The New Surface-Modified Flow Diverter p48 MW HPC Device Implanted in Arteries under 2.0 mm Diameter for Treatment of Distal Intracranial Aneurysms

Pedro Lucas Moreira Fernandes; Luis H. de Castro-Afonso; Guilherme Seizem Nakiri; Ricardo Santos de Oliveira; Benedicto Oscar Colli; Daniel Giansante Abud

doi:10.1055/a-2697-4429

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2697-4429

Original Article

The New Surface-Modified Flow Diverter p48 MW HPC Device Implanted in Arteries under 2.0 mm Diameter for Treatment of Distal Intracranial Aneurysms

Authors

Pedro Lucas Moreira Fernandes

¹Department of Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
Luis H. de Castro-Afonso

¹Department of Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil

²Department of Neurosciences and Behaviour Sciences, University of São Paulo, Interventional Neuroradiology, Avenida Bandeirantes, Ribeirao Preto, Brazil
Guilherme Seizem Nakiri

¹Department of Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
Ricardo Santos de Oliveira

¹Department of Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
Benedicto Oscar Colli

³Division of Neurosurgery, USP HCFMRP, Ribeirao Preto, São Paulo, Brazil
Daniel Giansante Abud

¹Department of Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil

Abstract

Introduction

Preliminary studies on the new modified surface flow diverters (FD) have shown promising results in the treatment of distal aneurysms. However, there is a lack of data in the literature regarding the use of these devices in very small-caliber arteries. The aim of this study was to analyze the safety and efficacy of the p48 MW HPC device (Wallaby-phenox, Bochum, Germany) device in the treatment of intracranial aneurysms associated with parent arteries with a diameter of <2.0 mm.

Methods

Sixteen patients were prospectively evaluated from November 2019 to July 2023. All patients underwent follow-ups at 1, 6, and 12 months. Safety was assessed using the modified Rankin Scale and the National Institutes of Health Stroke Scale. Efficacy was defined as complete (grade D) or partial (grade C) aneurysm occlusion, as assessed by the O'Kelly–Marotta scale (OKM).

Results

The mean proximal and distal artery diameters were 1.61 mm (1.3–1.9) and 1.5 mm (1.0–1.8), respectively. All procedures were performed with technical success, and no severe adverse events occurred. At the 12-month follow-up, no patients experienced serious adverse events, new neurological symptoms, or deficits. At this stage, seven aneurysms were completely occluded (OKM grade D: 43.7%), and four aneurysms showed entry remnant contrast (OKM grade C: 25%).

Conclusions

The treatment of distal unruptured aneurysms with the p48 MW HPC device device appears to be safe in vessels with a diameter of <2 mm. Larger studies with long-term follow-ups are necessary to better clarify the outcomes reported.

Keywords

flow diverter - distal intracranial aneurysms - small vessels

Full Text

References

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