Introduction: Flow diverting stents (FDS) were introduced as an attempt to treatment of unruptured wide necked and giant aneurysms from the internal carotid artery. There is no consensus on the pre, per and post-procedural management of complications. The present study was designed to review the practice and management of complications.
Methods: Articles were retrieved via a systematic search strategy on PubMed. The keywords included “flow diverter”, “endovascular”, “aneurysm”, “intracranial” and “pipeline”. The retrieved articles were looked for relevance. Clinical trials were selected and references were hand searched for further references. All articles were selected based on the title and abstract; full texts were obtained thereafter. The results were compiled into indications, practice management and complications of flow diverters.
Results: We examined and summarized the literature related to the management of periprocedural complications of FDS such as thromboembolic and ischemic complications, parent-vessel perforation or rupture, incomplete expansion, prolapse, foreshortening, and proximal migration. Additionally, we discuss immediate postprocedural and delayed complications such as perianeurysmal edema, delayed aneurysm rupture, distal intraparenchymal hemorrhage, in-stent stenosis, late stent thrombotic occlusion, and finally delayed parent vessel occlusion. Furthermore, we propose expert opinion regarding complication avoidance and management. Thromboembolic event are treated with intra-arterial administration of GPIIa/IIIb inhibitors and anticoagulation reversal is required in case of vessel rupture.
Conclusions: As the technology is relatively new and complications vary, the best management may differ depending on a number of variables. Further studies are required to better delineate the complication management approach.
Patient Care: This research aims to streamline complication management associated with FDS
Learning Objectives: Summarize the best management approach for complications associated with flow diverting stents.