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Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases
1From the Department of Radiology (M.B.), Istanbul University Medical School, Istanbul, Turkey.
Insights
Flow diverters show promise for treating complex pediatric intracranial aneurysms and fistulas. Midterm results indicate safety and effectiveness, with all treated lesions occluding without significant complications.
Area of Science:
- Endovascular neurosurgery
- Pediatric neurointerventional radiology
Background:
- Limited data exists on flow diverter use in pediatric patients.
- Flow diverters offer a potential treatment for complex cerebrovascular lesions in children.
Purpose of the Study:
- To evaluate the safety and efficacy of flow diverters in treating complex intracranial aneurysms and carotid cavernous fistulas in children.
- To report midterm outcomes of flow diverter treatment in a pediatric cohort.
Main Methods:
- Retrospective review of seven pediatric patients (aged 3-16 years) treated with flow diverters between 2011 and 2014.
- Patients received dual antiplatelet therapy with aspirin and clopidogrel.
- Angiographic and clinical data were analyzed for lesion occlusion and complications.
Main Results:
- All seven patients achieved complete occlusion of aneurysms and fistulas at midterm follow-up (mean 22.3 months).
- No clinically significant neurologic events or parent artery stenosis occurred.
- One patient had an asymptomatic parent artery occlusion.
Conclusions:
- Flow diverter placement appears safe and effective for treating complex intracranial aneurysms and fistulas in children on midterm follow-up.
- Current device sizes accommodate the pediatric population, negating the need for specialized pediatric devices.
- Longer-term follow-up is essential to confirm sustained efficacy and safety.
Background And Purpose:
There is very limited data concerning utilization of flow diverters in children. Our aim is to report results for the treatment of complex intracranial aneurysms and carotid cavernous fistulas by using flow diverters in children.
Materials And Methods:
Retrospective review of children (17 years of age or younger) treated with flow diverters between May 2011 and July 2014 was performed. Clinical and laboratory data and angiographic findings were extracted. Seven patients (6 males, 1 female; mean age, 12.7 years; range, 3-16 years) were included. Two presented with posttraumatic fistulas. The remaining patients presented with traumatic aneurysms of the cavernous carotid artery or fusiform aneurysms of the distal vertebral artery, M1, or A2 segments. All patients were premedicated with clopidogrel (75 mg daily for patients with body weights of >45 kg, 37.5 mg daily for 1 small child with a body weight of <45 kg) and aspirin (300 mg daily for ≥45 kg, 100 mg daily for smaller children).
Results:
VerifyNow and Multiplate Analyzer values were higher than expected. No clinical complications were noted. Imaging performed at 7-52 months after the procedure (mean/median, 22.3/14 months) revealed occlusions of all aneurysms and fistulas. One patient had an asymptomatic occlusion of the parent artery; otherwise, no hemodynamically significant parent artery restenosis was observed. There were no clinically significant neurologic events during follow-up.
Conclusions:
Although flow-diverter placement appears to be safe and effective on midterm follow-up in children, longer follow-up is critical. The current sizes of flow diverter devices and delivery systems cover the pediatric size range, obviating developing flow diverters specific to children.
