Treatment of complex cervical and intracranial aneurysms using telescoping flow diverter devices: Premilitary experience

Abstract

Objective To clarify the indications, technical essentials and complication preventing strategies concerning the telescoping flow diverter devices technique by summarizing our premilitary experience in treatment of cervical and intracranial aneurysms using this technique. Methods Fifteen cases with 15 cervical and intracranial aneurysms treated with telescoping flow diverter devices at Department of Neurosurgery, Changhai Hospital, Navy Military Medical University from August 2010 to April 2019 were retrospectively reviewed. Five aneurysms were treated with Pipeline embolization devices (PED) and 10 with Tubridge flow diverters using telescoping technique. Among all aneurysms, 7 were treated in intended manner, while 8 aneurysms were treated in salvaging purpose. In 9 patients, the first flow diverter was deployed distally, followed by a second flow diverter deployed proximally in the parent artery (D-P manner), while in the remaining 6 patients, the first flow diverter was deployed proximally, followed by deployment of a second flow diverter (P-D manner). Coiling was also performed in 11 patients. Modified Rankin scale (mRS) was used to comprehensively evaluate the patients after surgery, and O′kelly-Marotta (OKM) grading scale was to evaluate aneurysm embolization. Results The techniques were succeeded performed in all patients. Contrast stasis was observed in 14 aneurysms immediately post procedure. According to OKM grading scale, 7 were categorized as OKM grade A, 7 as grade B and 1 as grade C. No procedure-related complications were encountered. In 10 patients who had DSA follow-up lasting for 6-30 (median: 12) months, 7 aneurysms were totally occluded (OKM grade D), while further thrombosis was observed in the other 3 aneurysms (OKM grade B in 1 and grade C in 2). The parent arteries were patent in all except for 1 patient who developed occlusion at 9 months postoperatively. All patients were clinically followed up for 2-30 (median: 12) months. During that period, no new neurological deficits were revealed (mRS: 0-2), except for that 1 patient developing contralateral hemiplegia (mRS: 3). Conclusion Telescoping flow diverter devices could be used to treat complicated cervical and intracranial aneurysms safely with good short-term effect. It should be considered with priority in treatment of large, giant or fusiform aneurysms with extremely wide neck. Key words: Intracranial aneurysm; Flow diverter; Telescoping technique; Treatment outcome