Flow-diverting stents for the treatment of unruptured distal anterior cerebral artery aneurysms: analysis of the CRETA Registry

Luca Scarcia¹, Frédéric Clarençon^{2

3}, Adam A Dmytriw^{4

5}, Eimad Shotar², Kevin Premat², Pascal Jabbour⁶, Stavropoula I Tjoumakaris⁶, Reid Gooch⁶, Marios-Nikos Psychogios⁷, Nikolaos Ntoulias⁷, Peter B Sporns⁸, Ajit S Puri⁹, Jasmeet Singh⁹, Anna Luisa Kuhn⁹, Ameer E Hassan¹⁰, Oktay Algin¹¹, Markus A Möhlenbruch¹², Sophia Hohenstatt¹², Riccardo Russo¹³, Mauro Bergui¹³, Oded Goren¹⁴, Matthew J Kole¹⁴, Nourou Dine Adeniran Bankole¹⁵, Richard Bibi¹⁵, Gregoire Boulouis¹⁵, Takeshi Morimoto¹⁶, Fumihiro Sakakibara¹⁶, Raoul Pop¹⁷, Ciprian Juravle¹⁷, Joanna Wk Ho¹⁸, Angel Ferrario¹⁹, Virginia Pujol Lereis²⁰, Jared Cooper²¹, Chirag D Gandhi²¹, Giancarlo Salsano²², Lucio Castellan²², Arianna Camilli²³, Arturo Consoli^{24

25}, Alessandro Sgreccia²⁴, Eytan Raz²⁶, Charlotte Chung²⁶, Julien Burel²⁷, Chrysanthi Papagiannaki²⁷, Umair Rasheed²⁸, Khawaja Muhammad Baqir Hassan²⁸, Tao Hong²⁹, Zhe Ji²⁹, Riitta Rautio³⁰, Matias Sinislao³⁰, Maria Ruggiero³¹, Elvis Lafe³¹, Valerio Da Ros³², Luigi Bellini³², Joseph D Gabrieli³³, Giacomo Cester³³, Michael R Levitt³⁴, Kate T Carroll³⁴, Zack A Abecassis³⁴, Antonio Armando Caragliano³⁵, Sergio L Vinci³⁵, Guillaume Bellanger³⁶, Christophe Cognard³⁶, Gaultier Marnat³⁷, Lisa Saleille³⁷, Nicola Limbucci³⁸, Francesco Capasso³⁸, Mariangela Piano³⁹, Claudia Rollo³⁹, Alexis Guedon⁴⁰, Francesco Arpaia⁴⁰, Andrea Romi⁴¹, Fortunato Di Caterino⁴², Alessandra Biondi⁴², Erwah Kalsoum¹, Vyval Mykola⁴³, Adrien Guenego⁴⁴, Aman B Patel⁴, Vitor M Pereira⁵, Alessandro Pedicelli^{23

45}, Andrea Maria Alexandre⁴⁶; CRETA investigators

Affiliations

¹ Neuroradiology, Henri Mondor Hospital, Creteil, France.
² Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, 47, Bd de l'Hôpital, 75013, Paris, France.
³ Sorbonne University, Paris, France.
⁴ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA.
⁵ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁷ Diagnostic and Interventional Neuroradiology Department, Universitätsspital Basel, Basel, Switzerland.
⁸ Department of Radiology and Neuroradiology, Stadtspital, Zürich, Switzerland.
⁹ Division of Neurointerventional Radiology,Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.
¹⁰ Department of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
¹¹ Department of Radiology, Ankara University, Ankara, Turkey.
¹² Interventional Neuroradiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
¹³ Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
¹⁴ Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
¹⁵ Clinical Investigation Center (CIC), 1415, INSERM, Department of Interventional Neuroradiology, Teaching Hospital of Tours, Tours, France.
¹⁶ Department of Data Science, Hyogo Medical University, Nishinomiya, Japan.
¹⁷ Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France.
¹⁸ Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, Hong Kong.
¹⁹ Servicio de Neurorradiología Intervencionista, Departamento de Neurocirugía, FLENI, Buenos Aires, Argentina.
²⁰ Department of Neurology, Vascular Neurology Division, Institute of Neurological Research, FLENI, Buenos Aires, Argentina.
²¹ Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA.
²² UO Neuroradiologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
²³ Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Diagnostic and Interventional Neuroradiology Department, Hospital Foch, Suresnes, France.
²⁵ University of Versailles, Saint Quentin-des-Yvelines, France, France.
²⁶ Department of Radiology and Neurosurgery, NYU Langone Health, New York, New York, USA.
²⁷ Department of Radiology, Rouen University Hospital, Rouen, Normandy, France.
²⁸ Department of Neuroradiology, Lahore General Hospital, Lahore, Pakistan.
²⁹ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
³⁰ Department of Interventional Radiology, Turku University Hospital, Turku, Finland.
³¹ Neuroradiology Unit, AUSL della Romagna, Ravenna, Italy.
³² Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy.
³³ Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy.
³⁴ Department Neurological Surgery, University of Washington, Seattle, Washington, USA.
³⁵ Neuroradiology Unit - Biomedical Sciences and of Morphologic and Functional Images, Universita degli Studi di Messina, Messina, Italy.
³⁶ Service de Neuroradiologie Interventionnelle et Diagnostique, Hôpital Purpan- CHU Toulouse, France.
³⁷ Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
³⁸ Interventional Neuroradiology, Interventional Neuroradiology Unit, Careggi Universitary Hospital, Florence, Italy.
³⁹ Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
⁴⁰ Department of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, 75010, Paris, France.
⁴¹ Neuroradiology Unit, IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
⁴² Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France.
⁴³ Research and Practical Centre for Endovascular Neuroradiology, the NAMS of Ukraine, Kyiv, Ukraine.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
⁴⁵ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma, Roma, Italy.
⁴⁶ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma, Roma, Italy andrea.alexandre@policlinicogemelli.it.

PMID: 39694804
DOI: 10.1136/jnis-2024-022315

Flow-diverting stents for the treatment of unruptured distal anterior cerebral artery aneurysms: analysis of the CRETA Registry

Luca Scarcia et al. J Neurointerv Surg. 2025.

. 2025 Jan 27:jnis-2024-022315.

doi: 10.1136/jnis-2024-022315. Online ahead of print.

Authors

Affiliations

¹ Neuroradiology, Henri Mondor Hospital, Creteil, France.
² Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, 47, Bd de l'Hôpital, 75013, Paris, France.
³ Sorbonne University, Paris, France.
⁴ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA.
⁵ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁷ Diagnostic and Interventional Neuroradiology Department, Universitätsspital Basel, Basel, Switzerland.
⁸ Department of Radiology and Neuroradiology, Stadtspital, Zürich, Switzerland.
⁹ Division of Neurointerventional Radiology,Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.
¹⁰ Department of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
¹¹ Department of Radiology, Ankara University, Ankara, Turkey.
¹² Interventional Neuroradiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
¹³ Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
¹⁴ Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
¹⁵ Clinical Investigation Center (CIC), 1415, INSERM, Department of Interventional Neuroradiology, Teaching Hospital of Tours, Tours, France.
¹⁶ Department of Data Science, Hyogo Medical University, Nishinomiya, Japan.
¹⁷ Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France.
¹⁸ Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, Hong Kong.
¹⁹ Servicio de Neurorradiología Intervencionista, Departamento de Neurocirugía, FLENI, Buenos Aires, Argentina.
²⁰ Department of Neurology, Vascular Neurology Division, Institute of Neurological Research, FLENI, Buenos Aires, Argentina.
²¹ Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA.
²² UO Neuroradiologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
²³ Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Diagnostic and Interventional Neuroradiology Department, Hospital Foch, Suresnes, France.
²⁵ University of Versailles, Saint Quentin-des-Yvelines, France, France.
²⁶ Department of Radiology and Neurosurgery, NYU Langone Health, New York, New York, USA.
²⁷ Department of Radiology, Rouen University Hospital, Rouen, Normandy, France.
²⁸ Department of Neuroradiology, Lahore General Hospital, Lahore, Pakistan.
²⁹ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
³⁰ Department of Interventional Radiology, Turku University Hospital, Turku, Finland.
³¹ Neuroradiology Unit, AUSL della Romagna, Ravenna, Italy.
³² Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy.
³³ Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy.
³⁴ Department Neurological Surgery, University of Washington, Seattle, Washington, USA.
³⁵ Neuroradiology Unit - Biomedical Sciences and of Morphologic and Functional Images, Universita degli Studi di Messina, Messina, Italy.
³⁶ Service de Neuroradiologie Interventionnelle et Diagnostique, Hôpital Purpan- CHU Toulouse, France.
³⁷ Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
³⁸ Interventional Neuroradiology, Interventional Neuroradiology Unit, Careggi Universitary Hospital, Florence, Italy.
³⁹ Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
⁴⁰ Department of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, 75010, Paris, France.
⁴¹ Neuroradiology Unit, IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
⁴² Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France.
⁴³ Research and Practical Centre for Endovascular Neuroradiology, the NAMS of Ukraine, Kyiv, Ukraine.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
⁴⁵ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma, Roma, Italy.
⁴⁶ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma, Roma, Italy andrea.alexandre@policlinicogemelli.it.

PMID: 39694804
DOI: 10.1136/jnis-2024-022315

Abstract

Background: Data about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow diversion in unruptured DACA aneurysm treatment.

Methods: Databases from 39 centers were retrospectively reviewed for unruptured DACA aneurysms treated with flow-diverting stents. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed.

Results: A total of 168 patients with 168 unruptured DACA aneurysms were treated between January 2018 and December 2022. One hundred and twenty-five were women (74.4%) and the median age was 61 (IQR 52-67) years. The most common morphology was saccular (91.7%), with branch involvement in 61.9% of cases. Median parent vessel diameter was 1.9 mm (IQR 1.7-2.2) and stents were successfully deployed in 99.4% of cases. In 96.4% a single stent was implanted, while 3.6% of cases required two stents. Median imaging follow-up was 16.5 (IQR 7-24) months. At last follow-up the rate of occlusion (O'Kelly-Marotta scale C or D) was 82.1%. Symptomatic thromboembolic or hemorrhagic complications occurred in 5.3% of patients and the mortality rate was 0.6%. The rate of retreatment was 1.2%.

Conclusions: Flow-diverting stents are a reasonably safe and effective treatment option for unruptured DACA aneurysms.

Keywords: Aneurysm; Angiography; Flow Diverter.

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Conflict of interest statement

Competing interests: TM: Outside the submitted work, received lecturer’s fees from Abbott, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Pfizer, Tsumura and UCB; manuscript fee from Pfizer; advisory board for GlaxoSmithKline, Novartis and Teijin. FS: Outside the submitted work received lecturer’s fee from Idorsia Pharmaceuticals for the past 36 months. OG: Outside the submitted work, MicroVention proctor for the WEB device, Stryker consultant, Route 92 consultant.ML: Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Aeaean Advisers, Metis Innovative, Genomadix, AIDoc and Arsenal Medical; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, Synchron and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical. AMA: educational grants from Medtronic, Stryker, Balt and Microvention/Terumo unrelated to the current study. AP: educational grants from Medtronic, Stryker, Balt and Microvention/Terumo unrelated to the current study. AEH: Consultant/Speaker: Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera therapeutics, Proximie, NeuroVasc, NovaSignal, Vesalio, Rapid Medical, Imperative Care, Galaxy Therapeutics, Route 92, Perfuze, CorTech, Shockwave, Toro and Xcath. Principal Investigator: COMPLETE study – Penumbra, LVO SYNCHRONISE – Viz.ai, MARRS - Perfuze, RESCUE - ICAD - Medtronic. Steering Committee/Publication committee member: SELECT, DAWN, SELECT 2, EXPEDITE II, EMBOLISE, CLEAR, ENVI, DELPHI, DISTALS. DSMB - COMAND trial. ML Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Aeaean Advisers, Metis Innovative, Genomadix, AIDoc and Arsenal Medical; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, Synchron and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical. FC reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading) and Artedrone (Board); all not directly related to the present work. CC consultant for Medtronic, Microvention, Cerenovus, Stryker, Anaconda, unrelated to the current study.

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Flow-diverting stents for the treatment of unruptured distal anterior cerebral artery aneurysms: analysis of the CRETA Registry

Affiliations

Flow-diverting stents for the treatment of unruptured distal anterior cerebral artery aneurysms: analysis of the CRETA Registry

Authors

Affiliations

Abstract

Conflict of interest statement

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