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  • Clinical Experience with Flow Diverting Stent at Puerto Rico Medical Center

    Final Number:
    346

    Authors:
    Charles H Olivera MD; Juan Manuel Ramos-Acevedo MD; Cosme M. Gonzalez Villaman MD; Caleb Feliciano-Vals MD; Rafael Rodriguez-Mercado MD, FACS

    Study Design:
    Other

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction:

    The treatment of wide-necked, fusiform and large aneurysms represents a challenge for the interventional neurosurgeon whose goal is to successfully embolize the aneurysm with a minimum of medical and neurological complications. The use of flow diverting stent represents a useful tool for safe and effective treatment of these complex aneurysms. In this study, we describe our clinical experience with the use of flow diverting stent at the Endovascular Neurosurgery Department of the Puerto Rico Medical Center.

    Methods:

    Retrospective review of prospectively acquired database of patients with intracranial aneurysms treated with flow diverting stents between January 2011 and October 2015. Clinical results and complications were analyzed.

    Results:

    A total of 21 patients were treated. There was a notable female predominance (20 women, 1 man). Age range was 44 years to 84 years old (mean = 63.7 years). Size of aneurysm ranged from 4.2mm to 36mm. None of the patients had history of aneurysm rupture. Coils (in addition to stent) were used in 2 patients. Locations of aneurysms were: cavernous carotid (8), carotid-ophthalmic (3), posterior communicating (4), supraclinoid internal carotid artery (ICA) (4), superior hypophyseal (1), andl petrous ICA (1). Complications were: proximal stent migration (1), air embolism (1), femoral hematoma (2), ophthalmoplegia secondary to petrositis (1). The patients with stent migration and air embolism did not develop neurologic deficits. No deaths were recorded. Total occlusion was recorded in 33.3% of patients at 3 months by magnetic resonance angiogram and in 60% of patients at 6 months by diagnostic substraction angiography.

    Conclusions:

    Our clinical experience in the treatment of complex cerebral aneurysms with flow diverting stents has shown to be effective with low morbidity and no significant permanent neurological complications. Flow diverting stents are an effective and safe option for the treatment of complex cerebral aneurysms.

    Patient Care:

    It will add to reports on outcomes for aneurysms treated with flow diversion. Report will increase awareness of possible complications with the use of this treatment.

    Learning Objectives:

    1) Characterize the aneurysms that benefit from treatment with flow diversion. 2) Describe the outcomes for aneurysms treated with flow diverting stents.

    References:

    1. Fiorella D, Lylyk P, Szikora I, et al. The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR American J of Neuroradiol 2011;32: 34-40 2. Walcott BP, Pisapia JM, Nahed BV, et al. Early experience with flow diverting endoluminal stents for the treatment of intracranial aneurysms. J Clin Neurosci 2011;18: 737-40 3. Becske T, Kallmes DF, Saatci I, et al. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology 2013;267:858-68 4. Leung GKK, Tsang ACO, Lui WM. Pipeline embolization device for intracranial aneurysm: a systematic review. Clin Neuroradiol 2012;22:295-303 5. Saatci I, Yavuz K, Ozer C, et al. Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long term follow-up results. AJNR Am J Neuroradiol 2012;33:1436-46

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