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. 2022 Nov;43(11):6399-6405.
doi: 10.1007/s10072-022-06336-w. Epub 2022 Aug 19.

Predictors of flow diverter stent in large and giant unruptured intracranial aneurysms, single-center experience

Hazem Abdelkhalek  1 , Esam Ahmed Abdelhameed  2 , Ayman Zakarea  3 , Islam El Malky  4
Affiliations

Predictors of flow diverter stent in large and giant unruptured intracranial aneurysms, single-center experience

Hazem Abdelkhalek et al. Neurol Sci. 2022 Nov.

Abstract

Background: Flow diversion with or without coiling has been established as the treatment of choice for large unruptured aneurysms. This study aims to assess possible predictors for radiological and clinical outcome such as location of the aneurysm (anterior or posterior circulation), complexity by a branching artery, bifurcation, and adjuvant coiling.

Methods: This study was conducted on 65 consecutive patients with 65 large, unruptured intracranial aneurysms (size ≥ 10 mm) treated with flow diverters. Follow-up angiography was done for 60 patients (92.3%) at 12 ± 8.6 months range from 3 to 36 months.

Results: Complete occlusion was achieved in 50 from 60 aneurysms (83.4%), while 8 aneurysms (13.3%) had neck remnant, and another two aneurysms (3.3%) remained with aneurysmal remnant. Periprocedural complications were encountered in 14 patients (21.5%) with morbidity in six patients (9.2%) and mortality in one patient (1.5%). In a multivariate logistic regression, anterior versus posterior location was less likely associated with worse outcome; adjusted OR (95% CI) of 0.16 (0.07-0.01), p = 0.006. Complete occlusion in complex aneurysms with branching artery was 60% versus 88% in simple aneurysms without branching artery (p-value = 0.04).

Conclusions: Flow diverter deployment of a large, unruptured aneurysm in the anterior circulation might have a better outcome than one in the posterior circulation. Flow diverter of aneurysms with branching artery or at bifurcation might be associated with aneurysm persistence and complications respectively.

Keywords: Flow-diverter stent; Giant aneurysms; Large aneurysms; Stent assisted coiling.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Terminal carotid large (20 mm) aneurysm with coil adjuvant. a and b 3D and 2D image AP view right ICA showing terminal carotid aneurysm and the right A1 is arising from its sac. c Non-subtracted image showing flow diverter and coils. d 2D image AP control 12 months showing complete occlusion of the aneurysm
Fig. 2
Fig. 2
A giant carotid cavernous aneurysm. a and b DSA (digital subtraction angiography) in AP and lateral views for a giant aneurysm before stenting. c and d DSA in AP and lateral views after stenting 12-month follow-up
See this image and copyright information in PMC

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