Article Figures & Data
Tables
All Patients (n = 310) Patients with Coiling (n = 188) Patients with Flow Diverters (n = 122) P Value Mean age (SD) (yr) 57.4 (20–83) 57.9 (24–80) 55.7 (23–80) .10 Female sex (No.) (%) 249 (80.3%) 145 (77.1%) 104 (85.2%) .01 Mean (range) follow-up (mo) 23.4 (1–67) 24.5 (1–67) 22.4 (1–61) No. of aneurysms 318 196 122 Aneurysm location <.0001 Cavernous ICA 27 (8.5%) 1 (0.5%) 26 (21.3%) Paraclinoid/supraclinoid ICA 104 (32.7%) 34 (17.3%) 70 (57.4%) ICA terminus 13 (4.1%) 10 (5.1%) 3 (2.5%) ICA PcomA 36 (11.3%) 24 (12.2%) 12 (9.8%) MCA 19 (6.0%) 16 (8.2%) 3 (2.5%) ACA/AcomA 56 (17.6%) 56 (28.6%) 0 (0%) Vertebral artery 2 (0.6%) 1 (0.5%) 1 (0.8%) Basilar artery 37 (11.6%) 35 (17.9%) 2 (1.6%) PICA 10 (3.21) 7 (3.6%) 3 (2.5%) Other 14 (4.4%) 12 (6.1%) 2 (1.6%) Anterior circulation 263 (82.7%) 148 (75.5%) 115 (94.3%) Posterior circulation 55 (17.3%) 48 (24.5%) 7 (5.7%) Mean size (SD) 8.7 (±6.3 mm) 12.3 (±8.6 mm) <.0001 Small (<5 mm) 60 (18.9%) 46 (23.5%) 14 (11.5%) Medium (5–15 mm) 207 (65.1%) 131 (66.8%) 76 (62.3%) Large (16–25 mm) 26 (8.2%) 11 (5.6%) 15 (12.3%) <.0001 Giant (>25 mm) 25 (7.9%) 8 (4.1%) 17 (13.9%) <.0001 Symptoms Asymptomatic 249 (78.3%) 159 (81.1%) 90 (73.8%) Symptomatic 69 (21.7%) 37 (18.9%) 32 (26.2%) Headaches 35 (11.0%) 21 (10.7%) 14 (11.5%) Visual problems 18 (5.7%) 9 (4.6%) 9 (7.4%) Aneurysm discovered incidentally 210 (66.0%) 144 (73.5%) 66 (54.1%) Note:—PcomA indicates posterior communicating artery; AcomA, anterior communicating artery; ACA, anterior cerebral artery; PICA, posterior inferior cerebellar artery.
All Patients/Treatments (N = 310/352) Patients with Coiling/Treatments (n = 188/223) Patients with Flow Diverters/Treatments (n = 122/129) P Value Coiling-assist devices Balloon 9/352 (2.6%) 9/223 (4.0%) NA – Stent 10/352 (2.8%) 10/223 (4.5%) NA Flow diverter used Pipeline 124/352 (35.2%) NA 124/129 (96.1%) – Surpassb 5/352 (1.4%) NA 5/129 (3.9%) Angiographic occlusion at last follow-up Complete 165/318 (51.9%) 96/196 (49.0%) 69/122 (56.6%) <.0001 Near-complete 112/318 (35.2%) 86/196 (43.9%) 26/122 (21.3%) Incomplete 41/318 (12.9%) 14/196 (7.1%) 27/122 (22.1%) Angiographic follow-up for patients with imaging ≥6 mo posttreatment <.0001 Complete 147/267 (55.1%) 80/163 (49.1%) 67/104 (64.4%) Near-complete 92/267 (34.5%) 69/163 (42.3%) 23/104 (22.1%) Incomplete 28/267 (10.5%) 14/163 (8.6%) 14/104 (13.5%) Mean radiologic follow-up time (mo) 20 (0–67) 20 (0–67) 20 (0–61) .46 Retreatment .009 Recoiling 18/318 (5.7%) 18/196 (9.2%) 0/122 (0.0%) Retreatment with FD 15/318 (4.7%) 8/196 (4.1%) 7/122 (5.7%) Clipping 2/318 (0.6%) 2/186 (1.0%) 0/122 (0.0%) Recurrence 36/318 (11.3%) 29/196 (14.8%) 7/122 (5.7%) .009 Angiographic Occlusion at Last Follow-Up 1 Device 2 Devices ≥3 Devices 122 Aneurysms Complete 45 (49.5%) 12 (66.7%) 12 (92.3%) 69 (56.6%) Near-complete 22 (24.1%) 4 (22.2%) 0 (0%) 26 (21.3%) Incomplete 24 (26.4%) 2 (11.1%) 1 (7.7%) 27 (22.1%) All Patients (N = 310) All Treatments (n = 352) Patients with Coiling (n = 188) Coiling Treatments (n = 223) Patients with Flow Diverters (n = 122) Flow-Diverter Treatments (n = 129) P Value ICU admission Yes 82 (26.5%) 93 (26.4%) 37 (19.7%) 45 (20.2%) 45 (36.9%) 48 (37.2%) .005 No 228 (73.5%) 259 (73.6%) 151 (80.3%) 178 (79.8%) 77 (63.1%) 81 (62.8%) Reason for ICU admission 1) Complexity 39 (12.6%) 45 (12.8%) 16 (8.5) 20 (9.0) 23 (18.9%) 25 (19.4%) 2) Neurologic deterioration 4 (1.3%) 4 (1.1%) 3 (1.6%) 3 (1.3%) 1 (0.8%) 1 (0.8%) 3) Intraoperative rupture 3 (1.0%) 3 (0.9%) 3 (1.6%) 3 (1.3%) 0 (0%) 0 (0%) 4) Vessel occlusion 6 (1.9%) 6 (1.7%) 1 (0.5%) 1 (0.4%) 5 (4.1%) 5 (3.9%) 5) Coil dislocation 1 (0.3%) 1 (0.3%) 1 (0.5%) 1 (0.4%) NA NA 6) Pipeline 14 (4.5%) 15 (4.3%) NA NA 14 (11.5%) 15 (11.6%) Immediate complications (<30 days) 32 (10.3%) 32 (9.1%) 20 (10.6%) 20 (9.0%) 12 (9.8%) 12 (9.3%) .43 Intraoperative rupture 3 (1.0%) 3 (0.9%) 3 (1.6%) 3 (1.3%) 0 (0%) 0 (0%) Thromboembolic 5 (1.6%) 5 (1.4%) 4 (2.1%) 4 (1.8%) 1 (0.8%) 1 (0.8%) TIA 7 (2.3%) 7 (2.0%) 5 (2.7%) 5 (2.2%) 2 (1.6%) 2 (1.6%) Thrombus formation 7 (2.3%) 7 (2.0%) 3 (1.6%) 3 (1.3%) 4 (3.3%) 4 (3.1%) Groin hematoma 5 (1.6%) 5 (1.4%) 3 (1.6%) 3 (1.3%) 2 (1.6%) 2 (1.6%) Intraoperative aneurysm perforation 3 (1.0%) 3 (0.9%) 3 (1.6%) 3 (1.3%) 0 (0%) 0 (0%) Complication-related morbidity 4 (1.3%) 4 (1.1%) 2 (1.1%) 2 (0.9%) 2 (1.6%) 2 (1.6%) Complication-related mortality 3 (1.0%) 3 (0.9%) 1 (0.5%) 1 (0.4%) 2 (1.6%) 2 (1.6%) Mid- and long-term complications 12 (3.9%) 12 (3.4%) 6 (3.2%) 6 (2.7%) 6 (4.9%) 6 (4.7%) .54 Thromboembolic, stroke 6 (1.9%) 6 (1.7%) 4 (2.1%) 4 (1.8%) 2 (1.6%) 2 (1.6%) Periorbital pain 4 (1.3%) 4 (1.1%) 2 (1.1%) 2 (0.9%) 2 (1.6%) 2 (1.6%) Vessel stenosis/occlusion 2 (0.6%) 2 (0.6%) 0 (0%) 0 (0%) 2 (1.6%) 2 (1.6%) Persistent complication-related morbidity 3 (1.0%) 3 (0.9%) 2 (1.1%) 2 (0.9%) 1 (0.8%) 1 (0.8%) Complication-related mortality 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Target aneurysm rupture 2 (0.6%) 2 (0.6%) 1 (0.5%) 1 (0.4%) 1 (0.8%) 1 (0.8%) .19 PcomA (giant) 1 (0.3%) 1 (0.3%) 0 (0%) 0 (0%) 1 (0.8%) 1 (0.8%) MCA (large) 1 (0.3%) 1 (0.3%) 1 (0.5%) 1 (0.4%) 0 (0%) 0 (0%) Neurologic mortality 3 (1.0%) 3 (0.9%) 1 (0.5%) 1 (0.4%) 2 (1.6%) 2 (1.6%) .70 Neurologic morbidity 7 (2.3%) 7 (2.0%) 4 (2.1%) 4 (1.8%) 3 (2.5%) 3 (2.3%) .85 All-cause mortality 19 (6.1%) 19 (5.4%) 14 (7.4%) 14 (6.3%) 5 (4.1%) 5 (3.9%) .15 All Patients (N = 310) Patients with Coiling (n = 188) Patients with Flow Diverters (n = 122) P Value Mortality related to target aneurysm rupture or stroke 9 (2.9%) 5 (2.7%) 4 (3.3%) .15 Worsening of aneurysm-related symptoms 10 (3.2%) 7 (3.7%) 3 (2.5%) .79 Long-term good neurologic outcomes (mRS ≤ 2) 264 (85.2%) 155 (82.4%) 109 (89.3%) .33 Rupture of Target Aneurysm after Treatment R MCA L PcomA Partially Thrombosed R Carotid Ophthalmic Aneurysm size (mm) 11 38 20 Initial treatment Simple coiling Partial coiling/PED PED No. of devices 6 Coils 3 Coils/1 PED 1 PED Initial degree of occlusion Near-complete Incomplete Incomplete Follow-up imaging Complete radiologic/angiographic time (mo) 25.4 9.1 0.27 First imaging follow-up DSA MRA CTA (emergency) Timing of first imaging follow-up (mo) 7 3 8 Days (emergency) Degree of occlusion at first follow-up Incomplete/recurrence Incomplete (decrease) Incomplete Degree of occlusion at last follow-up Near-complete Incomplete (decrease) NA Recurrence/retreatment 2×/2× NA NA Retreatment Size of recurrence (mm) 5 Time (mo) 7 Endovascular technique Simple coiling No. of devices 2 Coils Immediate degree of occlusion Near-complete Retreatment Size of recurrence (mm) 13 Time (mo) 18.5 Endovascular technique Simple coiling No. of devices 7 Coils Immediate degree of occlusion Near-complete Rupture time 2.5 mo 9.1 mo 8 days Note:—R indicates right; L, left; PcomA, posterior communicating artery.
Jump to section
Related Articles
Cited By...
- Endovascular treatment of intracranial aneurysms using the Derivo Embolization Device: a multicenter experience
- The Safety and Efficacy of Flow Diversion versus Conventional Endovascular Treatment for Intracranial Aneurysms: A Meta-analysis of Real-world Cohort Studies from the Past 10 Years
- Cellular responses to flow diverters in a tissue-engineered aneurysm model
- Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis
- The FRED for Cerebral Aneurysms of the Posterior Circulation: A Subgroup Analysis of the EuFRED Registry
- Large Neck and Strong Ostium Inflow as the Potential Causes for Delayed Occlusion of Unruptured Sidewall Intracranial Aneurysms Treated by Flow Diverter
- High frequency optical coherence tomography assessment of homogenous neck coverage by intrasaccular devices predicts successful aneurysm occlusion
- Contemporary endovascular and open aneurysm treatment in the era of flow diversion
- Patients, not pictures: why complete occlusion may be a complete disaster
- Is intensive care monitoring necessary after coil embolization of unruptured intracranial aneurysms?
- Flow Diversion in Ruptured Intracranial Aneurysms: A Meta-Analysis