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Use of Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Multicohort Study

Krishnan Ravindran1, Alejandro Enriquez-Marulanda1, Peter T M Kan2

  • 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

World Neurosurgery
|July 21, 2018
PubMed

Insights

Flow diversion effectively treats brain aneurysms beyond the circle of Willis, achieving high occlusion rates with low complication risks. Further research is needed on flow limitation through covered side branches.

Area of Science:

  • Neuroendovascular surgery
  • Cerebrovascular disease
  • Medical device technology

Background:

  • Flow diversion is a novel endovascular technique for treating cerebral aneurysms.
  • Its efficacy and safety in treating distal circulation aneurysms remain incompletely understood.
  • Distal circulation aneurysms present unique challenges due to their location beyond the circle of Willis.

Purpose of the Study:

  • To evaluate the safety and efficacy of flow diversion for distal circulation aneurysms.
  • To assess treatment outcomes in an international multicenter cohort.
  • To analyze occlusion rates, complication profiles, and functional outcomes.

Main Methods:

  • Retrospective review of clinical and radiologic records from 46 patients with 46 distal circulation aneurysms.
  • Treatment involved Pipeline Embolization Device or Flow Re-Direction Endoluminal Device.
  • Data collected from 3 academic centers (USA and Europe) between 2014-2017.

Main Results:

  • Complete or near-complete occlusion (≥90%) achieved in 78.2% of aneurysms at a mean 13.0-month follow-up.
  • Side branch or perforator vessel coverage occurred in 76.1% but did not impact occlusion rates.
  • All patients demonstrated good functional outcomes (modified Rankin Scale 0-2), with 4.3% experiencing perforator vessel stroke and no hemorrhages.

Conclusions:

  • Flow diversion offers comparable occlusion rates to alternative treatments for aneurysms beyond the circle of Willis.
  • The procedure is associated with low morbidity and good functional outcomes.
  • The clinical implications of flow limitation through covered side branches warrant further investigation.
Abstract

Keywords:
Circle of WillisFlow-diverting stentIntracranial aneurysmPipeline Embolization Device

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