Subscribe to RSS
DOI: 10.1055/s-0043-1769781
291 Internal Carotid Artery Aneurysms Treated with Fred, Silk, and Pipeline Stents: A Cross-Sectional Study
291 Aneurismas na Artéria Carótida Interna Tratados com os Stents Fred, Silk e Pipeline: Um Estudo TransversalAbstract
Objective Intracranial aneurysms (IAs) are present in ∼ 2 to 5% of the population. Several treatments have been used, including endovascular options such as flow diverter devices (FDDs). The present study retrospectively analyzed the effectiveness of three FDDs in the treatment of 291 aneurysms in the internal carotid artery. The devices analyzed were the flow-redirection endoluminal device (FRED), the SILK Embolization Device and the PIPELINE Embolization Device (PED).
Method This is a cross-sectional study which evaluates the outcome of control arteriography. The O'Kelly-Marotta (OKM) Scale was used to assess the degree of filling and flow stasis in the aneurysm 12 months after surgery.
Results Conjoining the result of the three devices, most aneurysms (87.9%) were from the classification C-D, that is, they presented complete or almost complete aneurysmal occlusion. However, 6.6% did not obtain aneurysm occlusion, so they were classified as belonging to group A. In group B, a subocclusion was presented in 5.5%. In addition, by analyzing individually the result of each device, there was a bigger proportion of those classified in the group A among those who used SILK and in the group C-D among those who used FRED. Regarding complications, 10 cases were found, corresponding to 4.23% of all 236 patients. Therefore, four of these patients had complications when treated with PED; this proportion is higher than expected concerning the other groups.
Conclusion The three devices are safe choices. Particularly, the FRED was found to be the most effective in treating internal carotid artery aneurysms.
Resumo
Objetivo Aneurismas intracranianos (AIs) estão presentes em ∼ 2 a 5% da população. Vários tratamentos têm sido utilizados, incluindo opções endovasculares, como redirecionadores de fluxo (RFs). O presente estudo analisou retrospectivamente a eficácia de três dispositivos: dispositivo endoluminal de redirecionamento de fluxo (FRED, na sigla em inglês), dispositivo de embolização SILK e dispositivo de embolização pipeline (PED, na sigla em inglês), no tratamento de 291 aneurismas da artéria carótida interna.
Método Trata-se de um estudo transversal, avaliando o desfecho quanto ao grau de enchimento e a estase de fluxo no aneurisma com arteriografia de controle após 12 meses da cirurgia usando a Escala O'Kelly-Marotta (OKM).
Resultados Combinando o resultado dos três dispositivos, mais aneurismas (87,9%) eram do grupo D ou C, ou seja, apresentaram oclusão aneurismática completa ou quase completa; 5,5% apresentaram suboclusão, classificação B, e 6,6% não obtiveram oclusão do aneurisma, sendo da classificação A. Além disso, ao analisar individualmente o resultado de cada aparelho, houve maior proporção daqueles classificados no grupo A entre os que usaram SILK, e C-D entre os que usaram o FRED. Quanto às complicações, foram encontrados 10 casos, ou seja, 4,23% de todos os 236 pacientes, 4 destes pacientes tiveram complicações quando tratados com PED, sendo essa proporção maior do que o esperado em relação aos demais grupos.
Conclusão Os três dispositivos são escolhas seguras, sendo o FRED o mais eficaz no tratamento de aneurismas de artéria carótida interna.
Institution where the study took place
Universidade do Estado do Pará, UEPA. This research has its own funding.
Ethics Committee Approval Number
5.218.761 (CAAE: 48444321.6.0000.5174)
Publication History
Received: 06 August 2022
Accepted: 24 January 2023
Article published online:
28 June 2023
© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Zhao J, Wang R, Zhang D. et al. A comparative study of 43 patients with mirror-like intracranial aneurysms: risk factors, treatment, and prognosis. Neuropsychiatr Dis Treat 2014; 2231 DOI: 10.2147/ndt.
- 2 Silva NA, Shao B, Sylvester MJ, Eloy JA, Gandhi CD. Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping. Neurosurg Focus 2018; 44 (05) E4 DOI: 10.3171/2018.1.focus17714.
- 3 Kraemer CJK, Zhou W. Carotid Aneurysm Review. Int J Angiol 2019; 28 (01) 017-019 DOI: 10.1055/s-0039-1677675.
- 4 Rajah G, Narayanan S, Rangel-Castilla L. Update on flow diverters for the endovascular management of cerebral aneurysms. Neurosurg Focus 2017; 42 (06) E2 DOI: 10.3171/2017.3.focus16427.
- 5 Alderazi YJ, Shastri D, Kass-Hout T, Prestigiacomo CJ, Gandhi CD. Flow diverters for intracranial aneurysms. Stroke Res Treat 2014; 2014: 415653 DOI: 10.1155/2014/415653.
- 6 Kallmes DF, Brinjikji W, Cekirge S. et al. Safety and efficacy of the Pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies. J Neurosurg 2017; 127 (04) 775-780 DOI: 10.3171/2016.8.jns16467.
- 7 Becske T, Kallmes DF, Saatci I. et al. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology 2013; 267 (03) 858-868 DOI: 10.1148/radiol.13120099.
- 8 Killer-Oberpfalzer M, Kocer N, Griessenauer CJ. et al. European Multicenter Study for the Evaluation of a Dual-Layer Flow-Diverting Stent for Treatment of Wide-Neck Intracranial Aneurysms: The European Flow-Redirection Intraluminal Device Study. AJNR Am J Neuroradiol 2018; 39 (05) 841-847 DOI: 10.3174/ajnr.a5592.
- 9 Kocer N, Islak C, Kizilkilic O, Kocak B, Saglam M, Tureci E. Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results. J Neurosurg 2014; 120 (05) 1158-1171 DOI: 10.3171/2014.1.jns131442.
- 10 Möhlenbruch MA, Herweh C, Jestaedt L. et al. The FRED flow-diverter stent for intracranial aneurysms: clinical study to assess safety and efficacy. AJNR Am J Neuroradiol 2015; 36 (06) 1155-1161 DOI: 10.3174/ajnr.a4251.
- 11 Chancellor B, Raz E, Shapiro M. et al. Flow Diversion for Intracranial Aneurysm Treatment: Trials Involving Flow Diverters and Long-Term Outcomes. Neurosurgery 2020; 86 (Suppl. 01) S36-S45 DOI: 10.1093/neuros/nyz345.
- 12 Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke 2013; 44 (02) 442-447 DOI: 10.1161/strokeaha.112.678151.
- 13 Ye G, Zhang M, Deng L, Chen X, Wang Y. Meta-Analysis of the Efficiency and Prognosis of Intracranial Aneurysm Treated with Flow Diverter Devices. J Mol Neurosci 2016; 59 (01) 158-167 DOI: 10.1007/s12031-016-0723-x.
- 14 Zhou G, Su M, Zhu YQ, Li MH. Efficacy of Flow-Diverting Devices for Cerebral Aneurysms: A Systematic Review and Meta-analysis. World Neurosurg 2016; 85: 252-262 DOI: 10.1016/j.wneu.2015.09.088.
- 15 Burrows AM, Cloft H, Kallmes DF, Lanzino G. Periprocedural and mid-term technical and clinical events after flow diversion for intracranial aneurysms. J Neurointerv Surg 2015; 7 (09) 646-651 DOI: 10.1136/neurintsurg-2014-011184.
- 16 Bouthillier A, van Loveren HR, Keller JT. Segments of the internal carotid artery: a new classification. Neurosurgery 1996; 38 (03) 425-432 , discussion 432–433 DOI: 10.1227/00006123-199603000-00001.
- 17 Shapiro M, Raz E, Becske T, Nelson PK. Variable porosity of the pipeline embolization device in straight and curved vessels: a guide for optimal deployment strategy. AJNR Am J Neuroradiol 2014; 35 (04) 727-733 DOI: 10.3174/ajnr.a3742.
- 18 Kulcsár Z, Ernemann U, Wetzel SG. et al. High-profile flow diverter (silk) implantation in the basilar artery: efficacy in the treatment of aneurysms and the role of the perforators. Stroke 2010; 41 (08) 1690-1696 DOI: 10.1161/strokeaha.110.580308.
- 19 Berg P, Iosif C, Ponsonnard S, Yardin C, Janiga G, Mounayer C. Endothelialization of over- and undersized flow-diverter stents at covered vessel side branches: An in vivo and in silico study. J Biomech 2016; 49 (01) 4-12 DOI: 10.1016/j.jbiomech.2015.10.047.
- 20 O'kelly CJ, Krings T, Fiorella D, Marotta TR. A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interv Neuroradiol 2010; 16 (02) 133-137 DOI: 10.1177/159101991001600204.
- 21 Vlak MH, Algra A, Brandenburg R, Rinkel GJ. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 2011; 10 (07) 626-636 DOI: 10.1016/s1474-4422(11)70109-0.
- 22 Binh NT, Luu VD, Thong PM. et al. Flow diverter stent for treatment of cerebral aneurysms: A report of 130 patients with 134 aneurysms. Heliyon 2020; 6 (02) e03356 DOI: 10.1016/j.heliyon.2020.e03356.
- 23 Merritt WC, Berns HF, Ducruet AF, Becker TA. Definitions of intracranial aneurysm size and morphology: A call for standardization. Surg Neurol Int 2021; 12: 506 DOI: 10.25259/sni_576_2021.
- 24 Morita A, Kirino T, Hashi K. et al; UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366 (26) 2474-2482 DOI: 10.1056/NEJMoa1113260.
- 25 International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms–risk of rupture and risks of surgical intervention. N Engl J Med 1998; 339 (24) 1725-1733 DOI: 10.1056/nejm199812103392401.
- 26 Gariel F, Marnat G, Barreau X. et al; DIVERSION investigators. Safety and efficacy of the Silk flow diverter: Insight from the DIVERSION prospective cohort study. J Neuroradiol 2021; 48 (04) 293-298 DOI: 10.1016/j.neurad.2020.06.006.
- 27 Pumar JM, Banguero A, Cuellar H. et al. Treatment of Intracranial Aneurysms With the SILK Embolization Device in a Multicenter Study. A Retrospective Data Analysis. Neurosurgery 2017; 81 (04) 595-601 DOI: 10.1093/neuros/nyw123.
- 28 Briganti F, Leone G, Marseglia M. et al. Endovascular treatment of cerebral aneurysms using flow-diverter devices: A systematic review. Neuroradiol J 2015; 28 (04) 365-375 DOI: 10.1177/1971400915602803.
- 29 Hanel RA, Kallmes DF, Lopes DK. et al. Prospective study on embolization of intracranial aneurysms with the pipeline device: the PREMIER study 1 year results. J Neurointerv Surg 2020; 12 (01) 62-66 DOI: 10.1136/neurintsurg-2019-015091.
- 30 Rice H, Martínez Galdámez M, Holtmannspötter M. et al. Periprocedural to 1-year safety and efficacy outcomes with the Pipeline Embolization Device with Shield technology for intracranial aneurysms: a prospective, post-market, multi-center study. J Neurointerv Surg 2020; 12 (11) 1107-1112 DOI: 10.1136/neurintsurg-2020-015943.
- 31 Pierot L, Spelle L, Berge J. et al. SAFE study (Safety and efficacy Analysis of FRED Embolic device in aneurysm treatment): 1-year clinical and anatomical results. J Neurointerv Surg 2019; 11 (02) 184-189 DOI: 10.1136/neurintsurg-2018-014261.
- 32 Arrese I, Sarabia R, Pintado R, Delgado-Rodriguez M. Flow-diverter devices for intracranial aneurysms: systematic review and meta-analysis. Neurosurgery 2013; 73 (02) 193-199 , discussion 199–200 DOI: 10.1227/01.neu.0000430297.17961.f1.
- 33 Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001; 32 (09) 1998-2004 DOI: 10.1161/hs0901.095600.
- 34 Kamran M, Yarnold J, Grunwald IQ, Byrne JV. Assessment of angiographic outcomes after flow diversion treatment of intracranial aneurysms: a new grading schema. Neuroradiology 2011; 53 (07) 501-508 DOI: 10.1007/s00234-010-0767-5.