of narrowing or occlusion of a vessel branch originating from the treated aneurysm according to the CSC scale were 11% (12/108) at 6-month, 20% (17/87) at 1-year, and 23% (13/57) at 2-year follow-up, respectively, with all cases being asymptomatic.Conclusions: In this retrospective multicenter study, FRED Jr was safe and effective in the midterm occlusion of cerebral aneurysms. Most importantly, it was associated with a high rate of good clinical outcome.
Highlights
The treatment of intracranial aneurysms of complex morphology, such as aneurysms with a wide neck, irregular shape, or aneurysms with incorporated branching vessels, may be unfavorable or even unsuitable for traditional endovascular or microsurgical treatments [1, 2]
We evaluate the applicability of flow diverter stent treatment using the Flow Re-Direction Endoluminal Device (FRED) FRED Junior (Jr) for unruptured or previously treated but recanalized intracranial aneurysms in smaller vessels and examine the device’s safety and efficacy
One hundred eight (68%) of the treated aneurysms had a vessel arising either directly from the aneurysm or from the vicinity of the aneurysm sac, which was covered by the flow diverter
Summary
The treatment of intracranial aneurysms of complex morphology, such as aneurysms with a wide neck, irregular shape (e.g., daughter sac aneurysms), or aneurysms with incorporated branching vessels, may be unfavorable or even unsuitable for traditional endovascular or microsurgical treatments [1, 2]. Recanalized aneurysms after endovascular or microsurgical treatment often show characteristics of complex morphology, limiting the options for successful retreatment [3, 4]. In these cases, flow diversion stent treatment is an increasingly used alternative [1]. Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms In this retrospective multicenter study, we analyzed the safety and efficacy of the treatment of intracranial, unruptured, or previously treated but recanalized aneurysms using Flow Re-Direction Endoluminal Device (FRED) Jr with emphasis on midterm results
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