Morphologic and Clinical Outcome of Intracranial Aneurysms after Treatment Using Flow Diverter Devices: Mid-Term Follow-Up

Abstract

Flow diverters (FDs) are designed for the endovascular treatment of complex intracranial aneurysm configurations. From February 2009 to March 2013 28 patients (22 females, 6 males) were treated with FD; mean age was 57 years. Data, including aneurysm features, clinical presentation, history of previous bleeding, treatment, and follow-up results, are presented. Early postinterventional neurological deficits (transient: n = 3/enduring: n = 1) appeared in 4/28 patients (14%), and early improvement of neurological symptoms was observed in 7 patients with previous restriction of cranial nerve function. The overall occlusion rate was 20/26 (77%; 59% after 3 months). 77% achieved best results according to O'Kelly-Marotta score grade D with no contrast material filling (70% of those after 3 months). In 4/6 patients who did not achieve grade D, proximal and/or distal stent overlapping ≥5 mm was not guaranteed sufficiently. During follow-up we did not detect any aneurysm recurrence or haemorrhage. In-stent stenosis emerged as the most frequent complication (4/27; 15%) followed by 2 cases of vascular obliteration (AICA/VA). In conclusion endovascular reconstruction using a FD represents a modern and effective treatment in those aneurysms that are not suitable for conventional interventional or surgical treatment. The appearance of severe complications was rare.

Figure 1

Cranial nerve palsy (patient number 1). 55-year-old woman presented with left oculomotor palsy. Cranial CT (a) showed hyperdense mass in the ophthalmic segment of the left carotid artery. Wide-necked intracranial aneurysm was proved by digital subtraction angiography (DSA, b) and the patient was treated using a flow diverter (c, d). In follow-up, clinical symptoms improved; the mass (e) and DSA confirmed no filling of the aneurysm sack (f, g).

Figure 2

Postinterventional stenosis (patient number 25). 44-year-old man with incidental finding of aneurysm in the left carotid artery on MR angiography (a), confirmed by digital subtraction angiography (b, c). After flow diverter treatment, nonsymptomatic stenosis was detected and was stable in 6 months' follow-up (d); stenosis improved at 12 months' follow-up (e) and further noninvasive examinations.